Medical Billing and Coding
Learn how a clinical encounter becomes a paid claim: the revenue cycle, medical terminology, ICD-10-CM diagnosis coding, and the compliance rules that govern all of it.
About This Program
Medical billing and coding sits between the exam room and the payer. Coders translate documented care into standardized codes; billers turn those codes into claims and pursue them until they are resolved. This coursework builds both sides, starting from the revenue cycle as a whole so that every later topic has somewhere to attach. Every lesson works from documentation rather than assumption, because that is the rule the entire field runs on.
By the end of this program you can
- Explain the healthcare revenue cycle and identify where revenue is typically lost
- Decode medical terminology from its root, prefix, and suffix parts
- Describe the structure of ICD-10-CM codes and apply the official coding guidelines
- Use the Alphabetic Index and Tabular List together, as the guidelines require
- Distinguish upcoding from undercoding and explain why both are compliance problems
- Read a denial report and identify which phase of the revenue cycle owns each cause
- Select CPT and HCPCS codes, and apply modifiers correctly
- Code office visits using medical decision making or total time
- Verify eligibility, obtain prior authorization, and use an ABN appropriately
- Complete a CMS-1500, distinguish a rejection from a denial, and post a remittance
- Prioritize a denial queue by deadline and recoverable value, and write an appeal
- Apply HIPAA's minimum necessary standard, and recognize the line between error and fraud
Roles This Prepares You For
- Medical biller
- Medical coder
- Patient accounts representative
- Revenue cycle specialist
- Medical office administrative assistant
Related Certifications
- CPC — Certified Professional CoderAAPCPhysician-practice focused; the most widely held outpatient coding credential.
- CCA — Certified Coding AssociateAHIMAEntry-level credential across care settings.
- CCS — Certified Coding SpecialistAHIMAHospital and inpatient focused; expects more experience.
- CBCS — Certified Billing and Coding SpecialistNHABilling-weighted entry-level credential.
What This Coursework Is
This coursework builds the knowledge base for entry-level billing and coding work and helps prepare for a certification exam. It is not itself a certification, and it does not replace a current code set. ICD-10-CM is revised every October and CPT every January, so always work from the current year's official code books and guidelines rather than from any course material, including this one. Certification is awarded by the credentialing bodies below, each of which sets its own eligibility requirements.
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Course Modules
Work through the modules in order — each one builds on the last.
The Revenue Cycle
How a clinical encounter becomes a paid claim, who the parties are, and where practices actually lose money.
Medical Terminology for Coders
Decode medical terms from their parts, and map conditions to the body systems that organize the code books.
ICD-10-CM Diagnosis Coding
The structure of a diagnosis code, the two-step lookup the guidelines require, and the conventions that decide which codes may be reported together.
CPT & HCPCS Procedure Coding
Code what the provider did: CPT structure and categories, office visit level selection under the current rules, and the modifiers that keep legitimate claims from being denied.
Payers, Eligibility & Authorization
Do the front-end work that prevents most denials, and understand how payers decide what to pay.
Claim Submission
Build a clean claim, understand the fields that cause rejections, and follow it through adjudication to a correctly posted payment.
Denials, Appeals & A/R
Work a denial queue by deadline and recoverable value, write appeals that succeed, and manage accounts receivable before claims age into worthlessness.
Compliance & Ethics
The privacy rules governing everything you touch, the laws governing claim submission, and what to do when you are asked to code something you cannot support.