Masterclass Certificate in Medical Claim Processing Best Practices
-- ViewingNowThe Masterclass Certificate in Medical Claim Processing Best Practices is a comprehensive course designed to empower learners with the essential skills required in the medical billing and coding industry. This program highlights the importance of accuracy, efficiency, and ethical practices in medical claim processing, making it highly relevant in today's healthcare landscape.
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โข Medical Coding Basics: Understanding ICD, CPT, and HCPCS codes, code assignment and sequencing, code modifiers
โข Medical Claim Forms: CMS-1500 and UB-04, mandatory and optional fields, completing and submitting claims
โข Claim Processing Workflow: Pre-scrubbing, scrubbing, and post-adjudication, error resolution and correction
โข Compliance and Regulations: HIPAA, False Claims Act, Stark Law, Anti-Kickback Statute
โข Claim Editing and Auditing: Identifying and correcting errors, reducing claim denials, internal and external audits
โข Medical Necessity and Documentation: Ensuring medical necessity, supporting documentation, clinical criteria
โข Appeals and Grievances: Handling claim denials, filing appeals, patient grievances and complaints
โข Revenue Cycle Management: Charge entry, claim submission, remittance processing, and follow-up
โข Electronic Data Interchange (EDI): HIPAA-compliant EDI transactions, electronic claims, ERAs, and remittance advice
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