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
- Orientation to the Total Health Management Accounting Systems (E-THOMAS) Total Health Office Computer Application System
- Office Ergonomics
- Paper Claims: Commercial, Blue Cross/Blue Shield(BCBS), and Medicaid
- Electronic Claims: Commercial, Blue Cross/Blue Shield (BCBS), and Medicaid
- Ethical/Legal Standards in Claims Preparation
- Establish Medical Data base
- Patient Intake Procedures
- Daily Journal Report
- Patient Statements
- Accounts Receivable
COGNITIVE DOMAIN:
- Initiate patient registration, and verify current insurance coverage.
- Explain the Health Maintenance Organization (HMO) referral and authorization request process.
PSYCHOMOTOR DOMAIN:
- Use the Current Procedural Terminology (CPT) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) to demonstrate medical necessity for billing.
- Perform insurance verification, certification, and authorization for health insurance carriers such as Blue Cross/Blue Shield (BCBS), Medicaid, and Health Maintenance Organization (HMO) plans.
- Construct a complete electronic claim for traditional insurance carriers such as BC/BS, Medicare, Medicaid, Commercial Carriers, Tricare, and Workmen's Compensation.
AFFECTIVE DOMAIN:
- Demonstrate scope of practice for a medical insurance specialist.
- Demonstrate honesty and integrity in the performance of all medical business practice.
- Exercise ethical/legal standards in claims preparation and submission.
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 will be based on assignments, quizzes, unit tests, and final examination.
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.
Required textbooks determined by the program faculty.