MOA-165: Physician Billing Concepts

School
Health and Human Services
Division
Health Careers
Department
Medical Assistant/Billing
Academic Level
Undergraduate
Course Subject
Medical Assist/Recept Biller
Course Number
165
Course Title
Physician Billing Concepts
Credit Hours
4.00
Instructor Contact Hours Per Semester
62.00 (for 15-week classes)
Student Contact Hours Per Semester
62.00 (for 15-week classes)
Grading Method
A-E
Pre-requisites
MOA-101, MOA-110 both with a C grade or better.
Co-requisites
HIT-150
Catalog Course Description

This course is designed to build upon the knowledge gained in MOA-101, and MOA-110. The process of electronic claims preparation is practiced through classroom simulations. The student will use medical office computer applications to establish patient, insurance, facility data bases. This information allows the user to prepare statements, bill insurance companies, post payments to the patient account, and generate statements and other financial documents utilized in the physician’s office.

Goals, Topics, and Objectives

Core Course Topics
  1. Orientation to the Total Health Management Accounting Systems (E-THOMAS) Total Health Office Computer Application System
  2. Office Ergonomics
  3. Paper Claims: Commercial, Blue Cross/Blue Shield(BCBS), and Medicaid
  4. Electronic Claims: Commercial, Blue Cross/Blue Shield (BCBS), and Medicaid
  5. Ethical/Legal Standards in Claims Preparation
  6. Establish Medical Data base
  7. Patient Intake Procedures
  8. Daily Journal Report
  9. Patient Statements
  10. Accounts Receivable
Core Course Learning Objectives (Separated)

COGNITIVE DOMAIN:

  1. Initiate patient registration, and verify current insurance coverage.
  2. Explain the Health Maintenance Organization (HMO) referral and authorization request process.

PSYCHOMOTOR DOMAIN:

  1. Use the Current Procedural Terminology (CPT) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) to demonstrate medical necessity for billing.
  2. Perform insurance verification, certification, and authorization for health insurance carriers such as Blue Cross/Blue Shield (BCBS), Medicaid, and Health Maintenance Organization (HMO) plans.
  3. Construct a complete electronic claim for traditional insurance carriers such as BC/BS, Medicare, Medicaid, Commercial Carriers, Tricare, and Workmen's Compensation.

AFFECTIVE DOMAIN:

  1. Demonstrate scope of practice for a medical insurance specialist.
  2. Demonstrate honesty and integrity in the performance of all medical business practice.
  3. Exercise ethical/legal standards in claims preparation and submission.
General Information

Students graduating from the Medical Insurance Specialist Program will demonstrate cognitive knowledge based on academic subject matter required for competence in the profession.  They will incorporate cognitive thinking in the performance of psychomotor and affective domains.

Assessment and Requirements

Assessment of Academic Achievement

Assessment of academic achievement will be based on assignments, quizzes, unit tests, and final examination.

General Course Requirements and Recommendations

Emphasis will be placed upon individual learning experience.
Active participation in class assignments will be encouraged and required.
A cooperative rather than competitive atmosphere will be encouraged.
In case of absence, it is the student’s responsibility to obtain missed information from a classmate.
A test will be administered at the completion of each unit.
Each student is responsible for completion of the worksheets and review questions as assigned.

Texts

Required textbooks determined by the program faculty.

Approval Dates

Effective Term
Fall 2019
ILT Approval Date
AALC Approval Date
Curriculum Committee Approval Date
Review Semester
Fall 2019