Certificate in Medical Claim Processing for Hospitals
-- ViewingNowThe Certificate in Medical Claim Processing for Hospitals is a comprehensive course that provides learners with the essential skills needed to excel in the healthcare industry. This program focuses on the critical aspects of medical claim processing, including regulatory requirements, coding and reimbursement systems, and insurance claim submission and follow-up.
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โข Medical Coding Basics: Understanding ICD-10, CPT, and HCPCS codes; code assignment principles; code modifiers
โข Medical Claim Process: Components of a complete claim; submitting claims electronically; claim status inquiries
โข Claims Auditing: Verifying coding accuracy; identifying claim errors; correcting and resubmitting claims
โข Hospital Billing Systems: Electronic health records; practice management software; revenue cycle management
โข Patient Financial Responsibility: Determining patient deductibles and copays; collecting patient payments
โข Medicare and Medicaid Billing: Overview of government insurance programs; specific billing requirements; common claim errors
โข Third-Party Insurance Billing: Working with private insurance providers; insurance contracts; claim disputes
โข Regulatory Compliance: HIPAA privacy and security rules; Stark Law; False Claims Act; fraud prevention
โข Medical Claim Processing Best Practices: Continuous quality improvement; staff training and development; performance measurement.
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