Foundations of Medical Billing and Coding

This unit introduces students to the roles, work environments, and career pathways in medical billing and coding while covering foundational content: basic anatomy and terminology, coding systems (CPT/ICD/WHO), payer types (commercial, Medicare), clearinghouses, and the claim lifecycle. It also builds professional and ethical understanding of HIPAA, ACA, documentation standards, and credentialing to prepare learners for certification and subsequent technical units.

Learning Objectives

• Analyze distinctions between medical coding and billing roles, typical work settings (provider office, hospital, clearinghouse, remote), and daily workflows to determine appropriate career pathways
• Apply foundational medical terminology and anatomy knowledge alongside CPT/ICD/WHO coding conventions to assign appropriate procedure and diagnosis codes in simulated clinical scenarios
• Demonstrate understanding of payer systems—including commercial insurers, clearinghouses, contract vs non‑contract disputes, and Medicare basics—by tracing a claim through the submission, adjudication, and appeals processes
• Evaluate regulatory, ethical, and professional requirements (HIPAA, ACA, documentation standards, and credentialing options such as AAPC/AHIMA) and develop a targeted study/career plan for certification and workplace readiness