Focuses on the billing process unique to health care facilities. Examines the hospital billing environment, coding, payment methods, and Universal Billing 1992 (UB-92) claims along with billing simulations.
Goals, Topics, and Objectives
- The Hospital Environment
- Types of Facilities
- Hospital Billing Process
- Patient Registration
- Accounts Receivable Management
- Hospital Medical Insurance
- UB-92 Forms
- Center for Medicare and Medicaid Services (CMS)
- Skilled Nursing Facility Consolidated Billing
- International Classification of Diseases, Tenth Revision (ICD-10) Diagnostic and Surgical Codes
- Outline the key elements of hospital billing systems.
- Compare and contrast the types of billing systems.
- Discuss the hospital insurance billing process.
- Explain hospital insurance coding and payment methods.
- Describe the use of the Uniform Bill 1992 (UB-92) claim form used by hospitals and ambulatory centers to bill medicare and third party payers.
- Explain condition, occurrence, and value coding.
- Relate revenue coding to charges.
- Explain diagnosis and procedure coding.
- Prepare a successful UB-92 claim form.
- Explain revenue coding to charges.
Assessment and Requirements
Assessment of academic achievement will include assignments, quizzes, and tests.
Active participation in class assignments will be encouraged and required. Cooperative rather than a competitive atmosphere will be encouraged.
- Students are expected to attend all sessions of the class.
- In case of absence, it is the student's responsibility to contact a classmate in advance to obtain missed materials.
- Failure to officially withdraw from the class may result in a grade of E.
Students graduating from the Medical Insurance Specialist program should be able to demonstrate cognitive knowledge based on academic subject matter required for competence in the field. They will be able to incorporate cognitive knowledge in the performance of psychomotor and affective learning domains.
Required textbooks to be determined by program faculty.