Medical Insurance Billing

This program is designed for those who are new to the medical field and for those currently working in the field who wish to expand their knowledge in specific areas. In this comprehensive program, students will:

  • Learn the Language of Healthcare — Understand and use essential medical terminology with confidence.
  • Master the Billing Cycle — Process patient information, insurance claims, and payments accurately.
  • Code for Success — Apply ICD-10, CPT, HCPCS, and CDT codes to ensure proper reimbursement.
  • Get Hands-On Experience — Practice using real medical billing software to manage claims and reports.

Program consists of four courses (150 hours total) that must be taken in the following order:

  • MIB1: Medical Terminology
  • MIB2: Medical Insurance Billing Principles
  • MIB3: Medical and Dental Coding ICD-10, CPT, HCPCS and CDT
  • MIB4: Hands-On Medical Billing Software Applications

Participants will earn a Mt. SAC Community Education Certificate of Completion upon successful completion of all four courses. Attendance and examination requirements must be met before a certificate can be issued.

This program falls under the Communication, Critical Thinking, Information, Technology & Literacy, and Personal, Social, Civic & Environmental Responsibility Institutional Level Outcome (ILO).

  • MIB1: Medical Terminology

    In this medical terminology class, students will learn the foundational components of medical terms, including prefixes, suffixes, and root words, with a focus on how these parts combine to convey specific meanings. They will develop the ability to analyze, interpret, and construct medical terms related to anatomy, physiology, pathology, diagnostic procedures, and treatment methods. Students will also learn the correct pronunciation and spelling of medical terms, which is essential for effective communication in healthcare settings. By the end of the course, students will be able to confidently understand and use medical language in both written and verbal forms, preparing them for further studies or careers in the healthcare field.

    Upon the successful completion of this course, students will be able to:

    • Identify and define the basic components of medical terms, including prefixes, suffixes, word roots, and combining forms.
    • Analyze and interpret complex medical terms by breaking them down into their component parts.
    • Accurately spell and pronounce a wide range of medical terms used in healthcare settings.
    • Apply medical terminology to describe anatomical structures, physiological functions, medical conditions, diagnostic procedures, and treatments.
    • Demonstrate an understanding of terminology related to all major body systems and medical specialties.
    • Utilize medical terms appropriately in written and verbal communication within clinical and administrative healthcare environments.
    • Recognize and interpret commonly used abbreviations and symbols in medical records and healthcare documentation.
    • Prepare for further study in health-related programs by building a strong foundation in the language of medicine.
  • MIB2: Medical Insurance Billing Principles

    This course provides an in-depth introduction to medical insurance billing and collections practices used in today’s healthcare environment. Students will learn how to accurately complete insurance claims both professional (CMS 1500) and institutional (UB-04) forms, process and follow up on claims, and understand the reimbursement cycle. Emphasis is placed on various insurance programs including Medicare, Medicaid, commercial insurance, workers’ compensation, and managed care plans. The course also covers appeals process, medical coding basics, electronic health records, and compliance with federal regulations such as HIPAA and the Affordable Care Act. In addition, students will learn insurance collections procedures, including patient balance follow-up, denial management, and effective communication strategies for resolving unpaid claims. Through hands-on practice and real-world scenarios, students will gain the skills needed to navigate insurance policies, verify patient coverage, bill accurately, and ensure timely collections. This course prepares students for entry-level positions in medical billing and collections and provides a solid foundation for advanced study in health information management.

