9/1/2024 3:21:24 AM |
| Changed Course |
CATALOG INFORMATION
|
Discipline and Nbr:
MA 168 | Title:
MEDICAL INSUR BILLING |
|
Full Title:
Basic Medical Office Insurance Billing |
Last Reviewed:2/14/2022 |
Units | Course Hours per Week | | Nbr of Weeks | Course Hours Total |
Maximum | 1.50 | Lecture Scheduled | 1.50 | 17.5 max. | Lecture Scheduled | 26.25 |
Minimum | 1.50 | Lab Scheduled | 0 | 17.5 min. | Lab Scheduled | 0 |
| Contact DHR | 0 | | Contact DHR | 0 |
| Contact Total | 1.50 | | Contact Total | 26.25 |
|
| Non-contact DHR | 0 | | Non-contact DHR Total | 0 |
| Total Out of Class Hours: 52.50 | Total Student Learning Hours: 78.75 | |
Title 5 Category:
AA Degree Applicable
Grading:
Grade Only
Repeatability:
00 - Two Repeats if Grade was D, F, NC, or NP
Also Listed As:
Formerly:
MA 68.1
Catalog Description:
Untitled document
The student will develop basic knowledge and skills for understanding major health insurance plans as related to medical office billing.
Prerequisites/Corequisites:
Course Completion of MA 160, MA 161, MA 162, MA 163, MA 167; AND Concurrent Enrollment in MA 164, MA 165, MA 169, and MA 174
Recommended Preparation:
Eligibility for ENGL 1A or equivalent
Limits on Enrollment:
Schedule of Classes Information
Description:
Untitled document
The student will develop basic knowledge and skills for understanding major health insurance plans as related to medical office billing.
(Grade Only)
Prerequisites:Course Completion of MA 160, MA 161, MA 162, MA 163, MA 167; AND Concurrent Enrollment in MA 164, MA 165, MA 169, and MA 174
Recommended:Eligibility for ENGL 1A or equivalent
Limits on Enrollment:
Transfer Credit:
Repeatability:00 - Two Repeats if Grade was D, F, NC, or NP
ARTICULATION, MAJOR, and CERTIFICATION INFORMATION
Associate Degree: | Effective: | | Inactive: | |
Area: | | |
|
CSU GE: | Transfer Area | | Effective: | Inactive: |
|
IGETC: | Transfer Area | | Effective: | Inactive: |
|
CSU Transfer: | | Effective: | | Inactive: | |
|
UC Transfer: | | Effective: | | Inactive: | |
|
C-ID: |
Certificate/Major Applicable:
Both Certificate and Major Applicable
COURSE CONTENT
Student Learning Outcomes:
At the conclusion of this course, the student should be able to:
Untitled document
1. Describe the major types of health insurance plans and use appropriate medical insurance
billing and coding terminology.
2. Analyze the claims process, pre-service authorization, patient and medical office
responsibilities and guidelines for major insurance claims.
3. Accurately complete a variety of health insurance claim forms extracting information from
medical records and choosing appropriate diagnostic and procedural codes.
Objectives:
Untitled document
Students will be able to:
1. Define common insurance medical and diagnostic terms.
2. Describe the major federal, state, and private health insurance plans.
3. Extract from patient records information for completing insurance plans.
4. List criteria for eligibility, benefits, payments, time lines, billing limitations, deductibles, and
forms for major plans.
5. Explain the procedures and criteria for prior authorizations for major plans.
6. Correctly choose appropriate coding books according to plan/billing 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 various plans, given patient's
chart notes.
10. Interpret benefits received and apply correctly to patient and office accounting records.
11. Fill out a prior authorization form.
12. Interpret Explanation of Benefits/Remittance Advice.
13 Identify fraud and abuse regulations.
14. Understand medical necessity as it relates to insurance claims.
15. Understanding changing healthcare regulations as they occur.
Topics and Scope
Untitled document
I. Introduction to Medical Insurance
A. Types of medical insurance
B. Terminology of medical insurance
C. Introduction to procedural and diagnostic coding
II. The Health Insurance Claim Form
A. Claims process
B. Pre service 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
III. Major Types of Health Care Insurance Plans such as
A. MediCal/Medicaid/CSMP/Partnership Health Plan
B. Medicare/Medi-Medi
C. Blue Cross/Blue Shield
D. HMO'S, PPO'S, IPO'S (Health Maintenance Organizations, Preferred Provider
Organizations, Independent Provider Organizations)
E. Disability: Workers Compensation
IV. Criteria and Guidelines for Major Plans
A. Benefits and eligibility
B. Participating providers' responsibilities
C. Schedules of deductibles and fee payments for major plans ( i.e. Medicare and Military)
D. Covered services
E. Pre-authorization regulations and procedures
F. Billing limitations and timelines
G. Procedural and diagnostic coding requirements
V. Changes in Healthcare
A. Affordable Care Act (ACA)
B. Healthcare delivery changes
C. Implementation and navigation of the ACA
Assignments:
Untitled document
1. Read 30-50 pages of text per week
2. Complete 10-20 questions for each assigned chapter
3. Complete 8-10 exercises related to developing beginning skills in correctly identifying
procedural and diagnostic codes obtained from patient records
4. Prepare 4-6 typed insurance claims for representation of major insurance plans
5. Complete 1-2 written prior authorization forms
6. Identify diagnostic and procedural information from 2-4 patient charts for completion of
insurance claims
7. Quizzes (3-6) and final exam
8. Paper 2-3 pages, on changes in healthcare
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 20 - 35% |
Coding exercises, typed insurance claims, changes in healthcare paper, written prior authorization forms | |
Problem solving: Assessment tools, other than exams, that demonstrate competence in computational or non-computational problem solving skills. | Problem Solving 10 - 30% |
Homework problems: chapter questions, identification of procedural and diagnostic codes | |
Skill Demonstrations: All skill-based and physical demonstrations used for assessment purposes including skill performance exams. | Skill Demonstrations 0 - 0% |
None | |
Exams: All forms of formal testing, other than skill performance exams. | Exams 40 - 70% |
Quizzes and final exam | |
Other: Includes any assessment tools that do not logically fit into the above categories. | Other Category 0 - 0% |
None | |
Representative Textbooks and Materials:
Untitled document
Understanding Health Insurance: A Guide to Billing and Reimbursement. 14th ed. Green, Michelle. 2019
Print PDF