May 16, 2022
AOT 3100 - Intro to Medical Insurance
Clock Hours: 100
Prerequisites: Completion of General Office and Administrative Support
Industry Certifications To prepare students for the Billing Coding Specialist Certification (BCSC) test through American Medical Certification Association: http://www.americanmedicalcertification.com/Library/certification_exams.aspx and/or the Certified Billing and coding Specialist (CBCS) test through National Healtcareer Association: http://www.nhanow.com.
This course is designed to introduce the student to the basics of medical insurance, including insurance terminology, private payers and government programs, and general insurance procedures and policies. Students will learn how to complete the universal medical insurance form. Additionally, this course will introduce the basic concepts of medical billing and coding by gaining basic knowledge of the ICD-10 and CPT, and learn the purposes of diagnostic coding and procedural coding.
Student Learning Outcomes:
- Understand the role of an insurance billing specialist.
- Understand the claims process.
- Apply basic insurance information and understand the benefits, eligibility, pre-authorization procedures, filing deadlines, and third party liability (for Medicaid) common to all insurance carriers:
- Medicare - Part A & B
- The Blue Plans/Private Insurance/Managed
- Workers’ Compensation
- Disability Income
- Hospital Billing
- Transfer simple, moderate, and complex case histories
- Practice with case studies similar to situations to be encountered.
- Ability to determine primary insurance.
- Organization for effective collections.
- Apply legal considerations for sharing and protection of the patient’s health information/medical record.
- Avoid potentially fraudulent situations
- Practice medical records confidentiality and retention policies
- Explain the importance of a “Release of Medical Information” statement
- Claim follow-up and payment processing:
- Delinquent payments
- Understands claims review
- Billing secondary insurance
- The remittance advice
- Gain an understanding of claim coding:
- Knowledge of diagnostic coding: ICD-10-CM
- Procedural Coding: CPT and HCPCS
- Visit charges and complaint billing
- Calculation of patient balances.
- Overview of anatomical systems.
- Introduces format of the ICD-9-CM code set.
- Describes how to select codes for conditions.
- Walks through code selection process.
- Describes the transition to ICD-10-CM and CPT manual.