Explain the purpose and function of health insurance within the U.S. healthcare system.

Accurately complete insurance claims using the CMS-1500 and UB-04 claim forms.

Apply ICD-10-CM, CPT, and HCPCS coding systems to support reimbursement.

Analyze and interpret payer policies, including Medicare, Medicaid, TRICARE, and commercial insurance.

Ensure compliance with HIPAA, fraud prevention, and audit standards.

Demonstrate practical skills in billing and reimbursement through case studies and simulations.

Introduction to Health Insurance

Managed Care and Insurance Basics

HIPAA, Compliance, Privacy, and Fraud Prevention

Healthcare Payers and Policies (Medicare, Medicaid, TRICARE, Workers’ Comp, and Commercial)

Diagnostic Coding: ICD-10-CM

Procedural Coding: CPT and HCPCS

Hospital Billing and UB-04 Claim Form

Physician Billing and CMS-1500 Claim Form

Blue Cross/Blue Shield, Commercial, and Private Insurance

Medicare Reimbursement and Compliance

Medicaid and Other State Programs

TRICARE and Workers’ Compensation

Billing for Inpatient, Outpatient, and Ancillary Services

Reimbursement Methodologies and Revenue Cycle Management

Claims Processing, Follow-Up, and Appeals

Electronic Health Records and Billing Software Applications

Audit Procedures and Compliance Reporting

Case Studies in Billing and Reimbursement

Preparing for Professional Certification Exams