BUS 232 - Medical Insurance Procedures

Credits: 5
LEC hours per week: 5
Understanding of the medical insurance programs in today’s healthcare system. Students will apply knowledge learned to abstract information from medical records and complete universal claim forms that meet billing requirements of private, state and federal insurance programs. Formerly: OT 232.
Course Outcomes:

Given simulated medical records, documents and forms, student will be able to abstract information to accurately complete CMS 1500 claim forms according to various insurance program format requirements with correct procedure and diagnostic codes and accurate dollar amounts.
Demonstrate ability to recognize when forms are required and accurately complete forms such as: referrals, waivers, authorizations, disclosures, NPP, etc.
Demonstrate understanding of legal and ethical considerations with emphasis on confidentiality and fraud related to insurance and HIPPA regulations.
Given a patient’s schedule of benefits from various types of insurance contracts. accurately determine amounts owed by each party.

Course Topics:

Fundamentals of Health Insurance Coverage
Source Documents and the Insurance Claim Cycle
Coding Diagnoses
Documentation and the Medical Record
Completion and Submission of the CMS 1500 Claim form
Fees: Private Insurance and Managed Care
Medicare, Medicaid, TriCare, and Workersâ€™ Compensation Programs
Credit and Collection Practices
Tracking Reimbursement