Medical Billing & Coding

This foundational course equips learners with the safety knowledge, mathematical skills, communication strategies, and career readiness behaviors required to succeed in a medical billing and coding environment. Students earn OSHA 10 certification and first aid/CPR certification, practice healthcare-specific math and document literacy, and build the professional habits expected by employers and credential bodies. Lessons are directly mapped to the workplace competencies assessed on the AAPC CPC and AHIMA CCA examinations.

How the course runs. 7 blocks: Healthcare Workplace Safety and OSHA 10 Certification; First Aid, CPR, and Medical Emergency Response for the Office; Healthcare Math: Calculations for Billing and Coding; Technical Reading and Document Literacy in Healthcare Administration; Digital Tools and Health Information Privacy for Billing Staff; Professional Communication for Billing and Coding Environments; Career Readiness, Credentialing Roadmap, and Professional Portfolio.

What competent looks like. Demonstrate OSHA 10 general industry safety compliance and perform basic first aid and CPR to current American Heart Association or Red Cross standards in a healthcare office setting. Apply arithmetic, percentage, ratio, and basic algebra operations to calculate patient balances, insurance payments, adjustment amounts, and fee-schedule figures accurately. Read, interpret, and summarize technical health information documents including insurance explanation-of-benefits (EOB) forms, coding guidelines, and payer policy bulletins. Use standard digital tools—including spreadsheet software, practice-management software demonstrations, and secure email—to organize, transmit, and protect health information in compliance with privacy expectations. Communicate professionally in written and verbal formats with patients, payers, and clinical staff, applying medical terminology at a foundational level appropriate to a billing and coding associate. Construct a career plan that includes a resume, cover letter, professional portfolio, and a mapped study schedule aligned to the AAPC CPC and AHIMA CCA credentialing requirements.

Students learn to assign accurate ICD-10-CM diagnosis codes using the Official Guidelines for Coding and Reporting, the Alphabetic Index, and the Tabular List across all body systems and care settings. Emphasis is placed on coding conventions, specificity, sequencing rules, and the direct connection between documentation and reimbursement. Mastery of this content supports both the AAPC CPC and AHIMA CCA credentialing exams.

How the course runs. 10 blocks: ICD-10-CM Structure, Conventions, and the Official Guidelines; Alphabetic Index and Tabular List Navigation; Outpatient Coding Guidelines and First-Listed Diagnosis; Inpatient Coding Guidelines and Principal Diagnosis; Coding Neoplasms, Injuries, and External Causes; Coding Chronic and Complex Conditions: Diabetes, Heart Disease, and Hypertension; Coding Signs, Symptoms, Z Codes, and Encounters for Circumstances Other Than Illness; Body-System Chapters: Musculoskeletal, Respiratory, Genitourinary, and Mental Health; Coding from Complete Clinical Documentation: Multi-System Cases; ICD-10-CM Exam Readiness: Timed Simulation and Error Analysis.

What competent looks like. Assign valid ICD-10-CM codes to a minimum of 85% accuracy using the Alphabetic Index and Tabular List following Official Guidelines conventions. Apply ICD-10-CM Official Guidelines for Coding and Reporting to select the principal or first-listed diagnosis and required additional codes for inpatient and outpatient encounters. Interpret physician documentation to identify reportable conditions, signs, symptoms, complications, and co-morbidities across all major body-system chapters. Correctly sequence multiple diagnosis codes including manifestation/etiology pairs, combination codes, and codes requiring a 7th character extension. Recognize coding errors, unbundling of diagnosis codes, and documentation deficiencies that create compliance risk or affect claim accuracy. Demonstrate preparedness for the ICD-10-CM diagnosis coding domains tested on the AAPC CPC and AHIMA CCA credentialing exams.

Students learn to assign Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Level II codes to outpatient and physician-office services using the AMA CPT manual, HCPCS Level II reference, and coding guidelines. Emphasis is placed on code selection accuracy, modifier application, bundling rules, and compliance with payer policies. Successful completion prepares students for the CPT/HCPCS coding competencies tested on the AAPC CPC and AHIMA CCA credential examinations.

How the course runs. 10 blocks: CPT Manual Structure and Coding Conventions; Evaluation and Management (E/M) Coding; Surgery Section Coding — General Principles and the Surgical Package; Surgery Section Coding by Body System; CPT Modifiers — Purpose, Selection, and Application; Radiology, Pathology/Laboratory, and Medicine Section Coding; HCPCS Level II Coding — Structure, Categories, and Code Assignment; NCCI Edits, Bundling Rules, and Coding Compliance; Integrated Coding Practice — Physician Office and Outpatient Records; CPC and CCA Exam Preparation — CPT/HCPCS Domains.

