Introduction to Medical Billing
Learn how information moves from the patient encounter to the insurance claim, payment, follow-up, and final account resolution. Use this hub to understand the systems, forms, payers, coding tools, and revenue-cycle concepts behind medical billing.
Medical Billing Foundations
Work through the sections in order or jump directly to the billing topic you need. The portal remains freely browsable; the 41 instructional lessons will open as HVA Academy member posts as they are produced.
Medical Billing Foundations
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What Is Medical Billing?
Understand the role medical billing plays inside healthcare administration and reimbursement.
Open Member Lesson →Member Lesson 02 · HVA 101The Healthcare Revenue Cycle From Start to Finish
Follow information from patient registration and the encounter through claim submission, payment, follow-up, and final account resolution.
Open Member Lesson →Member Lesson 03 · HVA 101Who Does What in the Revenue Cycle?
Learn how providers, front-desk teams, coders, billers, clearinghouses, payers, patients, and collections functions interact.
Open Member Lesson →Health Insurance & Payer Fundamentals
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How Health Insurance Works
Build a working understanding of premiums, deductibles, copays, coinsurance, networks, benefits, exclusions, authorizations, and patient responsibility.
Open Member Lesson →Member Lesson 05 · HVA 101Health Insurance Models
Compare indemnity, HMO, PPO, EPO, POS, managed-care, employer-sponsored, and individual coverage structures.
Open Member Lesson →Patient Registration & Data Capture
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Patient Registration: Building a Clean Claim Before the Visit
See how demographics, subscriber data, insurance details, guarantor information, signatures, and provider data affect downstream billing.
Open Member Lesson →Member Lesson 07 · HVA 101Insurance Verification & Eligibility
Learn what to verify before services are billed, including active coverage, dates, benefits, cost sharing, networks, limits, referrals, and authorization requirements.
Open Member Lesson →Coding Systems for Billers
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ICD-10-CM for Medical Billers
Understand what diagnosis codes communicate and where they enter the professional billing workflow.
Open Member Lesson →Member Lesson 09 · HVA 101CPT for Medical Billers
Understand how professional services and procedures are represented in billing.
Open Member Lesson →Member Lesson 10 · HVA 101HCPCS Level II for Medical Billers
Learn how supplies, drugs, equipment, transportation, and other Level II items appear in claims.
Open Member Lesson →Member Lesson 11 · HVA 101Diagnosis-to-Procedure Relationships
Connect what happened, why it happened, what was documented, and what was billed.
Open Member Lesson →Medical Necessity
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What Medical Necessity Means in Billing
Understand coverage criteria, diagnosis-service relationships, documentation, payer policy, frequency limits, and authorization boundaries.
Open Member Lesson →Member Lesson 13 · HVA 101Clinical Documentation, Diagnosis & Medical Necessity
Connect clinical documentation and pathophysiology to the evidence supporting a billed service.
Open Member Lesson →Claim Forms & Claim Construction
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The CMS-1500 Claim Form
Learn how professional claims organize patient, provider, diagnosis, service, charge, place-of-service, modifier, and identifier data.
Open Member Lesson →Member Lesson 15 · HVA 101The UB-04 Claim Form
Get an introductory view of institutional claim structure, including facility data, bill types, revenue codes, diagnoses, procedures, and charges.
Open Member Lesson →Member Lesson 16 · HVA 101CMS-1500 vs. UB-04
Compare the two major claim forms and the billing environments they represent.
Open Member Lesson →Claim Submission & Adjudication
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From EHR to Payer: How a Claim Travels
Follow a claim from the EHR through the clearinghouse to payer processing and response.
Open Member Lesson →Member Lesson 18 · HVA 101Claim Rejection vs. Claim Denial
Distinguish front-end claim rejection from payer adjudication denial and understand why the difference changes the next action.
Open Member Lesson →Member Lesson 19 · HVA 101How Insurance Companies Adjudicate Claims
Understand the major eligibility, benefits, coding, medical-necessity, network, authorization, edit, allowance, and payment decisions involved in adjudication.
Open Member Lesson →Payments & Remittance
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Understanding the EOB and ERA
Read the basic structure of payer remittance information and patient-facing explanations of benefits.
