Course | Madison College Outline of Instruction

31509307Med Office Insurance & Finance

Course Information

Description

Introduces medical assistant students to health insurance and finance in the medical office. Students perform bookkeeping procedures, apply managed care guidelines, and complete insurance claim forms. Students use medical coding and managed care terminology to perform insurance-related duties.

Total Credits

Course Competencies

Perform bookkeeping procedures

Assessment Strategies

in an oral or written response to questions and/or scenarios

in a simulation or case study

Criteria

you define the following bookkeeping terms: charges, payments, accounts receivable, accounts payable, adjustments, and end of day reconciliation

you perform accounts receivable procedures to patient accounts including posting: charges, payments, and adjustments

you describe types of adjustments made to patient accounts including: non-sufficient funds (NSF) check, collection agency transaction, credit balance, and third party

you differentiate between accounts payable and accounts receivable
Explore the medical assistant's role in billing and payment receipt

Assessment Strategies

in an oral or written response to questions and/or scenarios

Criteria

you describe common billing procedures

you describe the medical assistant's role in the billing process

you describe collection techniques

you describe the impact of both the Fair Debt Collect Act and the Federal Truth in Lending Act of 1968 as they apply to collections

you identify types of information contained in the patient's billing record

you obtain accurate patient billing information

you inform a patient of financial obligations for services rendered

you demonstrate professionalism and sensitivity when discussing patient's billing record

you describe the medical assistant's role in regards to accepting all forms of payment

you identify precautions for accepting the following types of payments: cash, credit card, check, and debit card

you identify patient financial obligations for services

you define allowed amount, deductible, co-insurance, and co-pay

you identify the purpose and components of the Explanation of Benefits (EOB) and Remittance Advice (RA) Statements

you assist a patient in understanding an Explanation of Benefits (EOB)
Perform diagnostic coding

Assessment Strategies

in an oral or written response to questions and/or scenarios

Criteria

you describe how to use the most current diagnostic coding classification system

you discuss the effects of upcoding and downcoding

you define medical necessity as it applies to diagnostic coding

you perform diagnostic coding

you utilize medical necessity guidelines

you utilize tactful communication skills with medical providers to ensure accurate code selection
Perform procedural coding

Assessment Strategies

in an oral or written response to questions and/or scenarios

Criteria

you describe how to use the most current procedural coding system

you describe how to use the most current HCPCS level II coding system

you discuss the effects of upcoding and downcoding

you define medical necessity as it applies to procedural coding

you perform procedural coding

you utilize medical necessity guidelines

you utilize tactful communication skills with medical providers to ensure accurate code selection

you define bundling and unbundling of codes
Apply third party reimbursement policies and procedures

Assessment Strategies

in an oral or written response to questions and/or scenarios

Criteria

you identify: types of third party plans, information required to file a third party claim, and the steps for filing a third party claim

you outline manage care requirements for patient referral

you describe processes for verification of eligibility for services, precertification, and preauthorization

you identify fraud and abuse as they relate to third party reimbursement

you interpret information on an insurance card

you verify eligibility for services

you display tactful behavior when communicating with medical providers regarding third party requirements

you show sensitivity when communicating with patients regarding third party requirements

you obtain precertification or preauthorization including documentation

you define advanced beneficiary notice (ABN)
Complete an insurance claim form

Assessment Strategies

in an oral or written response to questions and/or scenarios

Criteria

you outline the steps for follow-up on claims

you accurately complete the insurance claim form according to established guidelines

you reconcile payment rejections with a sample explanation of benefits form

you cite the process for an appeal of an unpaid claim

you identify types of insurance plans

you describe how guidelines are used in processing an insurance claim

you compare processes for filing insurance claims both manually and electronically

you identify the process for tracking unpaid claims

you identify the process for claim denials and appeals