An advanced physician billing course focusing upon payment posting, fee schedules, HMO capitation reports, rejections, billable/non-billable services, claim status, and collections. Also discusses ethics in relation to billing and billing issues.
Goals, Topics, and Objectives
- Data Management Terms, Review Center for Medicare and Medicaid Services (CMS) 1500 Forms, Type and Place Codes.
- Pre-Test Paper and Electronic Claim Forms for Medicare, Medicaid, Commercial, and Traditional Insurance Carriers such as Blue Cross/Blue Shield
- Post Payments for Traditiional Health Insurance Carriers such as Blue Cross and Blue Shield and Coordination of Benefits (COB) Claims
- Post Payments for Traditional Health Insurance Carriers such as Blue Cross and Blue Shield (Electronic)
- Working Rejections and Traditional Health Insurance Carrier Corrections
- Post Payments for Medicare Paper and COB Claims
- Post Payments for Medicare Electronic
- Working Rejections and Medicare Corrections
- Determine the approved amount with appropriate adjustments for payment and co-payment factors.
- Demonstrate both manual and computer post payments.
- Analyze work rejections; and relate to write offs, re-billing, and status.
- Formulate bills for second- and third-insurance carriers.
- Generalize the basic collection laws.
- Prepare capitation reports/referrals.
- Analyze the impact of Health Insurance Portability and Accountability Act of 1996 (HIPAA) upon the billing process.
Assessment and Requirements
Assessment of academic achievement will include participation, assignments, quizzes, tests, and final exam.
Students graduating from the Medical Insurance Specialist program will demonstrate cognitive knowledge based on academic subject matter. They will incorporate cognitive knowledge in the performance of psychomotor and affective learning domains.
Required textbooks to be determined by program faculty.