Medical Billing Certificate
MBILL 019 — Medical Billing Certificate, 600.0 hours
Lakewood University's Medical Billing program is to provide a comprehensive understanding of medical billing and its components. This program will contain many topics regarding medical billing topics such as managed care, insurance claim processing, a brief introduction to ICD-10-CM coding, HCPCS coding, and CPT coding and reimbursement methodologies. It will also cover claim form submission for Medicare, Medicaid, Blue Cross Blue Shield, Workers’ Compensation, and TRICARE. It will also cover the basic office needs, how coding and billing interrelate, and how to maintain and establish the electronic health record.
Program Objectives
- Define medical terms
- Explain the importance of health insurances and managed health care
- Process an insurance claim through the following: commercial insurance, Blue Cross/Blue Shield, Medicare, Medicaid, TRICARE, and Workers’ Compensation
- Demonstrate the basics of medical coding
- Explain the importance of coding for medical necessity
- Explain the legalities of medical billing
- Follow essential CMS-1500 Claim instructions
Professor
Gina has over 30 years of healthcare experience, including managing billing compliance and medical audit functions, and conducting educational sessions for a major New England hospital system. She was also previously employed as the director of the Coding Center, which provided chart auditing services, on-site coding education programs, and coding certification courses.
Online Support (IT) and Moodle Navigation
All members of the Lakewood University community who use the University’s computing, information or communication resources must act responsibly. Support is accessible by calling 1-800-517-0857 option 2 or by emailing info@lakewood.edu
Books and Resources
Green, Michelle A. Understanding Health Insurance: A Guide to Billing and Reimbursement, 2024 Edition. 19th Edition. Cengage Learning US, 2024.
Evaluation Method
Graded work will receive a numeric score reflecting the quality of performance.
Course Requirement Summary
- Assignments - Total of 140 Points
- Weekly discussion forums-Total of 80 Points
- Lesson Test - 280 Points
- Final Exam - 50 Points
Grading Scale
Graded work will receive a numeric score reflecting the quality of performance as given above in evaluation methods. The maximum number of points a student may earn is 550. To determine the final grade, the student's earned points are divided by 550.
Your overall course grade will be determined according to the following scale:
A = (90% -100%)
B = (80% - 89%)
C = (70% - 79%)
D = (60% - 69%)
F < (Below 60%)
Assignment and Discussion Forum Post Rubrics
Writing Assignment Grading Rubric
|
Points |
Excellent |
Good |
Poor |
Very Poor |
No Response |
|
Original Posting ____/10 |
Writing assignment was well thought out, coherent, and thoughtfully organized with all parts of the questions addressed along with appropriate grammar and spelling |
Writing was clear and relatively well organized and responded to many/most of the key points with a few mistakes in regard to grammar and spelling |
Writing was somewhat confusing and not well organized and had little or no focus on the subject matter with significant grammar and spelling errors |
Writing is confusing and hard to follow with no organization while missing the point of the assignment entirely |
No Assignment |
|
Total Points ____/10 |
Additional Comments: |
Discussion Question Grading Rubric
|
Points |
Excellent Pass |
Good Pass |
Poor Fail |
No Response Fail |
|
Original Posting PASS/FAIL |
Original post reflected good focus to the discussion with well thought out ideas and appropriate grammar and spelling |
Original post responded to the topic in a general fashion but failed to organize them well and had a few mistakes in regard to grammar and spelling |
Responded with little or no focus to the discussion and contained short, irrelevant and/or confusing commentary with significant grammar and spelling errors |
No posting |
|
Reply to fellow student PASS/FAIL |
Response to fellow student reflected good focus to the post with well thought out ideas and appropriate grammar and spelling |
Response to fellow student in a general fashion but failed to organize them well and had a few mistakes in regard to grammar and spelling |
Little or no focus to the post and contained short, irrelevant and/or confusing commentary with significant grammar and spelling errors |
No posting |
|
Total Points PASS/FAIL |
Additional Comments: |
Academic Integrity/ Plagiarism
Cheating (dishonestly taking the knowledge of another person whether on a test or an assignment and presenting it as your work) and plagiarism (to take and pass off as one's own the ideas or writing of another) are a serious issue. While it is legitimate to talk to others about your assignments and incorporate suggestions, do not let others "write" your assignments in the name of peer review or "borrow" sections or whole assignments written by others. We do get ideas from life experiences and what we read but be careful that you interpret these ideas and make them your own.
I am aware that many types of assignments are available on the internet and will check these sources when there is legitimate suspicion.
Penalty is a zero on the assignment. In cases where there is a major or continuous breach of trust, further discipline, such as an "F" in the course, may be necessary.
The major consequence of any form of cheating is damage to your character and the result of trust and respect.