What competent looks like. Locate and assign accurate CPT Category I, II, and III codes using the CPT Index, tabular sections, and applicable guidelines for a range of outpatient and physician-office services. Apply CPT modifiers correctly to indicate altered procedures, multiple procedures, bilateral services, and other reportable circumstances. Assign HCPCS Level II alphanumeric codes for supplies, durable medical equipment, drugs, and services not captured by CPT, including appropriate HCPCS modifiers. Apply National Correct Coding Initiative (NCCI) bundling edits and CPT coding conventions to avoid unbundling, upcoding, and other compliance violations. Code operative reports, evaluation and management (E/M) services, and ancillary services from realistic medical documentation with a minimum accuracy rate of 80 percent. Recognize how CPT and HCPCS code selection links to claim reimbursement, payer edits, and compliance risk under federal coding guidelines.

Students build the anatomical and medical-terminology foundation required to assign accurate diagnostic and procedural codes across all body systems. Lessons progress from word-part analysis through organ system structure and function to clinical documentation interpretation, directly supporting accurate ICD-10-CM and CPT code selection. Competencies align with AAPC CPC exam content domains covering anatomy and medical terminology and with AHIMA CCA exam content areas covering biomedical sciences.

How the course runs. 10 blocks: Word-Part Analysis: Prefixes, Roots, Combining Forms, and Suffixes; Anatomical Organization: Directional Terms, Planes, Cavities, and Regions; Integumentary System: Skin Layers, Appendages, and Skin-Condition Terminology; Musculoskeletal System: Bones, Joints, and Movement Terminology; Cardiovascular and Lymphatic Systems: Heart, Vessels, and Hematologic Terminology; Respiratory and Digestive Systems: Structures, Pathology, and Clinical Terms; Nervous System and Sensory Organs: Brain, Spinal Cord, Eye, and Ear Terminology; Genitourinary and Endocrine Systems: Structures, Hormones, and Pathology Terms; Clinical Documentation Interpretation: Reading Operative Notes, Discharge Summaries, and SOAP Notes; Terminology Integration: Full-System Review and Coding-Relevance Application.

What competent looks like. Deconstruct and define medical terms by analyzing prefixes, roots, combining forms, and suffixes drawn from Greek and Latin origins with at least 85% accuracy. Describe the gross anatomy, major structures, and physiological functions of each body system covered in ICD-10-CM chapter organization, using correct anatomical terminology. Interpret clinical documentation—including operative reports, discharge summaries, and SOAP notes—to identify anatomically specific diagnoses and procedures relevant to code selection. Apply directional terms, anatomical planes, body cavities, and regional terminology to locate lesions, incision sites, and organ positions as described in provider documentation. Distinguish between normal anatomy and common pathological conditions in each system, recognizing terminology that signals specificity required for accurate ICD-10-CM coding. Demonstrate correct spelling and pronunciation of at least 300 high-frequency medical terms used in billing and coding practice.

This course teaches students to navigate the U.S. health insurance landscape, prepare and submit clean claims, and manage the full revenue cycle from patient eligibility verification through payment posting and denial resolution. Students apply coding knowledge from ICD-10-CM and CPT/HCPCS courses to real-world claim scenarios across major payer types including Medicare, Medicaid, and commercial insurers. Mapped to AAPC CPC exam domains covering insurance concepts and revenue cycle, and AHIMA CCA exam content areas covering reimbursement methodologies and claims processing.

How the course runs. 10 blocks: The U.S. Health Insurance Landscape; Patient Registration and Eligibility Verification; The Revenue Cycle: From Encounter to Payment; The CMS-1500 Claim Form: Professional Billing; The UB-04 Claim Form: Institutional Billing; Medicare and Medicaid Billing Rules; Electronic Claims Submission and the Clearinghouse; Explanation of Benefits, Remittance Advice, and Payment Posting; Claim Denials, Appeals, and Follow-Up; Patient Financial Responsibility and Billing Ethics.

