Mar 29, 2024  
Course/Program Inventory 
    
Course/Program Inventory

AOT 8005 - Medical Insurance and Billing



Clock Hours: 100

Delivery Mode
on-ground

Industry Certifications These competencies are aligned to prepare students for the Billing Coding Specialist Certification (BCSC) test through American Medical Certification Association and/or the Certified Billing and coding Specialist (CBCS) test through National Health Career Association

Course Description:
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.

Student Learning Outcomes:
Students will be able to demonstrate knowledge of:

  1. Understand the role of an insurance billing specialist. 
  2. Understand the claims process. 
  3. 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 
  • Medicaid 
  • The Blue Plans/Private Insurance/Managed 
  • Workers’ Compensation 
  • TRICARE/CHAMPVA 
  • Disability Income 
  • Hospital Billing 
  1. Transfer simple, moderate, and complex case histories
  • Practice with case studies similar to situations to be encountered.
  1. Ability to determine primary insurance. 
  2. Organization for effective collections. 
  3. 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
  1. Claim follow-up and payment processing. 
  • Delinquent payments 
  • Rebilling 
  • Appeals 
  • Understands claims review 
  • Billing secondary insurance 
  • The remittance advice 
  1. Gain an understanding of claim coding. 
  • Diagnostic coding: ICD-10-CM 
  • Procedural Coding: CPT and HCPCS 
  • Visit charges and complaint billing 
  1. Calculation of patient balances.