The Insurance Billing Specialist: Role and Responsibilities
• Differentiate between medical ethics and medical etiquette.
• Learn essential ways to keep insurance and medical knowledge current
• Identify the background and importance of accurate insurance claims submission, coding, and billing.

Compliance
• Three major categories of security safeguards under HIPAA and the civil and criminal penalties of non-compliance with HIPAA regulations.
• The Privacy Rule as it pertains to protected health information.
• Definition and explanation of protected health information (PHI).
• Definition of fraud and abuse and potential fines and penalties related to billing insurance claims.
• Differences between a notice, consent, and an authorization when disclosing PHI.

Basics of Health Insurance
• Distinguish among the three major classes of health insurance contracts.
• Four concepts of a valid insurance contract.
• The difference between an implied and an expressed physician-patient contract.
• Four actions to prevent problems when given signature authorization for insurance claims.
• Essential tips to minimize rejection by insurance carriers.

Medical Documentation
• Identify principles and steps of the documentation.
• Definitions for common medical, diagnostic and legal terms.
• Preparation of legally correct medicolegal forms and letters.
• Reasons why an insurance company may decide to perform an external audit.
• How to respond appropriately to the subpoena of a witness and records.

Diagnostic Coding
• The purpose and importance of coding diagnoses to the highest level of specificity.
• Use diagnostic code books properly and obtain codes accurately.
• Perform diagnostic coding accurately after completing the problems on worksheets.

Procedural Coding
• The importance and usage of modifiers in procedure coding.
• Code problems from worksheet using the CPT manual.
• The difference between CPT and HCPCS, Category II and Category III codes.

The Paper Claim: CMS-1500
• Explore reasons why claims are rejected.
• Minimize the number of insurance forms returned because of improper completion.
• Expedite the handling and processing of the CMS-1500 insurance claim form.
• Explain the difference between clean, pending, rejected, incomplete, and invalid claims.

Electronic Data Interchange: Transactions and Security
• Transactions and code sets for insurance claims transmission.
• The necessary components of a practice management system.
• The difference between carrier-direct and clearinghouse electronically transmitted insurance claims.
• Privacy measures for electronic mail, internet, and instant messaging.
• Using patient encounter forms, crib sheets, and scannable encounter forms in electronic claims submission.
• How to conquer potential computer transmission problems.

Receiving Payments and Insurance Problem Solving
• Identify three health insurance payment policy provisions.
• Reasons for claim inquiries or rebilling a claim
• Four objectives of state insurance commissioners/state medical societies.
• Communicating problems with insurance commissioners/state medical societies.
• Levels of review and redetermination in the Medicare program.
• Sample letters of appeals for claims.

Office and Insurance Collection Strategies
• Secrets for more effective collections.
• Summarization of credit laws applicable to a physician office setting.
• Patient credit options that yield big results.
• Effective uses of a billing service, collection agency, and credit bureau in the collection process.
• When to direct delinquent collections to small claims court.
• Guidance on state prompt pay laws

Managed Care Plans
• Understanding a prepaid health plan and types of managed care plans.
• Explain and understand the difference in various managed care plans
• State reasons for a quality improvement organization.
• Four types of authorizations for medical services, tests, and procedures.

Medicare
• The A to Z of Medicare eligibility criteria, benefits and non-benefits.
• Differentiate between an HMO Risk Plan and an HMO Cost plan.
• Utilizing the lifetime beneficiary claim authorization and information release document.
• How to submit claims for Medicare beneficiaries with supplemental insurance.
• List CMS-1500 block numbers that require Medigap information when submitting a Medicare/Medigap claim.

Medicaid and Other State Programs
• Medicaid managed care system guidelines, terminology, abbreviations, eligibility classifications, benefits and non-benefits.
• Eligibility requirements and claims procedures for the Maternal and Child Health Program.
• Filing Medicaid claims for patients who have other coverage.
• Minimize Medicaid rejections due to improper form completion.

Worker's Compensation
• Workers' compensation insurance vs.employer's liability insurance.
• Types of compensation benefits for non-disability, temporary disability, and permanent disability claims.
• Terminology and abbreviations pertinent to worker's compensation cases.
• Follow-up actions for delinquent worker's comp claims
• Signs of fraud and abuse involving employees, employers, insurers, medical providers, and lawyers, and when to report.

Disability Income Insurance and Disability Benefit Programs
• Explanation and eligibility requirements for disability benefit programs and voluntary disability insurance plans.
• Terminology and abbreviations for disability insurance and benefit programs.
• Benefits and exclusions contained in individual and group disability income insurance.
• How to determine whether disability is considered temporary or permanent.
• State eligibility requirements, benefits, and limitations of SSDI and SSI.

REGISTER NOW!

This four-day intensive CMIS training class provides a thorough study of one of the most complex tasks of the physician's business: insurance coding and billing. Program participants will receive an A to Z explanation of the total process and take away skills that will prepare them to improve processes and streamline billing procedures. After completing the class, and passing the CMIS exam, participants will have the additional credibility and knowledge afforded through the credentialing process. In turn, through their enhanced skill sets they will be better able to secure the financial success of the medical practice.

Course Prerequisite:

A basic understanding of medical insurance processing for the physician practice is recommended. Participants will receive a thorough review of the complete scope of medical claims and insurance processes.

Class Materials:

Students must bring current editions of CPT, ICD-9-CM, HCPCS manuals and a medical dictionary to each class meeting.

Certification by Exam

For those with proven skills and experience in this area of practice administration, an "Exam Only" option is available. The CMIS exam is proctored live in hundreds of locations across the country. This option is available for a testing fee of $249 and includes an exam preparation handbook. If you want to test your skills and earn certification without attending the preparatory program, click here. PMI will contact you to make testing arrangements.

ABOUT PMI

Practice Management Institute® (PMI) is the training, networking and credentialing source for medical office professionals. For more than 25 years, physicians and their staff have looked to PMI for skills that contribute to a more efficient, profitable and compliant office. Classes are hosted in 300 of the nation's leading hospitals, medical societies and colleges. PMI awards certification by exam to accomplished medical office coding, reimbursement, and management professionals. In all, nearly 13,000 medical office professionals have earned their credentials through PMI.