Advanced Certificate in Medical Claims Management
-- ViewingNowThe Advanced Certificate in Medical Claims Management is a comprehensive course designed to equip learners with the essential skills necessary for career advancement in the healthcare industry. This program focuses on the importance of accurate and timely medical claims processing, which is a critical component of any successful healthcare organization.
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โข Medical Coding Practices: Understanding and applying medical coding systems, including ICD-10-CM, CPT, and HCPCS codes. Analyzing medical records to assign accurate codes.
โข Billing and Reimbursement Methodologies: Examining various payment systems, fee schedules, and reimbursement methodologies for different medical services and insurance plans.
โข Advanced Claims Processing: Delving into complex claim scenarios, secondary and tertiary claims, and coordinating benefits between multiple payers.
โข Medicare and Medicaid Claims Management: Mastering billing and coding requirements specific to federal and state healthcare programs.
โข Risk Adjustment and HCC Coding: Managing risk adjustment data and Hierarchical Condition Category (HCC) coding for Medicare Advantage plans.
โข Medical Necessity and Documentation Audits: Performing audits to ensure medical necessity and proper documentation support claim submissions.
โข Compliance and Regulatory Requirements: Adhering to industry standards, policies, and legal guidelines, such as HIPAA, Anti-Kickback Statute, and Stark Law.
โข Appeals and Grievance Management: Managing denied claims, appeals, and patient grievances to maximize reimbursements and maintain positive patient relationships.
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