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
- Introduction to Medical Insurance
- Insurance Specialist & Medical Assistant-Roles & Responsibilities
- Diagnostic Coding
- Procedure Coding
- Healthcare Common Procedure Coding System (HCPCS) Coding
- The Life Cycle of an Insurance Claim
- Managed Health Care
- Blue Cross Blue Shield (BCBS)
- Commercial Insurance Carriers
- Ethical and legal standards in business practices
- Describe the process used to identify and select diagnostic codes using the ICD-10-CM coding system.
- Describe the process used to identify and select procedure codes using the CPT manual coding system.
- Describe the process used to identify and select procedure codes using the HCPCS coding system.
- 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.
- Utilize the ICD-10-CM and the CPT manuals to complete a paper-based and an electronic insurance claim form.
- Explain the advantages of the Affordable Care Act and how it impacts the delivery of health care in ambulatory services.
- Demonstrate honesty and integrity in the performance of medical billing and insurance coding practices.
- Apply ethical and legal standards in the performance of all medical business practices.
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 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%
Required textbooks to be determined by department faculty.