    Upon the successful completion of this course, students will be able to:

    • Explain the medical billing cycle, including patient registration, insurance verification, charge entry, claim submission, payment posting, and collections.
    • Identify and differentiate between major types of health insurance plans, including Medicare, Medicaid, commercial insurance, workers’ compensation, and managed care.
    • Accurately complete CMS-1500 and UB-04 claim forms and identify key information required for insurance reimbursement.
    • Apply medical billing terminology and coding principles to ensure accurate claim processing and reduce billing errors.
    • Understand and comply with regulatory guidelines, including HIPAA, the Affordable Care Act, and fraud and abuse prevention standards.
    • Interpret explanation of benefits (EOBs) and remittance advice documents to reconcile claims and payments.
    • Perform basic collections procedures, including account follow-up, denial resolution, and communication with patients and insurers.
    • Communicate effectively with patients, insurance companies, and healthcare providers regarding billing and insurance matters.
    • Demonstrate professionalism and confidentiality in handling sensitive patient and financial information.
  • MIB3: Medical and Dental Coding ICD-10, CPT, HCPCS and CDT

    This course offers comprehensive training in medical coding, focusing on the proper use and application of ICD-10-CM, CPT, and HCPCS Level II code sets. Students will learn how to analyze medical documentation and assign accurate codes for diagnoses, procedures, and services provided in both outpatient and inpatient settings. Emphasis is placed on understanding coding guidelines, code selection criteria, and the importance of accuracy and compliance in the healthcare reimbursement process. The course covers coding conventions, medical necessity, and how to interpret physician notes to extract relevant information. Students will also explore the relationship between coding, billing, and insurance claims, as well as the role of coding in fraud prevention and healthcare data reporting. Hands-on coding exercises and real-world case studies will help students build the skills necessary for entry-level coding positions.

    Upon the successful completion of this course, students will be able to:

    • Identify and explain the structure, purpose, and application of ICD-10-CM, CPT, HCPCS Level II, and CDT (Current Dental Terminology) coding systems.
    • Accurately assign diagnosis codes using ICD-10-CM for both medical and dental conditions based on clinical documentation.
    • Select appropriate procedure and service codes using CPT and HCPCS Level II for medical procedures, and CDT codes for dental procedures and treatments.
    • Interpret and apply official coding guidelines to ensure coding accuracy, regulatory compliance, and proper reimbursement across medical and dental billing.
    • Analyze medical and dental records to extract relevant clinical information necessary for precise code assignment.
    • Differentiate between medical and dental coding requirements and understand their unique applications within healthcare billing.
    • Recognize the impact of accurate coding on insurance claims processing, reimbursement, and healthcare data reporting.
    • Apply coding knowledge to real-world scenarios, including case studies involving medical and dental conditions and procedures.
    • Utilize coding resources and software tools effectively for medical and dental coding tasks.
  • MIB4: Hands-On Medical Billing Software Applications

    This course provides hands-on training in the use of medical billing software commonly utilized in healthcare facilities to manage patient accounts, process insurance claims, and streamline revenue cycle operations. Students will gain practical experience with medical billing platforms to learn tasks such as appointment setting, patient registration, charge entry, claim submission, payment posting, and account follow-up. The course emphasizes real-world application, data accuracy, and compliance with healthcare regulations such as HIPAA. Through guided exercises and simulated practice, students will develop the technical skills needed to confidently navigate medical billing software and support the financial operations of a medical office or billing department. This course is ideal for individuals preparing for entry-level roles in medical billing, coding, or health information technology.

    Upon the successful completion of this course, students will be able to:

    • Navigate and operate common medical billing software platforms to perform essential billing tasks.
    • Enter and manage patient demographic and insurance information accurately within the software system.
    • Process charges and payments, including entering procedures, applying appropriate codes, and posting payments.
    • Generate and submit electronic insurance claims through the billing software, understanding the steps to ensure clean claims.
    • Track and follow up on claim status, including identifying and resolving claim denials and rejections using software tools.
    • Perform patient billing and collections functions, including generating statements and managing account balances.
    • Utilize reporting features to monitor billing performance, identify outstanding claims, and produce financial summaries.
    • Troubleshoot common software issues and optimize workflow efficiency within the billing platform.
    • Demonstrate professional communication skills when interacting with patients, insurance companies, and healthcare providers using information from the software system.

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