This program provides a complete introduction to the US healthcare system and its connection to medical billing and Revenue Cycle Management (RCM). It is designed for beginners, job seekers, and anyone interested in understanding how healthcare services, insurance providers, and billing systems work together.
The course begins by explaining the structure of the US healthcare system, including the roles of patients, healthcare providers, and insurance payers. It introduces important concepts such as inpatient and outpatient services, primary care providers (PCPs), and the difference between in-network and out-of-network healthcare providers.
Learners are also guided through essential insurance and billing terminology including subscribers, policyholders, dependents, deductibles, copays, coinsurance, and out-of-pocket expenses. The course explains how these concepts affect patient billing and insurance reimbursements.
In addition, the program covers critical RCM processes such as pre-authorization, timely filing limits (TFL), Explanation of Benefits (EOB), Electronic Remittance Advice (ERA), and denial management. Real-world denial examples like duplicate denials and TFL denials are explained step by step to help learners understand practical billing workflows.
By the end of the course, learners gain a strong foundation in US healthcare operations and medical billing procedures, making it ideal for beginners preparing for healthcare administration or RCM careers.
