Comprehensive Medical Billing and Coding Course – Part 1

Comprehensive Medical Billing and Coding Course – Part 1: Syllabus

Course Overview:

This foundational course provides a comprehensive introduction to the healthcare industry with a focus on medical billing and coding. Learners will gain knowledge of healthcare systems, medical terminology, coding systems, and the process of submitting medical claims.

Module 1: Introduction to Healthcare and Medical Terminology

Duration: 1 Week
Objectives:

• Understand the structure of the healthcare system in the U.S.

• Define key medical terms using roots, prefixes, and suffixes.

• Familiarize with common terminology used in diagnosis and treatment.

Topics Covered:

• Overview of healthcare providers and payers

• Roles and responsibilities in medical billing and coding

• Word-building rules: combining forms, suffixes, and prefixes

• Common medical abbreviations

• Body systems and related terminology

Activities:

• Vocabulary quizzes

• Flashcards for medical roots/prefixes/suffixes

• Practice exercises on terminology

End-of-Module Assessment:

• Multiple-choice quiz on terminology and healthcare structure

• Short written assignment: Define 10 medical terms and explain their components

Module 2: Medical Coding Systems

Duration: 2 Weeks
Objectives:

• Understand the purpose and use of major coding systems.

• Learn how to navigate ICD, CPT, and HCPCS codes.

Topics Covered:

• Introduction to ICD-10-CM (diagnosis codes)

• Introduction to CPT (procedure codes)

• Overview of HCPCS Level II codes (supplies and services)

• Coding guidelines and documentation importance

Activities:

• Code lookup exercises

• Case study practice

• Mini assessments using mock charts

End-of-Module Assessment:

• Scenario-based coding assignment using ICD-10-CM and HCPCS

• Quiz on code categories and guidelines

Module 3: Claim Submission Process – Elaborated with Examples

Duration: 1 Week
Objectives:

• Learn the steps involved in submitting medical claims.

• Understand common forms such as CMS-1500 and UB-04.

• Identify reasons for claim denials and how to avoid them.

Topics Covered:

• Lifecycle of a medical claim

• Payer types and reimbursement methods

• Explanation of Benefits (EOB)

• Common errors in claim submission

• Real-world claim submission walkthroughs

Activities:

• Sample form completion (CMS-1500)

• Review and correct sample rejected claims

• Interactive scenario-based learning

End-of-Module Assessment:

• Claim submission project: Complete and submit a mock claim form

• Evaluation on identifying and correcting claim errors

Module 4: CPT Coding

Duration: 2 Weeks
Objectives:

• Understand CPT code categories and format.

• Apply proper CPT codes to clinical scenarios.

Topics Covered:

• CPT code structure and guidelines

• Evaluation and Management (E/M) coding

• Procedure coding by specialty (e.g., surgery, radiology)

• Modifiers in CPT coding

Activities:

• Coding scenarios and simulations

• Group discussions on E/M levels

• Weekly coding quizzes

End-of-Module Assessment:

• Practical CPT coding assignment based on case studies

• Quiz on E/M coding and use of modifiers

Completion Criteria:

Students must successfully complete all end-of-module assessments to receive a Certificate of Completion.