Further develops the methods and skills necessary for optimal reimbursement for services rendered in a healthcare setting. Explores billing and reimbursement cycle, HIPAA, diagnostic coding and procedural coding, coding compliance, and claims processing as well as physician and hospital coding reimbursement. Also provides an overview of the key financial circumstances impacting the healthcare delivery system.
Goals, Topics, and Objectives
- The Healthcare Environment
- Revenue Reimbursement Cycle of Physician and Hospital
- Claims Processing and Compliance
- Center for Medicare and Medicaid Services (CMS):
- Overview of Medicare
- Medicaid
- Uniform Bill 92 (UB92)
- CMS Form 500
- HIPAA Transactions Overview (Testing and Certification)
- Submitting Claims/Claims Adjustments/Troubleshooting Claims
- Explain the billing and reimbursement cycle.
- Discuss Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Legal Medical Record compliance in relation to medical billing.
- Differentiate between diagnostic coding and procedural coding in relation to reimbursement.
- Apply standards of coding compliance.
- Summarize provider charges and payment methods.
- Describe claims processing, follow-up and collections.
- Compare and contrast physician and hospital coding reimbursement.
- Demonstrate honesty and integrity in the performance of all medical billing practices.
- Apply ethical and legal standards to the performance of insurance billing for reimbursement.
Assessment and Requirements
Assessment of academic achievement will include participation, assignments, quizzes, tests and final exam.
Instructors (or their designees) reserve the right to require students to provide proper picture identification for test taking, submission of graded papers, projects or other appropriate applications.
Active participation in class assignments will be encouraged and required. Cooperative rather than competitive atmosphere will be encouraged.
Students graduating from the Medical Insurance Specialist Program should be able to demonstrate cognitive knowledge based on academic subject matter required for competence. They will incorporate cognitive knowledge in the performance of psychomotor and affective learning domains.
Required textbooks to be determined by program faculty.