Comprehensive Medical Billing and Coding Course – Part 2

Comprehensive Medical Billing and Coding Course – Part 2: Syllabus

Course Overview:

This intermediate section builds upon the foundational knowledge from Part 1. It covers key concepts in medical insurance, denial management, and handling patient billing. Learners will gain real-world skills for navigating payers, resolving denied claims, and managing patient financial communication.

Module 5: Insurance Basics and Payer Types – Elaborated

Duration: 1 Week
Objectives:

• Understand the fundamentals of health insurance and coverage types.

• Differentiate between public and private payers.

• Learn terminology and processes related to insurance eligibility and verification.

Topics Covered:

• Insurance terminology: premiums, deductibles, copayments, coinsurance

• Overview of public payers: Medicare, Medicaid, TRICARE

• Overview of private/commercial payers: PPOs, HMOs, employer-sponsored plans

• Coordination of benefits (COB) and third-party liability

• Eligibility verification process and prior authorizations

Activities:

• Insurance comparison chart

• Sample eligibility checks

• Role-playing patient-payer interaction

End-of-Module Assessment:

• Quiz on payer types and insurance concepts

• Short written scenario: Match a patient case to the correct payer type and coverage considerations

Module 6: Denials and Appeals

Duration: 1 Week
Objectives:

• Identify common reasons for medical claim denials.

• Understand the appeals process and how to initiate it effectively.

• Learn documentation strategies to support successful appeals.

Topics Covered:

• Categories of denials: administrative, clinical, eligibility-based

• Common denial codes and explanation

• Steps in the appeals process: internal and external reviews

• Timeframes and documentation required for appeals

• Best practices to prevent denials

Activities:

• Denial case reviews

• Appeal letter writing practice

• Denial tracking log exercise

End-of-Module Assessment:

• Write an appeal letter based on a sample denied claim

• Multiple-choice quiz on denial codes and appeal procedures

Module 7: Addressing Patient Billing Inquiries and Payment Options

Duration: 1 Week
Objectives:

• Develop communication strategies for discussing bills with patients.

• Understand patient financial responsibility and payment options.

• Learn to manage billing disputes and negotiate payment plans.

Topics Covered:

• Patient billing cycle

• Explanation of Benefits (EOB) vs. patient billing statement

• Handling patient questions and complaints

• Payment plans, financial hardship policies, and discounts

• HIPAA considerations in patient billing communication

Activities:

• Simulated billing call scenarios

• Review of sample billing statements

• Develop sample payment plan options

End-of-Module Assessment:

• Role-play exercise: Handle a mock patient inquiry about a confusing bill

• Written assignment: Draft a clear and concise billing explanation email

Completion Criteria:

Students must complete all end-of-module assessments in Modules 5–7 to advance to the final part of the program or receive a Certificate of Completion for Part 2.