What competent looks like. Verify patient insurance eligibility and benefits accurately using payer portals and electronic verification tools before claim submission. Complete and submit error-free CMS-1500 and UB-04 claim forms for professional and institutional billing scenarios. Identify and resolve common claim denials and rejections by analyzing Explanation of Benefits and Remittance Advice documents. Apply knowledge of Medicare, Medicaid, and commercial payer guidelines to determine correct billing and documentation requirements. Calculate patient financial responsibility including deductibles, copayments, and coinsurance based on payer Explanation of Benefits. Demonstrate compliant claims appeal procedures and follow-up processes that protect patient rights and practice revenue.

Students develop hands-on proficiency with electronic health record (EHR) systems as they are used in medical billing and coding workflows, including patient registration, chart navigation, documentation review, and claim generation. The course connects EHR tasks directly to ICD-10-CM and CPT/HCPCS code selection, payer rules, and compliance obligations students have studied in earlier courses. Emphasis is placed on data accuracy, privacy under HIPAA, and the coder's role within a real EHR-enabled revenue cycle.

How the course runs. 10 blocks: The Revenue Cycle Inside an EHR: Architecture and Roles; HIPAA Privacy, Security, and the EHR Audit Trail; Patient Registration, Demographics, and Insurance Verification; Navigating Clinical Documentation in the EHR; Assigning and Entering ICD-10-CM and CPT Codes in the EHR; Generating and Scrubbing an Electronic Claim; Electronic Remittance Advice and Payment Posting; EHR Reporting Tools for Coding Compliance and Productivity; EHR Downtime Procedures, Data Integrity, and System Security; Integrated EHR Workflow Simulation: Full Encounter Cycle.

What competent looks like. Navigate a practice-management EHR environment to locate and interpret clinical documentation needed for accurate diagnosis and procedure code assignment. Enter and verify patient demographic and insurance data in an EHR, identifying and correcting common errors that cause claim denials. Apply HIPAA Privacy and Security Rule requirements to EHR access, audit logs, and release-of-information workflows. Generate, review, and submit a clean electronic claim (837P or 837I format) using EHR billing module data and resolve at least one common edit or rejection. Demonstrate proper use of EHR query and reporting tools to support coding compliance, productivity tracking, and documentation improvement. Perform all EHR tasks without compromising patient safety or data integrity, following facility policies for access controls and breach response.

This course covers the legal, regulatory, and ethical framework that governs medical billing and coding, including federal fraud-and-abuse statutes, Office of Inspector General guidance, payer compliance requirements, and internal audit techniques. Students develop the skills to identify coding and billing irregularities, implement corrective actions, and document compliance activities in a manner consistent with professional standards. Competencies addressed align with AAPC CPC exam domains covering compliance and regulatory topics and AHIMA CCA exam content areas addressing healthcare data quality and legal issues.

How the course runs. 10 blocks: The Compliance Landscape: Why Rules Exist in Healthcare Billing; False Claims Act, Anti-Kickback Statute, and Stark Law; OIG Compliance Program Elements and the Compliance Plan; Coverage Policies: LCDs, NCDs, and Medical Necessity; Coding Compliance: Upcoding, Unbundling, and Documentation Integrity; HIPAA Privacy and Security in the Billing and Coding Workflow; Professional Ethics: AAPC and AHIMA Codes of Ethics in Practice; Internal Coding Audit Methodology and Worksheet Design; Responding to Audits: Corrective Action Plans and Overpayment; Compliance in Specialty Settings and Emerging Risk Areas.

What competent looks like. Explain the purpose and key provisions of major federal fraud-and-abuse laws—including the False Claims Act, Anti-Kickback Statute, and Stark Law—and describe how each applies to everyday coding and billing decisions. Apply OIG Compliance Program Guidance elements to evaluate whether a hypothetical medical practice has an adequate compliance plan. Perform a targeted coding audit on a set of outpatient and inpatient records, calculate error rates, and document findings using standard audit worksheets. Distinguish between upcoding, unbundling, medically unnecessary services, and identity theft schemes, and select appropriate corrective actions for each. Interpret payer coverage policies, local coverage determinations (LCDs), and national coverage determinations (NCDs) to support compliant claim submission. Demonstrate professional ethical reasoning by applying AAPC and AHIMA codes of ethics to realistic compliance scenarios encountered in the billing and coding workplace.

Students synthesize all program competencies by building a complete, real-world billing and coding case portfolio drawn from multi-specialty simulated patient encounters, applying ICD-10-CM, CPT, and HCPCS coding; claim preparation; compliance review; and EHR documentation in an integrated workflow. Each student defends their completed portfolio in a structured oral examination before a panel, demonstrating readiness for entry-level employment and credentialing examinations. This course bridges coursework to the clinical practicum and certification preparation that follow.

