10160177Specialized Insurance Claims
Course Information
Description
Identifies in-depth insurance knowledge following the healthcare revenue cycle. Explore healthcare law. Investigate private payers, Medicare, Medicaid, TRICARE, CHAMPVA, worker's compensation, and disability insurance. Knowledge of deductibles, coinsurance, copayments, exclusions, medical necessity, referrals, prior authorization, coordination of benefits, COBRA, Charity Care, collections, pre-existing periods, allowed amounts, malpractice, outpatient benefits, and lifetime maximums. Intermediate diagnostic, procedural, and HCPCS coding. Claims reimbursement methods, contractual allowances, fee schedules, and other rules to facilitate timely payment of claims.
Total Credits
2
Course Competencies
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Explore the medical billing specialist field.Assessment StrategiesWritten product or oral analysisQuizCriteriayou participate in discussions analyzing the medical billing specialist field.reflection includes a description of duties in the professionreflection summarizes common billing processes in healthcareyou achieve a minimum of 76% on the quiz.
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Be sensitive to the importance of keeping medical records private and secure.Assessment StrategiesResearch projectQuizCriteriaproject includes evidence of external research related to HIPAA, HITECH, and other privacy laws.project includes four elements of privacy and security lawsproject lists the responsibilities of the medical billing specialist related to patient privacy and security lawsyou achieve 76% on the quiz.
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Illustrate knowledge of diagnostic coding.Assessment StrategiesSkill DemonstrationQuizCriteriayou identify the primary diagnosis and coexisting conditions.you utilize ICD-10-CM format to assign accurate codes.you assign accurate diagnoses and external cause codes.you achieve a minimum of 76% on the quiz.
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Illustrate knowledge of procedural coding.Assessment StrategiesSkill DemonstrationQuizCriteriayou accurately identify procedures to be coded.you accurately identify Evaluation and Management (EM) codes.you utilize correct CPT format to assign accurate procedure codes.you assign accurate HCPCS procedure codes.you achieve a minimum of 76% on the quiz.
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Investigate healthcare payment methods.Assessment StrategiesProjectCritiqueQuizCriteriapresentation meets minimum requirements of grading rubricyou create a presentation for the class on an assigned topic.you view presentations on payment arrangements, processes, and rulesyou reflect on presentations and provide critiques.you achieve a minimum of 76% on the quiz.
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Conduct healthcare claim preparation.Assessment StrategiesWritten product - formQuizCriteriayou accurately abstract insurance informationCMS-1500 claim form is completed accurately so payment is processed and not deniedyou achieve a minimum of 76% on the quiz.
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Examine private payers/BlueCross BlueShield.Assessment StrategiesSkill DemonstrationQuizCriteriaCMS-1500 claim form for private payers is 100% accurateyou accurately calculate patient and payer balances for participating and nonparticipating private payers.you achieve a minimum of 76% on the quiz.
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Explore Medicare.Assessment StrategiesResearch projectQuizCriteriayou achieve a minimum of 76% on a Medicare website scavenger hunt.you achieve a minimum of 76% on the quiz.
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Explore Medicaid.Assessment StrategiesResearch Project - Blog responseQuizCriteriaresearch project compares Wisconsin's Medicaid program to another state.blog response utilizes accurate grammar and punctuation.you achieve a minimum of 76% on the quiz.
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Explore TRICARE and CHAMPVA.Assessment StrategiesResearch projectSkill DemonstrationQuizCriteriayou explore the TRICARE and CHAMPVA websites.you participate in course wiki.you accurately complete CMS-1500 claims for for TRICARE/CHAMPVA patients.you achieve a minimum of 76% on the quiz.
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Examine the Worker's Compensation system.Assessment StrategiesSkill DemonstrationQuizCriteriayou accurately complete CMS-1500 claim form for a Worker's Compensation claim.you achieve a minimum of 76% on the quiz.
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Investigate Disability compensation.Assessment StrategiesQuizCriteriayou achieve a minimum of 76% on the quiz.
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Identify inpatient and outpatient hospital billing processes.Assessment StrategiesWritten ProductQuizCriteriayou accurately compare and contrast inpatient and outpatient hospital services.you accurately discuss hospital coding processes.you achieve a minimum of 76% on the quiz.
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Investigate payments, appeals, and secondary claimsAssessment StrategiesPresentationCritiqueQuizWritten product - collection letterCriteriayou create a presentation for the class on an assigned topic.you view presentations on payments, appeals, and secondary claims.you reflect on presentations and provide critiques.you achieve a minimum of 76% on the quiz.you accurately calculate patient and payer balances.collection letter utilizes correct business and grammar guidelines and is 100% accurate