CERTIFIED MEDICAL BILLER
1. Certified Outpatient Billing Specialist (COBS)
Certified Outpatient Billing Specialist (COBS acronym used for credentials)
Examination Objective- To test core competencies of graduated students from community college adult education programs and/or county career centers in outpatient medical billing.
Examination Content
o Patient privacy under HIPAA (Health Insurance Portability & Accountability Act);
o Legal & ethical standards of the medical billing profession;
o Responsibilities as a biller under the Civil False Claims Act;
o Basic understanding of the differences between Government insurance programs, Managed Care Organizations and indemnity plan insurances;
o Coordination of benefits, Medicare secondary payer, payer of last resort guidelines for compliance;
o CMS 1500 Claim form – filing requirements, NPI, group and individual provider number compliance;
o Basic knowledge of assigning CPT (Current Procedural Terminology), HCPCS level II, modifiers and ICD-9-CM coding to create accurate claims;
o Performing pre-billing audits;
o Interpreting Remittance Advice/Explanation of Benefits from insurance;
o Consumer protection laws & billing patients;
o Appealing denied claims and the Medicare appeals process.
2. Certified Inpatient Billing Specialist (CIBS)
Certified Inpatient Billing Specialist (CIBS acronym used for credentials)
Examination Objective- To test core competencies of graduated students from community college adult education programs and/or county career centers in inpatient/hospital medical billing.
Examination Content
o Hospitals and the regulatory environment;
o Chargemaster;
o Hospital billing processes;
o Accounts Receivable Management;
o Responsibilities as a biller under the Civil False Claims Act;
o Basic understanding of the differences between Government insurance programs, Managed Care Organizations and indemnity plan insurances;
o Coordination of benefits, Medicare secondary payer, payer of last resort guidelines for compliance;
o Hospital UB04 and 1500 claims forms
o Hospital Coding: hospital outpatient CPT, modifiers, ICD-9-CM volumes I, II and III.
o Interpreting Remittance Advice/Explanation of Benefits from insurance;
o Consumer protection laws & billing patients;
o Appealing denied claims and the Medicare appeals process.
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