MOA-110: Processing Health Insurance Claims

School
Health & Human Services
Department
Medical Assistant/Billing
Academic Level
Undergraduate
Course Subject
Medical Assist/Recept Biller
Course Number
110
Course Title
Processing Health Insurance Claims
Credit Hours
2.00
Instructor Contact Hours Per Semester
47.00 (for 15-week classes)
Student Contact Hours Per Semester
47.00 (for 15-week classes)
Grading Method
A-E
Pre-requisites
AH-100 with a C grade or higher, Permission of Program Director
Catalog Course Description

An introductory-level insurance billing course centering on the medical office. Presents the coding systems used in conjunction with the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the Current Procedural Terminology (CPT) manual. Also discusses how information is used to process health insurance claims for Blue Cross/Blue Shield (BCBS), Medicare, Medicaid, Tricare, Commercial, and Workers Compensation.

Goals, Topics, and Objectives

Core Course Topics
  1. Introduction to Medical Insurance
  2. Insurance Specialist & Medical Assistant-Roles & Responsibilities
  3. Diagnostic Coding
  4. Procedure Coding
  5. Healthcare Common Procedure Coding System (HCPCS) Coding
  6. The Life Cycle of an Insurance Claim
  7. Managed Health Care
  8. Blue Cross Blue Shield (BCBS)
  9. Medicaid
  10. Medicare
  11. Tricare
  12. Commercial Insurance Carriers
  13. Ethical and legal standards in business practices
Core Course Learning Objectives (Separated)

COGNITIVE DOMAIN:

  1. Describe the process used to identify and select diagnostic codes using the ICD-10-CM coding system.
  2. Describe the process used to identify and select procedure codes using the CPT manual coding system.
  3. Describe the process used to identify and select procedure codes using the HCPCS coding system.

PSYCHOMOTOR DOMAIN:

  1. Complete an insurance claim form for the following carriers: Blue Cross/Blue Shield (BCBS),Health Maintenance Organization (HMO), Medicare, Medicaid, Tricare, and Worker's Compensation.
  2. Utilize the ICD-10-CM and the CPT manuals to complete a paper-based and an electronic insurance claim form.
  3. Explain the advantages of the Affordable Care Act and how it impacts the delivery of health care in ambulatory services.

AFFECTIVE DOMAIN:

  1. Demonstrate honesty and integrity in the performance of medical billing and insurance coding practices.
  2. Apply ethical and legal standards in the performance of all medical business practices.
General Information

Medical Assistant students who graduate from a program that is accredited through the Commission on Accreditation of Allied Health Education Programs will apply cognitive knowledge based on academic subject matter required for competence in the field. They will incorporate cognitive knowledge in the performance of their psychomotor and affective learning domains.

Assessment and Requirements

Assessment of Academic Achievement

Assessment will consist of learning activities, participation, examinations and a final exam.

The following four components identify the value given to each assessment category. * Examinations, 30% * Learning Activities, 30% * Attendance/Participation, 10% * Final Examination, 30%

Texts

Required textbooks to be determined by department faculty.

Approval Dates

Effective Term
Fall 2019
ILT Approval Date
01/11/2019
AALC Approval Date
01/29/2019
Curriculum Committee Approval Date
02/04/2019