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MEDICAL INSURANCE BILLING CONCEPTS
Associate Degree in Medical Office Assisting
MA 273
The course introduces you to the study of Medical Insurance Billing Concepts, which is essential to healthcare reimbursement. The course is designed to provide you with the basic medical coding skills. The focus of the class is on CPT/HCPCS coding.
This is a five-semester hour course. This course is allotted ten weeks of time. You must complete all of the requirements for the course successfully by the end of the ten-week period. The first day of week one will begin the day that you register for the course, or the day, which you notify me that your textbook has arrived, and you are ready to begin your studies. Please be cognizant of the time frame. It is rare that extensions of time are permitted, unless you have good justification. Upon successful completion of this course, you will be awarded five-semester hours of credit.
The following books are required for this course.
Book 1: Insurance Handbook for the Medical Office - 9TH 06, Fordney, Marilyn, Publisher: Elsevier. ISBN: 1--41600100-X
Book 2: Insurance Handbook for Medical Office -Student Workbook - 9TH 06, Fordney, Marilyn, Publisher: Elsevier. ISBN: 1--41600097-6
Book 3: Supplemental material: Texts must be current and relevant to the course, such as latest edition, CPT-CURRENT PROCEDURAL TERMINOLOGY, *ICD-9-CM-INTERNATIONAL CLASSIFICATIONS OF DISEASES, TABER'S CYCLOPEDIC MEDICAL DICTIONARY, latest editions, PHYSICIAN'S DESK REFERENCE, Slone, Medical Economics Company.
You will complete each workbook exercise and view lecture notes before taking the designated Midterm or Final Examination.
Midterm Exam will be completed online.
Final Examination will be completed online.
• Each test has a set time 48-hour time before it is due.
• Once a test is opened, it must be completed or the grade will be forfeited. If the student opens the wrong test, the student must contact the instructor at that time. It is up to students to be sure they are ready to take a test before entering it.
• Both tests will have sections that require the use of the CPT or HCPCS coding book. For all questions that do not need a “code,” the student is not to use the CPT or HCPCS book.
The grading scale for this course is as follows:
90-100% = A
80-89% = B
70-79% = C
Below 70% = Fail
Points:
(Web-Board) Participation - 10 pts
Weekly Assignments - 0 pts (optional)
Journaling Project - 10 pts
Exam (2) - 80 pts (40 pts each)
TOTAL 100 pts
To provide instruction relevant to the allied health field including various health insurance plans. Instruction includes procedural coding, diagnostic coding and billing. Careers in the medical field will be explored.
Upon successful completion of this course, students will be able to:
- Define and exhibit correct usage of insurance terms used in processing insurance forms in medical offices, clinics, hospitals, and other medical areas.
- Recognize and name the various types of health insurance plans.
- Interpret billing procedures, forms, and entitlement of the various government health programs.
- Define basic coverage provided beneficiaries of the following government health programs: Medicaid, (Medi-Cal in California) MEDICARE, CHAMPUS, HMO's, Worker's Compensation, TAR, SDI, and the Blue Plans.
- Define basic coverage provided beneficiaries of the following standard health programs: CIGNA, Blue Shield, Blue Cross, Kaiser, Foundation for Medical Care, State Disability, and various HMO's.
- Demonstrate proficiency and accuracy in selecting the correct procedure code for each service provided from the current edition of Physician's Current Procedural Terminology, ICD-9 CM, and HCPCS.
- Utilize the International Classification of Diseases diagnosis book.
- Utilize government forms and group health forms.
- Perform basic physician office billing procedures.
SECTION II
Upon successful completion of this course, each student will be able to:
- Process medical insurance claims properly in order to minimize rejection.
- Perform CPT-4 (procedure) coding accurately.
- Perform ICD-9-CM (diagnosis) coding accurately.
- Explain the purpose of diagnosis related groups (DRGs).
- Abstract from the patient s medical record the necessary information for completing the Health Insurance Claim Form.
- Demonstrate a working knowledge of the benefits/nonbenefits of Blue Cross/Blue Shield plans, Medicare, Medicaid, Medi-Medi, CHAMPUS/CHAMPVA and VA Outpatient Clinic Programs.
- Demonstrate a working knowledge of the eligibility requirements, benefits and limitations of employment compensation disability and complete claim forms properly.
- Demonstrate a working knowledge of workers compensation laws and complete medical reports properly.
- Explain the benefits and eligibility requirements of HMOs.
- Prepare typewritten insurance forms according to proper specifications.
- Process and key information into the computer correctly to complete a computerized application of the preparation of medical insurance forms.
COURSE OUTLINE:
I. OVERVIEW OF HEALTH INSURANCE
A. Kinds of health insurance
B. Types of health insurance coverage
C. Steps in processing an insurance claim
II. CODING FOR PROFESSIONAL SERVICES
A. Current Procedural Terminology (CPT)
B. International Classification of Diseases, 9th Revision, Clinical
Modification (ICD-9-CM).
III. HEALTH INSURANCE COVERAGE
A. Blue Cross/Blue Shield
B. Medicaid
C. Medicare
1. Supplemental insurance (Medi-Gap)
2. Medi-Medi
D. CHAMPUS, CHAMPVA, and VA
E. Unemployment compensation disability
F. Workers compensation
G. Pre-paid health insurance plans
IV. COMPUTERIZED BILLING/COMPUTER MODULE
A. Types of computer systems
B. Forms used in computerized billing
C. Records management
D. Electronic claims
V. INSURANCE PROBLEM SOLVING
A. Follow-up procedures
B. Delinquent claims
C. Credit procedures
D. Collection methods
Upon completion of this course, you will be able to:
- Provide an overall, but general description of the medical insurance billing concepts as it exists today.
- Understand medical insurance billing theory and methodology, focusing specific attention to systems theory, information theory, management concepts, and systems development methodologies.
- Have a good working knowledge of how RMA/ CMA/CPC/CCS are different and how they relate.
If you have, any questions about the course please feel free to e-mail me at the address provided or contact Breyer State at adm@breyerstate.com
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