How the course runs. 4 blocks: Capstone Case Set Orientation and Multi-Specialty Coding Sprint; Claim Preparation, Compliance Audit, and EHR Documentation; Portfolio Assembly and Peer Review; Integrated Capstone Defense and Debrief.

What competent looks like. Accurately assign ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes across at least four medical specialties using current code sets, achieving a coding accuracy rate of 85% or higher on the final case portfolio. Prepare complete, compliant CMS-1500 and UB-04 claim forms for simulated encounters, identifying and correcting at least five common claim errors before submission. Apply HIPAA privacy and security rules, OIG compliance principles, and payer-specific guidelines to audit a set of coded encounters and produce a written compliance summary. Demonstrate proficiency in an electronic health record and practice management software system by entering, retrieving, and correcting patient encounter data for all capstone cases. Construct a professional billing and coding portfolio containing annotated work samples, a personal compliance statement, and a reflective narrative suitable for use in job applications. Defend coding and billing decisions verbally to a review panel, citing authoritative references such as the AHA Coding Clinic, CPT guidelines, and payer LCD/NCD sources.

Students complete 243 supervised hours at an approved healthcare or billing-service worksite, applying ICD-10-CM, CPT, HCPCS, insurance claims, EHR, and compliance skills under the direct oversight of a credentialed coding or billing professional. The externship bridges classroom instruction and entry-level employment by immersing students in real patient-encounter workflows, payer-specific claim submission, and workplace professionalism standards. A structured employer evaluation and a reflective practice log document competency attainment across all credential exam domains covered by the AAPC CPC and AHIMA CCA.

How the course runs. 4 blocks: Practicum Orientation and Site Integration; Supervised Coding and Claims Processing; Compliance, Documentation Quality, and Professional Communication; Practicum Closure, Employer Evaluation, and Log Submission.

What competent looks like. Assign accurate ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes to actual patient encounters under qualified supervision, achieving a site-supervisor accuracy rating of at least 80 percent. Submit or audit complete CMS-1500 and/or UB-04 claims through the site's practice management or EHR system in compliance with payer guidelines and HIPAA privacy rules. Identify and escalate potential compliance concerns—including upcoding, unbundling, or missing documentation—to the supervising coder or compliance officer following the site's established reporting protocol. Demonstrate professional conduct, punctuality, and communication skills sufficient to earn a passing employer evaluation across all rated workplace-readiness competencies. Maintain a reflective practice log that maps each week's worksite tasks to specific AAPC CPC and AHIMA CCA exam domains, providing evidence of breadth across coding, reimbursement, and compliance content areas. Apply medical terminology, anatomy, and clinical documentation knowledge to interpret provider notes, operative reports, and discharge summaries accurately in a live clinical or administrative environment.

This course provides a structured, exam-mapped review of every content domain tested on the AAPC CPC and AHIMA CCA certification examinations, using timed practice sets, case-based coding simulations, and full-length mock exams. Learners identify personal weak areas through diagnostic analysis and apply targeted remediation before sitting for their chosen credential. Emphasis is placed on exam strategy, time management across large code-set questions, and the accurate use of approved reference materials under exam-like conditions.

How the course runs. 4 blocks: Diagnostic Baseline and Exam Blueprint Analysis; Domain-by-Domain Targeted Review: Coding Systems and Guidelines; Reimbursement, Compliance, and Exam-Strategy Review; Full-Length Mock Certification Examinations.

What competent looks like. Accurately assign ICD-10-CM diagnosis codes, CPT procedure codes, and HCPCS Level II codes for multi-system patient cases at a passing performance level on timed practice sets. Demonstrate correct application of coding guidelines, modifiers, bundling rules, and medical necessity principles across all major body systems and service types tested on the CPC and CCA exams. Analyze personal diagnostic data from practice sets to identify weak content domains and implement a targeted study plan that raises performance to passing thresholds. Complete a full-length, timed mock CPC examination and a full-length, timed mock CCA examination, each scored at or above each credentialing body's published passing standard. Navigate approved code books and digital references efficiently under timed conditions, applying alphabetic index look-up, tabular verification, and guideline cross-referencing within realistic per-question time limits. Explain exam-day procedures, eligibility requirements, and professional conduct expectations for both the AAPC CPC and AHIMA CCA credentialing processes.