BankOfMedicare University
Free Medical Billing and Reimbursement University
Learn the rules behind clean claims, coding systems, remittance, denials, appeals, Medicare compliance, and DME reimbursement from reviewed official sources.
Billing Fundamentals
Claims, code sets, eligibility, privacy, clean-claim controls, and payment basics.
New billers and cross-functional teams
Professional Claims
CMS-1500, 837P, place of service, provider roles, and professional claim logic.
Practices, suppliers, and professional billers
Institutional Claims
CMS-1450, 837I, type of bill, revenue lines, and institutional data relationships.
Hospitals and facility billing teams
Coding Rules
NCCI PTP, MUE, distinct-service modifiers, units, and code-set discipline.
Coders, auditors, and denial teams
Denials and Appeals
Remittance interpretation, root-cause triage, correction, reopening, and appeal workflow.
Denial and payment integrity teams
Medicare Compliance
Timely filing, prior authorization, MSP, ABNs, enrollment, and documentation.
Medicare operations and compliance staff
DME Reimbursement
HCPCS, DME MACs, coverage, orders, delivery, rental, replacement, and fee research.
DME suppliers and reimbursement teams
22 lessons
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The Medical Billing Claim Lifecycle
Follow a claim from scheduling and eligibility through coding, submission, adjudication, payment, denial, and follow-up.
ICD-10, CPT, and HCPCS: What Each Code System Does
Understand diagnosis, inpatient procedure, professional service, supply, drug, and equipment code-set roles without mixing them.
CMS-1500 and 837P Professional Claims
Learn the core data relationships on professional and supplier claims, from provider identifiers to service lines.
CMS-1450 (UB-04) and 837I Institutional Claims
Understand type of bill, revenue codes, occurrence and value data, diagnosis and procedure reporting, and institutional claim flow.
Clean Claim Scrubbing Checklist
Build a repeatable pre-submission review that catches demographic, provider, coding, authorization, and coordination errors.
Medicare Timely Filing: The One-Year Rule
Calculate the general Original Medicare filing deadline and distinguish a late original claim from an adjustment or reopening.
Place of Service Codes for Professional Claims
Choose the two-digit setting code that matches where the professional service was actually furnished.
NCCI Procedure-to-Procedure Edits
Read Column One, Column Two, and modifier indicators before deciding whether services may be reported together.
Medically Unlikely Edits and Units of Service
Understand MUE values, adjudication indicators, units, and when records may support services above a published edit.
Modifier 59 and XE, XP, XS, XU
Use distinct-service modifiers only when separate encounter, practitioner, structure, or unusual non-overlapping service facts are documented.
How to Read an ERA: Group Codes, CARCs, and RARCs
Translate an 835 remittance into financial responsibility, root cause, and the next operational action.
Corrected Claim, Reopening, or Appeal?
Choose the right path based on whether the payer lacked correct claim data, made a minor processing error, or issued a disputed coverage or payment decision.
Original Medicare Appeals: Five Levels and Deadlines
Build an appeal from redetermination through judicial review, starting with the remittance and deadline.
Prior Authorization Workflow and Denial Prevention
Match the authorized service, provider, setting, units, and dates to the final claim and retain the clinical decision trail.
Medicare Secondary Payer and Coordination of Benefits
Determine payer order, collect other-insurance facts, and submit primary adjudication data correctly when Medicare pays second.
ABNs and GA, GY, GZ, GX Modifiers
Separate expected medical-necessity denial, statutory exclusion, voluntary notice, and no-notice scenarios.
Medical Necessity and Documentation That Supports Payment
Connect the contemporaneous record to the billed service, level, quantity, frequency, order, and coverage criteria.
HIPAA Privacy and Minimum-Necessary Billing Workflows
Use approved systems, role-based access, and minimum-necessary practices when handling claims and payment records.
Fee Schedule Amount vs Coverage and Payment
Separate a published payment reference from benefit category, coverage criteria, coding, documentation, and final adjudication.
Medicare DME Reimbursement Basics
Connect HCPCS, benefit category, coverage policy, orders, delivery, rental logic, modifiers, and the DMEPOS fee schedule.
Eligibility and Benefits: 270/271 Workflow
Use electronic eligibility as a point-in-time input while confirming plan, network, benefit, authorization, and COB details.
NPI, Taxonomy, and Medicare Enrollment
Keep identity, specialty, location, reassignment, ordering, and billing enrollment facts aligned with the claim.