Disability Accommodations
Students who have a disability and wish to request an academic accommodation should contact Jim Gepperth, the Disabilities Services Coordinator and Academic Dean. The student can request an accommodation at any time although it is encouraged to do so early in the enrollment process. The student should complete an accommodation request form which begins a conversation between the school and the student regarding the nature of their disability and an accommodation that would help the student succeed in their program. The school may request documentation regarding the disability to address the accommodation request effectively. The school will communicate to the student the type of accommodation arranged. This process typically follows a team approach, bringing together persons from the academic department (including the instructor) and personnel from other departments as necessary. Additional information on disability accommodations may be found in the Lakewood University Catalog.
Disability Services Email: disabilityservices@lakewood.edu
Supplemental Texts
You can use the following resources to assist you with proper source citation.
American Psychological Association Style Guide- https://www.mylakewoodu.com/pluginfile.php/118179/mod_resource/content/1/APA%20Style%20Guide%207th%20edition.pdf
The Purdue OWL website is also a helpful resource for students. Here is a link to the OWL website: https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html
Library
Mary O'Dell is the Librarian on staff at Lakewood University
She is available by appointment. You can make an appointment with her by emailing her at modell@lakewood.edu or call at 1-800-517-0857 X 730
You may also schedule a meeting at this link: https://my.setmore.com/calendar#monthly/r3a761583354923270/01032020
She can assist you with navigating LIRN, research, citations etc.
Support
Each student at Lakewood University is assigned a Success Coach. Your Success Coach exists to assist you with academic and supportive services as you navigate your program. They will reach out to you, often, to check-in. Please use the resources they offer.
Student Services is available to assist with technical questions regarding Lakewood University and all services available to you.
1-800-517-0857 option 2
info@lakewood.edu
studentservices@lakewood.edu
Career Services
Students are offered Career Services at any point as they journey their academics at Lakewood University.
1-800-517-0857 option 2
careerservices@lakewood.edu
Objectives
- Define medical terms
- Explain the importance of health insurances and managed health care
- Process an insurance claim through the following: commercial insurance, Blue Cross/Blue Shield, Medicare, Medicaid, TRICARE, and Workers’ Compensation
- Demonstrate the basics of medical coding
- Explain the importance of coding for medical necessity
- Explain the legalities of medical billing
- Follow essential CMS-1500 Claim instructions
Lessons
- Health Insurance Specialist Career
Reading: Understanding Health, Chapter 1 Assignment #1 Essay
Medical Billing Lesson Test #1
Lesson Evaluation
- Introduction to Health Insurance
- Managed Health Care
Reading: Understanding Health, Chapters 2-3 Assignment #2
Medical Billing Lesson Test #2
Lesson Evaluation
- Managed Health Care
Reading: Understanding Health,Chapter 4 Assignment #3
Medical Billing Lesson Test #3
Discussion Forum — Life Cycle of a Claim
Lesson Evaluation
- Revenue Cycle Management
Reading: Understanding Health, Chapter 5 Assignment #4
Medical Billing Lesson Test #4
Discussion Forum — The 1970s Affect on Healthcare
Lesson Evaluation
- Legal and Regulatory Issues
Reading: Understanding Health, Chapters 6 Assignment #5
Medical Billing Lesson Test #5
Lesson Evaluation
- ICD-10-CM Coding
Reading: Understanding Health, Chapter 7 Assignment #6
Medical Billing Lesson Test #6
Lesson Evaluation
- CPT Coding
Reading: Understanding Health, Chapter 8 Assignment #7
Medical Billing Lesson Test #7
Lesson Evaluation
- CMS Reimbursement Methodologies
Reading: Understanding Health, Chapter 9 Assignment #8
Medical Billing Lesson Test #8
Lesson Evaluation
- Coding Compliance, Clinical Documentation Improvement and Coding for Medical Necessity
Reading: Understanding Health, Chapter 10 Assignment #9
Medical Billing Lesson Test #9
Lesson Evaluation
- CMS-1500 and UB-04 Claims
Reading: Understanding Health, Chapter 11 Discussion Forum—InsureKids
Assignment #10
Medical Billing Lesson Test #10
Lesson Evaluation
- Commercial Insurance
Reading: Understanding Health, Chapter 12 Assignment #11
Medical Billing Lesson Test #11
Lesson Evaluation
- Blue Cross Blue Shield
Reading: Understanding Health, Chapter 13 Assignment #12
Medical Billing Lesson Test #12
Discussion Forum—Blue Cross Blue Shield Lesson Evaluation
- Medicare
Reading: Understanding Health, Chapter 14 Forum—CMS Quarterly Medicare Updates Assignment #13
Medical Billing Lesson Test #13
Lesson Evaluation
- Medicaid
Reading: Understanding Health, Chapter 15 Assignment #14
Medical Billing Lesson Test #14
Lesson Evaluation
- TRICARE
Reading: Understanding Health, Chapter 16 Assignment #15
Discussion Forum—TRICARE Medical Billing Lesson Test #15
Lesson Evaluation
- Workers' Compensation
Reading: Understanind Health , Chapter 17 Assignment #16
Medical Billing Lesson Test #16 over
Chapter 17
Discussion Forum—Course Experience Lesson Evaluation