Medical Billing - Ontario

Medical Billing Course Introduction

Medical Billing is 40 hours in duration, and is the third course in Unit 4: Medical Office Administrative Procedures of the Medical Office Assistant program. In this Instructor led course, students learn the fundamental manual and electronic concepts of province-specific medical billing. There are five (5) lessons. Each lesson covers a major topic and has been designed to build on acquired skills. The lessons are covered in order. During the course, students work with a Canadian textbook.

Course Prerequisite(s)

Students must have strong English skills (oral and written), and have successfully completed Learning Medical Language (MDL07E1), Medical Office Procedures (MDP00E1), keyboarding courses to a speed competency of 45 wpm, and word processing courses to an advanced level.

Course Aim

This course is designed to familiarize students with the principles involved in billing provincial health plans, Workers’ Compensation, and third party insurers for the medical procedures that are performed in a medical office or clinic.

Of Interest to

Those who are interested in a career as a Medical Office Assistant in a doctor’s office, clinic or hospital or Medical Office Assistants and other Health Professionals who wish to learn procedures for medical billing.

Course Competencies

Upon successful completion of this course, students will be able to:
  • Outline eligibility for a health care plan, explain premium assistance, and list criteria for dependent eligibility.
  • Understand different billing options.
  • Explain the procedure for physician registration, including the significance of registration number units.
  • Identify specialty codes and the appropriate specialization.
  • Interpret the Schedule of Benefits and know how to use it.
  • Identify significant parts of a claims card and know how to complete it, either by regular submission, pre-coded submission or both.
  • Identify supporting documentation required for specific services.
  • Understand reprocessing of returned claims.
  • Interpret and reconcile the remittance advice form.
  • Process remittance advice inquiries.
  • Explain non-payment of claims and appeals, out-of- province benefits and claims submissions, and Workers’ Compensation Claims/Billings.
  • Understand Third Party Insurance.
  • Summarize advantages of submitting claims on machine-readable input.
  • Outline considerations for purchasing software and hardware for use in a medical environment.
  • Outline specific procedural benefits of machine- readable input.
  • Outline how to access assistance.
  • Use medical billing software to register patients, schedule appointments, generate electronic claims and reconcile payments. Health-care Personnel; Medical Office Support Staff; Medical Ethics; Medical Law; Medical Environment

Course Content

Introduction and Eligibility

Concepts of Health Care Billing, rules and regulations associated with Medical billing, restrictions on doctors, eligibility and applying for Provincial Health Care coverage, Health Cards and proof of Eligibility, confidentiality of health information and records, billing options, procedure for physician registration and the registration number, Schedule of Benefits, submission dates and payment dates, and an introduction of the Medical Billing Software Program.

Manual and Electronic Billing

Billing claim cards, use of treatment and diagnostic codes for confidentiality, identification numbers, service codes, reciprocal/out of province billing, surgical billing, and generating electronic claims.

Payments to Doctors

Billing systems for medical doctors and non-medical practitioners, supporting documentation for specific services, interim payments to doctors, reprocessing of returned claims, remittance advice forms, processing remittance advice inquiries, non-payment of claims/appeals, and reconciling payments with billing records.


Interpretation of the remittance advice form, reconciling a remittance advice, Electronic Reconciliation, diskette submission, accounts receivable reports, and more billing codes.

Out of Province Billing, Worker’s Compensation, Third Party Insurance

Out-of-Province benefits and claims submissions, specialized Trip Codes, advantages of machine-readable input, purchasing software and hardware, Workers’ Compensation claims and Third party insurance, and accessing assistance.

Medical Billing Software

Practical Exercises using medical billing software to register patients, schedule appointments, generate electronic claims and reconcile payments will be presented throughout the various lessons.

Course Notes

As this course is Instructor led, the instructor is able to informally evaluate students on a day-by-day basis. Formal evaluation is accomplished a final examination administered at the end course that combines theory and practical skills. The student must attain a minimum mark of 75% to pass this course. *Not all courses are offered at each location.


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