Medical Billing and Medicare Reimbursement Professional Program

A comprehensive foundation-to-advanced professional program covering U.S. payer structure, code systems, eligibility, provider data, claim transactions, documentation, modifiers, payment, denials, appeals, compliance, audits, and Medicare DMEPOS reimbursement through applied case work.

Start Course

Difficulty

advanced

Estimated duration

35h

Modules

Published lessons

Course progress0%

Program competencies

What successful learners should be able to do

Verify payer, plan, benefit, network, authorization, provider, and coordination facts before billing.
Translate authenticated records into supported diagnosis, service, HCPCS, modifier, unit, and setting data.
Build and reconcile CMS-1500 and 837P claim relationships and distinguish institutional claim concepts.
Read acknowledgments and 835 remittance data, then classify rejection, denial, reduction, liability, and payment.
Choose correction, replacement, reopening, or appeal based on procedural status, evidence, and deadlines.
Apply documentation, privacy, audit, coverage, fee, and DMEPOS controls without manufacturing support.

Required work products

Build a practical billing portfolio

Eligibility and benefits verification worksheet
Provider and payer-order validation record
Code, modifier, unit, and edit research log
Clean-claim release checklist
Policy-to-evidence documentation crosswalk
ERA and denial root-cause analysis
Correction, reopening, or appeal decision memo
End-to-end capstone case packet

Practice work must use de-identified or fictional information. Do not place protected health information in public or unapproved systems.

Target audience

New and experienced DME billing, supplier, clinic, and healthcare revenue-cycle staff.

Learning outcomes

Apply a source-linked workflow for revenue cycle foundations.
Apply a source-linked workflow for payers eligibility and provider data.
Apply a source-linked workflow for coding systems and claim logic.
Apply a source-linked workflow for professional claims and transactions.
Apply a source-linked workflow for documentation authorization and liability.
Apply a source-linked workflow for remittance denials and appeals.

Modules and lessons

Module 01Revenue Cycle FoundationsBuild the payer, code-system, revenue-cycle, and role foundation required for later work.

The U.S. Medical Billing Revenue Cycle65 min Medicare, Medicaid, and Commercial Payers65 min ICD-10, CPT, and HCPCS Code Systems65 min Medical Billing Roles and Control Boundaries65 min Open module overview

Module 02Payers Eligibility and Provider DataControl coverage, benefits, payer order, authorization, provider identities, and enrollment.

Eligibility and Benefits Verification65 min Coordination of Benefits and Medicare Secondary Payer65 min NPI, Taxonomy, Enrollment, and Provider Relationships65 min Prior Authorization and Benefit Controls65 min Open module overview

Module 03Coding Systems and Claim LogicApply HCPCS, setting, edit, unit, and modifier logic to supported facts.

HCPCS Level II and DME Product Coding65 min Place of Service and Setting Logic65 min NCCI Procedure-to-Procedure Edits65 min Medically Unlikely Edits and Units65 min Modifier 59 and XE, XP, XS, XU65 min Open module overview

Module 04Professional Claims and TransactionsBuild, scrub, submit, and reconcile professional claims while understanding institutional differences.

CMS-1500 and 837P Professional Claims65 min Institutional Claim Literacy: CMS-1450 and 837I65 min Clean Claim Scrubbing and Release Controls65 min Submission Evidence, Rejections, and Timely Filing65 min Open module overview

Module 05Documentation Authorization and LiabilityConnect medical necessity, documentation, notices, authorization, and privacy controls.

Medical Necessity and Documentation65 min ABNs and GA, GY, GZ, and GX65 min HIPAA Privacy and Minimum Necessary65 min Open module overview

Module 06Remittance Denials and AppealsInterpret remittance and choose correction, reopening, or appeal paths.

Reading the 835 ERA, CARCs, and RARCs65 min Correction, Reopening, or Appeal65 min Original Medicare Appeals65 min Open module overview

Module 07Compliance Audits and Financial ControlsManage audit, claim-history, fee, coverage, and financial-control questions.

DME Audits: CERT, TPE, SMRC, RAC, and UPIC65 min Common Working File and Claim History65 min Fee Schedules, Coverage, and Payment65 min Open module overview

Module 08Medicare DMEPOS ReimbursementApply the complete DMEPOS intake, authorization, documentation, coding, delivery, and reimbursement workflow.

DMEPOS Reimbursement Foundations65 min DMEPOS Eligibility and Benefits Case65 min DMEPOS Prior Authorization Case65 min Open module overview

Module 09Professional CapstoneResolve an incomplete claim from intake through final recommended action.

Professional Medical Billing Capstone100 min Open module overview

Knowledge checks

Foundation Competency AssessmentPassing score: 80%Coding and Claim Logic AssessmentPassing score: 80%Claims, Denials, and Appeals AssessmentPassing score: 80%Professional Program Final ExaminationPassing score: 85%

Enrollment and completion

Enrollment stores private progress in your existing account. Public lesson reading remains available without enrollment.

A private educational completion certificate may be issued after verified course completion. This is not an official Medicare certification program.