Foundations of Medical Billing and Coding

This unit provides a foundational overview of the roles, environments, and regulatory landscape of medical billing and coding, including basic anatomy, terminology, payer types, coding concepts, documentation standards, compliance, and professional pathways. It prepares students with the knowledge and professional habits needed for applied coding and billing practice in subsequent units.

Learning Objectives

• Analyze the distinctions between medical coding and medical billing roles, compare work settings (physician office, hospital, clearinghouse, remote), and determine appropriate career and certification pathways.
• Apply foundational coding and claims concepts — including CPT/ICD assignment, clearinghouse workflows, and payer types (commercial, Medicare, WHO reporting) — to trace a claim through the revenue cycle.
• Demonstrate understanding of legal and ethical requirements by interpreting HIPAA, ACA, payer contract disputes, documentation standards, and professional integrity scenarios to ensure compliant claim submission.
• Evaluate credentialing options (AAPC, AHIMA), specialty certifications, and remote-work requirements and construct a measurable study and career development plan aligned with personal goals.