1/4/2025 9:25:03 PM	MSR 68.1 Course Outline as of Spring 1991	Changed Course
CATALOG INFORMATION
Discipline and Nbr:  MSR 68.1	Title:  BASIC MED OFF INS
Full Title:  Basic Medical Office Insurance
Last Reviewed:2/14/2022

Units		Course Hours per Week			Nbr of Weeks	Course Hours Total
Maximum	1.50	Lecture Scheduled	2.00		8 max.	Lecture Scheduled	16.00
Minimum	1.50	Lab Scheduled	3.00		8 min.	Lab Scheduled	24.00
		Contact DHR	0			Contact DHR	0
		Contact Total	5.00			Contact Total	40.00
		Non-contact DHR	0			Non-contact DHR Total	0

Total Out of Class Hours:  32.00

Total Student Learning Hours: 72.00

Title 5 Category:  AA Degree Applicable
Grading:  Grade or P/NP
Repeatability:  33 - 3 Enrollments Total
Also Listed As: 
Formerly:  MSR 68

Catalog Description:

Students develop basic knowledge and skills for processing insurance claims in the physician's office. Emphasis is on accuracy in completing basic medical insurance forms for major health plans, familiarity with basic coding books, filing claims for prompt and full reimbursement, developing manual and computer skills in insurance billing and implementing prior authorization procedures. Interpretation of benefits, and treatment of payments, adjustments and balances are summarized. (Letter grade only for certificate, or CR/NC)

Prerequisites/Corequisites:
For certificate, student must have completed MS/R 62A and completed or be enrolled in 62B. Open enrollment with 3 units of medical terminology with grade of "C" or better.

Recommended Preparation:
Eligibility for English 100A or equivalent; experience in a medical office, clinic or hospital.

Limits on Enrollment:

Schedule of Classes Information
Description:

Preq: For certificate, student must have completed MS/R 62A & completed or be enrolled in MS/R 62B; open enrollment with 3 units of medical terminology with grade of "C". Recomm: Eligibility for Engl 1A or equiv; experience in a medical office, clinic or hospital. Student will develop basic knowledge & skills for accurate processing of insurance claims for major health plans in the medical office. (Grade only for certificate; or CR/NC)(Repeat Code 33)

(Grade or P/NP)
Prerequisites:For certificate, student must have completed MS/R 62A and completed or be enrolled in 62B. Open enrollment with 3 units of medical terminology with grade of "C" or better.
Recommended:Eligibility for English 100A or equivalent; experience in a medical office, clinic or hospital.
Limits on Enrollment:
Transfer Credit:CSU;
Repeatability:33 - 3 Enrollments Total

ARTICULATION, MAJOR, and CERTIFICATION INFORMATION

Associate Degree:		Effective:		Inactive:
Area:
CSU GE:	Transfer Area			Effective:	Inactive:
IGETC:	Transfer Area			Effective:	Inactive:
CSU Transfer:	Transferable	Effective:	Spring 1984	Inactive:	Spring 2006
UC Transfer:		Effective:		Inactive:
C-ID:

Certificate/Major Applicable: Certificate Applicable Course

COURSE CONTENT

Outcomes and Objectives:
At the conclusion of this course, the student should be able to:

The students will:

1.  Define common insurance medical and diagnostic terms.

2.  Describe the major federal, state, and private health

   insurance plans.

3.  Abstract from patient records information for completing insurance

   plans.

4.  List criteria for eligibility, benefits, payments, time lines,

   billing limitations, deductibles, and forms for each of the nine

   major plans.

5.  Explain the procedures and criteria for prior authorizations for

   all major plans.

6.  Correctly choose appropriate coding books according to plan

   regulations.

7.  Describe the differences between procedural and diagnostic coding

   books.

8.  Code basic levels of service and procedures properly, using the

   appropriate coding books and specific guidelines for each plan.

9.  Accurately complete a series of health insurance claims for each

   plan, given the patient's chart notes and ledger cards.

10. Use the computer to develop skills in completing health claims

   forms ad choosing procedural and diagnostic codes.

11. Interpret benefits received and apply correctly to patient and

   office accounting records.

12. Locate errors on medical insurance claim forms.

13. Complete insurance claim tracer forms.

14. List specific coding tips for specific plans.

15. Develop procedures for handling denials, rejections, delinquent

   filings, and appeals.

Topics and Scope

1.  Introduction to Medical Insurance.

     A. Types of medical insurance.

     B. Terminology of medical insurance.

     C. introduction to procedural and diagnostic coding.

2.  The Health Insurance Claim Form.

     A. Claims process.

     B. Pre-service estimates and authorizations.

     C. Patient responsibilities.

     D. Medical office responsibilities.

     E. Preparation of the form: procedures, instructions.

     F. Requirements of the three major fiscal agents.

     G. Special problems: abstracting information, timelines, legal

        implications.

3.  Major Types of Health Care Insurance Plans.

     A. MediCal/Medicaid/CSMP/CCS.

     B. Medicare/Medi-Medi.

     C. CHAMPUS/CHAMPVA.

     D. Blue Cross/ Blue Shield.

     E. HMO'S, PPO'S, IPO'S.

     F. Disability: Workers Compensation.

4.  Criteria and Guidelines for Major Plans.

     A. Benefits and eligibility.

     B. Participating providers' responsibilities.

     C. Schedules of deductibles and fee payments.

     D. Covered Services.

     E. Pre-authorization regulations and procedures.

     F. Billing limitations and timelines.

     G. Recent and specific coding requirements.

     H. Other regulations and hints.

Assignments:

1.  Complete writing assignments including:

     A. Review questions for 8 chapters.

     B. Exercises related to developing beginning skills in correctly

        identifying procedural and diagnostic codes obtained from

        patient records.

     C. Preparation of typed insurance claims for 7 major plans.

2.  Complete written prior authorization claims.

3.  Complete a chart listing criteria for major health plans.

4.  Abstract information from patient charts for correct completion

   of insurance claims.

5.  Read 50 pages of text per week.

6.  Complete a series of computer programs to prepare a variety of

   health insurance claims forms.

Methods of Evaluation/Basis of Grade.

Writing: Assessment tools that demonstrate writing skill and/or require students to select, organize and explain ideas in writing.		Writing 10 - 25%
Written homework, Reading reports
Problem solving: Assessment tools, other than exams, that demonstrate competence in computational or non-computational problem solving skills.		Problem Solving 20 - 40%
Homework problems, Lab reports
Skill Demonstrations: All skill-based and physical demonstrations used for assessment purposes including skill performance exams.		Skill Demonstrations 20 - 40%
Class performances, Field work
Exams: All forms of formal testing, other than skill performance exams.		Exams 10 - 30%
Multiple choice, Matching items, Completion
Other: Includes any assessment tools that do not logically fit into the above categories.		Other Category 10 - 25%
COMPUTER ASSIGNMENTS

Representative Textbooks and Materials:

INSURANCE HANDBOOK FOR THE MEDICAL OFFICE by Marilyn Fordney, 3rd ed.,

W.B. Saunders Co., 1989.

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