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Dec 21, 2024
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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:
- 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
- Medicaid
- The Blue Plans/Private Insurance/Managed
- Workers’ Compensation
- TRICARE/CHAMPVA
- 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
- Rebilling
- Appeals
- Understands claims review
- Billing secondary insurance
- The remittance advice
- Gain an understanding of claim coding.
- Diagnostic coding: ICD-10-CM
- Procedural Coding: CPT and HCPCS
- Visit charges and complaint billing
- Calculation of patient balances.
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