Billing Basics for the Healthcare Professional: Coding and Reimbursement

Goals & Objectives:

Course Overview

Coding and reimbursement can be a challenge for many healthcare professionals to ensure proper payment. As reimbursement systems continue to evolve, staying informed about proper coding, payer policies, and compliance regulations is essential for improving financial outcomes and reducing errors in billing. It is essential for sports medicine and healthcare professionals to have a substantial base of knowledge on how to properly document and bill for services provided to a patient. Through proper documentation, the healthcare professional justifies the need for reimbursement while also providing a record to reduce the risk of future liability episodes. This course addresses the unique challenges faced by healthcare professionals in the realm of billing and reimbursement. It also targets rehabilitation professionals working in outpatient clinics or sports medicine practices who perform direct billing and coding or work closely with billing departments as well as athletic trainers employed by sports teams, schools, universities, rehabilitation centers, or health clubs who are involved in billing for services such as injury assessments, rehabilitation programs, or prevention services. The course will prioritize the understanding and application of the correct Current Procedural Terminology (CPT) and International Classification of Disease (ICD-10) codes for various therapy services; gaining insights into common payer rules, regulations, and reimbursement guidelines; and covering documentation best practices to ensure reimbursement and avoid audits. Case studies will be utilized to reinforce successful billing and coding decisions. At the completion of this course, the healthcare provider will have a stronger understanding of billing methods to ensure that compliance and regulatory standards are achieved through accurate and compliant documentation while also demonstrating value to their organization through reimbursement rates.

Learning Outcomes

Upon completing this course, the learner should be able to:

• Recognize the reason and importance of third-party billing and obtaining an NPI number.
• Identify types of insurance plans and common cost-sharing terminology included within plans.
• Identify common ICD-10 codes used by rehab professionals.
• Compare different subsets of CPT codes used in a rehabilitation setting.
• Connect the 8-minute rule and rule of eights to different scenarios.