Medical billers keep healthcare organisations solvent. This course walks through the entire revenue cycle: registration and eligibility, charge entry, claim creation and submission, payer processing, payment posting, denial management, patient billing and compliance. It explains the forms, codes, terms and workflows a biller uses every day, with a worked example in every lesson. It is independent study material and does not issue any credential.
Modules
Billing Foundations
Lessons
Front-End Billing
Lessons
Claims and Submission
Lessons
Payment and Denials
Lessons
Patient Billing and Collections
Lessons
Compliance and Career
Lessons
Other Lessons
Module 4 Review
Module review: key terms, activity and quiz.
Lesson 1.1: The Revenue Cycle, Start to Finish
The revenue cycle is the full sequence of administrative and financial steps a healthcare organization goes through to get paid for care it delivers. It typically starts before the patient ever arrives: pre-registration
Lesson 1.2: The CMS-1500 Claim Form
The CMS-1500 is the standard claim form used by non-institutional providers, meaning physicians, nurse practitioners, physician assistants, and most outpatient professional services, to bill Medicare, Medicaid, and most
Lesson 1.3: The UB-04 Claim Form
The UB-04 (also called the CMS-1450) is the standard claim form used by institutional providers: hospitals, skilled nursing facilities, home health agencies, hospice, and other facility-based providers billing for facili
Module 1 Review
Module review: key terms, activity and quiz.
Lesson 2.1: Insurance Verification and Eligibility
Verifying eligibility before or at the time of service is one of the highest-leverage steps in the whole revenue cycle, because a claim for a patient who was not actually covered on the date of service, or covered by a d
Lesson 2.2: Prior Authorization
Prior authorization (also called pre-authorization or pre-certification) is a payer requirement that certain services, procedures, imaging studies, or medications be approved in advance before the payer will agree to pay
Lesson 2.3: Charge Entry and Claim Scrubbing
Charge entry is the process of translating the coded encounter into a billable claim: entering the correct CPT/HCPCS procedure codes with any required modifiers, linking them to the correct ICD-10-CM diagnosis codes, app
Module 2 Review
Module review: key terms, activity and quiz.
Lesson 3.1: What a Clearinghouse Does
A clearinghouse is an intermediary company that sits between healthcare providers and insurance payers, receiving claims from the provider’s practice management or billing software, checking them for basic formatting and
Lesson 3.2: HIPAA Electronic Transaction Standards
HIPAA’s Administrative Simplification provisions established standard electronic formats for common healthcare business transactions, so that providers, clearinghouses, and payers can exchange information in a consistent
Lesson 3.3: Common Rejection Reasons and Clean Claim Submission
A clean claim is one that is accepted by the payer on first submission with no errors requiring correction or additional documentation, and it is the goal of every step covered so far in this course. Common rejection rea
Module 3 Review
Module review: key terms, activity and quiz.
Lesson 4.1: EOB and ERA Basics
When a payer finishes processing (adjudicating) a claim, it generates two related documents: an Explanation of Benefits (EOB), sent to the patient, and an Electronic Remittance Advice (ERA, the 835 transaction), sent to
Lesson 4.2: Claim Adjustment Reason Codes and Remark Codes
Claim Adjustment Reason Codes (CARCs) are standardized codes on the ERA/EOB that explain why a claim line was adjusted, denied, or paid differently than billed. Examples include codes indicating the amount exceeds the fe
Lesson 4.3: Payment Posting and Reconciliation
Payment posting is the process of entering the payer’s adjudication decision (from the ERA or, less commonly today, a paper EOB) into the practice’s billing system, applying the paid amount, the contractual adjustment, a
Lesson 5.1: Categorizing Denials
Effective denial management starts with categorizing why a claim was denied, since the correction path differs significantly by category. Common categories include: eligibility/coverage denials (the patient was not cover
Lesson 5.2: Building an Effective Appeal
A strong appeal letter identifies the claim clearly (patient, date of service, claim number), states the specific reason the payer gave for the denial, and directly addresses that reason with supporting evidence rather t
Lesson 5.3: Tracking Root Causes to Reduce Future Denials
The most effective denial management programs do not just fix denials one at a time; they track denial reasons by category, by payer, by provider, and by service type to identify patterns and fix the root cause upstream.
Module 5 Review
Module review: key terms, activity and quiz.
Lesson 6.1: Accounts Receivable Aging and Follow-Up
Accounts receivable (AR) aging organizes all outstanding balances, both from payers and from patients, into time buckets based on how long they have been outstanding since the claim was submitted or the balance was creat
Lesson 6.2: Patient Collections and Financial Policy
Once insurance has paid its portion, any remaining patient responsibility becomes the practice’s job to collect directly from the patient. A clear, written financial policy, shared with patients at or before the first vi
Lesson 6.3: Compliance Basics and Professional Credentials for Billers
Billers work with protected health information (PHI) constantly and must follow HIPAA privacy and security requirements, including accessing only the patient information needed to do their job, using secure systems for a
Module 6 Review
Module review: key terms, activity and quiz.