Medical Billing Course – Detailed Curriculum

Module 1: Introduction to US Healthcare System

• Overview of US Healthcare Industry
• Structure of Healthcare Delivery System
• Types of Providers (Hospital, Physician, Facility, Group Practice)
• Types of Insurance:
  • Medicare (Part A, B, C, D)
  • Medicaid
  • Commercial Insurance
  • HMO / PPO / EPO Plans
• Coordination of Benefits (COB)

Module 2: Revenue Cycle Management (RCM) Overview

• End-to-End RCM Workflow
• Front-End, Mid-Cycle & Back-End Process
• Patient Registration & Demographics
• Insurance Verification Process
• Authorization & Referral Process

Module 3: Medical Terminology & Basics of Coding

• Basic Anatomy & Physiology
• Common Medical Terminology
• Introduction to ICD-10-CM
• Introduction to CPT & HCPCS
• Diagnosis vs Procedure Codes
• Linking Diagnosis with CPT

Note: Billing-focused understanding (not full coding certification).

Module 4: Charge Entry Process

• Superbill Understanding
• CPT & ICD Entry
• Modifier Usage (Basic Overview)
• Data Accuracy Importance
• Common Errors in Charge Entry

Module 5: Claim Submission Process

• CMS-1500 Form Understanding
• UB-04 Overview
• Electronic Claim Submission
• Clearinghouse Process
• Batch Submission Workflow

Module 6: Rejections & Edits Handling

• Clearinghouse Rejections
• Front-End Rejections
• Claim Edits
• Correction & Resubmission Process

Module 7: Payment Posting

• EOB (Explanation of Benefits)
• ERA (Electronic Remittance Advice)
• Insurance Payment Posting
• Patient Responsibility Calculation
• Write-offs & Adjustments
• Secondary Insurance Posting

Module 8: Denial Management (Billing Perspective)

• Common Billing Denials
• Authorization Denials
• Eligibility Issues
• Coding vs Billing Denials
• Corrective Actions

Module 9: Compliance & HIPAA

• HIPAA Basics
• PHI Protection
• Compliance Guidelines
• Documentation Standards

Module 10: Practical Training

• Real Claim Case Studies
• Workflow Simulation
• Software Process Demonstration
• Error Identification Practice
• Mock Billing Scenarios

Accounts Receivable (AR) Course – Detailed Curriculum

Module 1: Introduction to AR in RCM

• Role of AR in Revenue Cycle
• Importance of Follow-Up
• Aging Reports Understanding
• AR Buckets & Priority Accounts

Module 2: Insurance Fundamentals

• Medicare Guidelines
• Medicaid Basics
• Commercial Insurance Policies
• Claim Filing Limits
• Timely Filing Rules

Module 3: AR Workflow Process

• Claim Status Check
• Account Review Process
• Insurance Portal Navigation
• Phone Follow-Up Process
• Documentation & Call Notes

Module 4: Denial Management (Advanced)

• Types of Denials:
  • Medical Necessity
  • Authorization
  • Bundling Issues
  • Modifier Missing
  • Non-covered Services
• Root Cause Analysis
• Appeal Process
• Reconsideration & Redetermination

Module 5: Live Calling & Communication Training

• US Accent Neutralization
• Call Opening & Closing Scripts
• Professional Email Writing
• Handling Objections
• Escalation Process
• Call Disposition Documentation

Module 6: Appeals & Documentation

• Appeal Letter Drafting
• Required Supporting Documents
• Timely Appeal Filing
• Follow-Up on Appeals

Module 7: Productivity & Quality Metrics

• KPI Understanding
• Productivity Targets
• Quality Score
• First Call Resolution
• AR Days Reduction

Module 8: Practical Training

• Real Denial Case Studies
• Mock Insurance Calls
• Portal-Based Case Resolution
• Scenario-Based Learning
• Live Workflow Simulation