Billing Administration Course

Lesson 1 • Billing Document Types

Identifies invoices, statements, claims, and remittance documents. Understanding each document's purpose prevents submission errors.

Lesson 2 • Core Billing Terminology

Defines essential billing terms used across industries. Accurate terminology prevents claim errors and supports clear communication with payers.

Lesson 3 • Compliance Fundamentals

Introduces regulatory obligations governing billing accuracy and data privacy. Establishes the ethical baseline required before any claim is submitted.

Lesson 4 • Payer Categories and Structures

Distinguishes government, commercial, and self-pay payer types. Payer category determines billing rules, timelines, and reimbursement logic.

Lesson 1 • Charge Capture Processes

Connects service documentation to charge entry in the billing system. Missed charges directly reduce revenue without triggering a denial.

Lesson 2 • Modifiers and Special Indicators

Teaches when and how to append modifiers that alter reimbursement or clarify circumstances. Improper modifier use triggers audits and payment reductions.

Lesson 3 • Diagnosis Code Systems

Explains how diagnosis codes justify medical necessity for billed services. Mismatched diagnosis codes are a leading cause of claim denial.

Lesson 4 • Coding Audits and Quality Checks

Applies audit techniques to verify coding accuracy before submission. Proactive auditing reduces denial rates and compliance risk.

Lesson 1 • Electronic vs. Paper Claims

Compares electronic data interchange submission to paper claim workflows. Electronic submission accelerates payment and reduces manual errors.

Lesson 2 • Timely Filing Requirements

Covers payer-specific deadlines for initial submission and corrected claims. Filing outside the window results in permanent non-payment regardless of accuracy.

Lesson 3 • Claim Form Completion

Walks through every required field on standard claim forms. Incomplete fields are the most preventable cause of claim rejection.

Lesson 4 • Claim Scrubbing and Validation

Uses automated and manual scrubbing to catch errors before transmission. Clean claims reduce rework and accelerate cash flow.

Lesson 1 • Patient Balance Posting

Transfers remaining balances to patient responsibility after payer payment. Accurate patient balance posting drives effective collections.

Lesson 2 • Reading Remittance Advice

Decodes electronic and paper remittance documents line by line. Accurate remittance reading is the prerequisite for correct payment posting.

Lesson 3 • Contractual Adjustments and Write-offs

Applies contracted rate logic to calculate and post allowable adjustments. Incorrect adjustments inflate or deflate net revenue figures.

Lesson 4 • Reconciliation and Deposit Balancing

Matches posted payments to bank deposits and system totals daily. Unreconciled deposits signal posting errors or missing payments.

Lesson 1 • Payer Appeal Processes

Navigates first-level, second-level, and external review appeal pathways. Each level has distinct deadlines, formats, and decision-makers.

Lesson 2 • Writing Effective Appeal Letters

Structures persuasive appeals with clinical, contractual, and regulatory support. A well-constructed appeal letter significantly increases overturn rates.

Lesson 3 • Denial Classification and Tracking

Categorises denials by type, payer, and root cause using a denial log. Classification is the foundation of targeted prevention strategies.

Lesson 4 • Denial Prevention Strategies

Implements upstream workflow changes that reduce denial volume proactively. Prevention yields higher ROI than reactive appeals management.

Lesson 1 • AR Aging Report Analysis

Interprets aging buckets to prioritise collection activity by financial risk. Older AR has lower collectability, making prioritisation critical.

Lesson 2 • AR Performance Metrics

Tracks key indicators including days in AR, collection rate, and net collection rate. Metrics expose workflow gaps and support management reporting.

Lesson 3 • Payer Follow-Up Workflows

Establishes systematic outreach to payers on unpaid or pending claims. Consistent follow-up prevents claims from aging into uncollectable status.

Lesson 4 • Patient Collections and Statements

Designs patient statement cycles and collection communication strategies. Patient AR requires different tactics than payer AR due to relationship sensitivity.

Lesson 1 • Contract Negotiation Preparation

Builds data packages to support rate increase requests during renegotiation. Data-driven negotiation achieves better outcomes than anecdotal arguments.

Lesson 2 • Contract Fundamentals

Explains contract structure, term definitions, and reimbursement methodologies. Understanding contract language is prerequisite to identifying underpayments.

Lesson 3 • Value-Based Contract Billing

Adapts billing workflows for quality-based and shared-savings contract models. Value-based contracts require different documentation and reporting than fee-for-service.

Lesson 4 • Fee Schedule Analysis

Compares contracted rates to cost benchmarks and market rates. Fee schedule analysis reveals whether contracts are financially viable.

Lesson 1 • Continuous Improvement in Billing

Applies process improvement methodologies to identify and eliminate billing inefficiencies. Structured improvement cycles sustain performance gains over time.

Lesson 2 • Compliance Programme Management

Builds and maintains an internal compliance programme covering audits, training, and reporting. A functioning compliance programme reduces regulatory and financial risk.

Lesson 3 • Policy and Procedure Development

Creates written billing policies that standardise decisions and reduce variability. Documented procedures are essential for audits and staff consistency.

Lesson 4 • Billing Technology Management

Oversees practice management system configuration, upgrades, and integrations. Technology gaps directly impair billing accuracy and reporting capability.

Lesson 5 • Financial Reporting for Leadership

Produces revenue cycle dashboards and executive summaries from billing data. Leadership decisions depend on accurate, timely financial reporting.