Open Member Lesson →Member Lesson 21 · HVA 101Payment Posting
Understand payer payments, contractual adjustments, patient responsibility, denials, recoupments, zero-pay remittances, and posting accuracy.
Open Member Lesson →Member Lesson 22 · HVA 101Allowed Amounts, Adjustments & Patient Responsibility
See how billed charges become allowed amounts, payer payments, adjustments, and patient balances.
Open Member Lesson →Accounts Receivable & Collections
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What Is Accounts Receivable in Medical Billing?
Understand what remains outstanding after billing and why A/R management matters.
Open Member Lesson →Member Lesson 24 · HVA 101The Medical Billing Follow-Up Workflow
Use a structured sequence to verify submission, review payer response, identify the required action, correct or appeal, resubmit, and reconcile.
Open Member Lesson →Member Lesson 25 · HVA 101Aging Reports & A/R Buckets
Learn how 0–30, 31–60, 61–90, 91–120, and 120+ day buckets organize outstanding balances.
Open Member Lesson →Member Lesson 26 · HVA 101Patient Balances & Collections
Understand the billing and administrative concepts involved when responsibility shifts to the patient.
Open Member Lesson →Denials & Appeals
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Why Medical Claims Get Denied
Review common denial causes including eligibility, authorization, coding, medical necessity, timely filing, duplicates, bundling, enrollment, COB, and documentation.
Open Member Lesson →Member Lesson 28 · HVA 101The Denial Management Workflow
Follow the operational process for identifying, categorizing, correcting, appealing, tracking, and preventing denials.
Open Member Lesson →Member Lesson 29 · HVA 101Corrected Claim vs. Reconsideration vs. Appeal
Learn when a billing problem calls for corrected data, payer reconsideration, or a formal appeal.
Open Member Lesson →Member Lesson 30 · HVA 101Reading Adjustment and Remark Codes
Build foundational literacy with claim adjustment reason codes and remittance advice remark codes.
Open Member Lesson →Government Payers
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Medicare Billing Fundamentals
Learn the foundational structure and terminology of Medicare billing.
Open Member Lesson →Member Lesson 32 · HVA 101Medicaid Billing Fundamentals
Understand Medicaid billing fundamentals and the importance of state- and program-specific rules.
Open Member Lesson →Member Lesson 33 · HVA 101TRICARE Billing Fundamentals
Learn the basic billing environment for eligible uniformed-service members, retirees, and families.
Open Member Lesson →Private & Commercial Payers
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Blue Cross Blue Shield: Understanding the Association Model
Understand the relationship between the BCBS Association, local plans, networks, and payer processing.
Open Member Lesson →Member Lesson 35 · HVA 101Commercial Insurance Billing Fundamentals
Learn the common billing concepts that apply across private health plans.
Open Member Lesson →Member Lesson 36 · HVA 101Network Contracts & Contractual Adjustments
Understand how network participation and negotiated allowances affect reimbursement and adjustments.
Open Member Lesson →Workers’ Compensation
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Legal, Regulatory & Compliance Foundations
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HIPAA for Medical Billing
Understand the privacy, security, and administrative role HIPAA plays in billing workflows.
Open Member Lesson →Member Lesson 39 · HVA 101Fraud, Waste & Abuse
Learn the basic distinctions and why billing teams need compliance awareness.
Open Member Lesson →Member Lesson 40 · HVA 101False Claims, Billing Integrity & Documentation
Connect claim accuracy, documentation, billing integrity, and compliance risk.
Open Member Lesson →Member Lesson 41 · HVA 101Patient Collections & Compliance Basics
Understand foundational compliance considerations when collecting patient balances.
Open Member Lesson →Billing Reference Library
Need a definition, abbreviation, transaction, claim concept, payer term, or coding-system reference while you study?
Open the Main HVA Reference Library
Search the structured medical terminology, billing, insurance, claims, EDI, coding-system, provider-administration, and revenue-cycle reference library.
Build the Clinical and Administrative Foundation
Medical billing is easier to understand when the underlying terminology, anatomy, physiology, and disease concepts are already familiar.
Start with the Main Reference Library
Use Medical Terminology first, then Anatomy & Physiology and Pathophysiology before moving through the billing learning path.