Course

Course Summary
Credit Type:
Course
ACE ID:
ECRA-0336
Organization's ID:
HIT104
Organization:
Eastwick College
Location:
Classroom-based
Length:
12 weeks (36 hours)
Dates Offered:
Credit Recommendation & Competencies
Level Credits (SH) Subject
Lower-Division Baccalaureate 2 Health Information Management, Medical Billing and Coding, or Health Information Technology
Description

Objective:

The course objective is to develop and understanding of health insurance in order to process claims for reimbursement. Managed care, the patient encounter, legal issues, and requirements of major health insurance providers, including Medicare and Medicaid, are taught. Students learn to abstract information from patient records and complete a variety of medical insurance forms. Emphasis is placed on using the CMS 1500 issued by the Centers for Medicare and Medicaid Services. Standard formats and coding systems are applied.

Learning Outcomes:

  • Describe the relationship between covered entities and business associates
  • List the five types of information that new patients provide before their encounters
  • Distinguish between the electronic claim transaction and the paper claim form
  • Compare billing provider, pay-to provider, rendering provider, and referring provider
  • Compare employer-sponsored and self-funded health plans
  • Describe the major features of group health plans regarding eligibility, portability, and required coverage
  • Discuss provider payment under preferred provider organizations, health maintenance organizations, point-of-service plans, and indemnity plans
  • Describe the coverage provided by Medicare Part A, Part B, Part C, and Part D
  • Describe the purpose of the Medicaid program
  • Explain the four federal workers' compensation plans
  • Describe the steps payers follow to adjudicate claims
  • Describe covered services and non-covered services under medical insurance policies
  • Compare indemnity and managed care approaches to health plan organization
  • Explain the method used to classify patients as new and or established
  • Discuss the eligibility requirements for TRICARE
  • Identify the types of codes and other information contained on an RA/EOB

General Topics:

  • Introduction to medical billing
  • HIPAA and medical records
  • Patient encounters and billing information
  • Health care preparation and transmission
  • Blue Cross/Blue Shield
  • Medicare
  • Medicaid
  • Tricare (CHAMPUS)
  • Workers compensation and disability
  • Payments and appeals
  • Patient billing and collections
Instruction & Assessment

Instructional Strategies:

  • Classroom Exercise
  • Lectures
  • Practical Exercises

Methods of Assessment:

  • Examinations

Minimum Passing Score:

70%
Supplemental Materials