Foundations of Medical Billing & Coding

This unit introduces students to the foundational roles, systems, and regulations that shape medical billing and coding careers, including distinctions between coding and billing, work settings, major payers, credentialing bodies, and essential legal/ethical requirements. Students will gain practical familiarity with basic anatomy and terminology, introductory CPT/ICD coding concepts, claims flow, and professional practices to prepare for applied coding and claims processing in subsequent units.

Learning Objectives

• Analyze the differences between medical coding and medical billing roles and compare typical work environments (e.g., physician offices, hospitals, clearinghouses, remote settings) using real-world job scenarios.
• Apply foundational anatomy, medical terminology, and introductory ICD/CPT coding concepts to assign appropriate diagnosis and procedure codes for guided practice cases.
• Demonstrate knowledge of major payers, clearinghouse functions, credentialing organizations (AAPC, AHIMA), and basic Medicare/ACA requirements by completing simulated claim submissions and identifying payer-specific rules.
• Evaluate professional and legal responsibilities—including documentation standards, HIPAA compliance, fraud/abuse issues, and remote-work practices—and recommend corrective actions for noncompliant claim scenarios.