A Guide to Professional Billing
The accurate processing of health insurance claims has become
more exacting, while at the same time health insurance plan options have
rapidly expanded. These changes, combined with modifications in state and
federal regulations affecting the health insurance industry, are a constant
challenge to medical office personnel. Those responsible for processing health
insurance claims require thorough instruction in all aspects of medical
state and federal regulations
abstracting relevant information from source documents
completing claim forms accurately
coding diagnoses and procedures.
This online course, Understanding Health Insurance, A Guide to
Professional Billing, provides the required information in a clear and
The objectives of the online course are to:
Introduce information about major insurance programs and federal health care
Provide a basic knowledge of national diagnosis and procedure coding systems.
Simplify the process of completing claim forms
This online course is designed for use by college and
vocational school programs to help medical assistants, medical insurance
specialists, and health information technicians acquire basic skills in health
insurance claims preparation. It can also be used as an in-service training
tool for new medical office personnel and independent billing services, or
individually by claims processors in the health care field.
Features of the Course Content
Major features of this online course include:
Content that is divided into seventeen modules identified in the Main Menu.
The Table of Contents for each module orients the learner to the major
divisions of content covered. Each content topic links to the related head in
Learning objectives at the beginning of each module help organize the material.
The objectives can be used as a self-test for checking comprehension and
mastery of the content.
Key terms and abbreviations, highlighted throughout the module, are defined in
the module glossary to help learners master the technical vocabulary associated
with claims processing. Clicking on a key term or abbreviation takes the
learner to the glossary term. Terms from all modules are also provided in a
comprehensive course glossary. A comprehensive list of abbreviations is also
provided as a resource.
At the conclusion of each module topic head, a "Check Your Understanding"
section contains exercises with various types of questions that provide an
opportunity to apply concepts and skills immediately. The learner will see
results/feedback for all questions.
Numerous examples are provided in each module to illustrate the correct
application of rules and guidelines.
Audio-vignettes (Commonly Asked Questions) in each module provide clarification
about key concepts. The learner can listen to the Q & A session as well as
read the content in a pop-up text box.
Coding exercises are located within the respective coding modules: ICD-9-CM
Coding, CPT Coding, and HCPCS Coding.
Coding Tips provide practical suggestions for mastering the use of the CPT and
the coding manuals.
Module Reviews reinforce learning and identify topics requiring further study.
The learner will answer each question, see feedback, and will be able to review
content by linking to the topic head. No score is provided.
Web links are included in each Module so that learners can research the latest
information about insurance claims processing. A comprehensive Web links
resource lists links in alphabetic order and by module for easy access to
A Practice Section includes Quizzes and Games for each Module.
Two standard quizzes are provided per Module. For each question answered, the
learner will see feedback for correct and incorrect answers. A score will be
provided and recorded in the grade book.
CMS Quizzes (for Modules 11-17) give learners the opportunity to complete
CMS-1500 claim forms by abstracting information from patient encounter forms
and medical reports. Two levels of application (case studies) are provided: (1)
patient encounter forms include all information required to complete the
CMS-1500 form (including diagnosis and procedure codes); (2) patient encounter
forms and medical reports provide all information needed, except the actual
diagnosis and procedure codes. Learners use information provided to locate the
proper codes in the ICD-9-CM and CPT-4 coding manuals.
Several types of games are provided to help learners master vocabulary and key
concepts. Games include Tic-Tac-Toe,Hangman, Flashcards, and Crossword Puzzles
An Exam Section includes exams for each Module. Feedback is not provided for
the exam; learners receive a grade at the conclusion of the exam. The grade is
recorded in the grade book.
Special appreciation is expressed to Medicode, St. Anthony
Publishing, and Ingenix Publishing for granting permission to reprint selected
tables and pages from:
St. Anthony Publishing Illustrated ICD-9-CM Code Book for Physician Payment
St. Anthony Publishing Medicare Correct Coding & Payment Manual