This course is designed for students who are new to health care but want to work in a hospital setting.
Certification: One of Five Courses for the Certified Healthcare Admissions Associate Certification
Certifying Body: National Association of Healthcare Access Management
Contact Hours: 25
This course is one of five courses comprising the Patient Access Specialist certification program. Students will be introduced to medical billing and the claims submission process. Students will also learn about insurance claim preparation and transmission as well as the various types of insurance available, depending on the patient’s individual profile. In addition, the course will review the various types of health care billing and provide students with an in-depth understanding of Medicare and Medicaid billing.
• Identify the correct information needed to prepare and transmit accurate, complete health care claims
• Explain the rules for eligibility and claims processing for Medicare plans
• Explain the rules for eligibility and claims processing for Medicaid plans
• Describe the background and billing and reimbursement process for Tricare, workers’ compensation, disability, and Blue Cross
• The Health Insurance II course includes 25 non-credit contact hours.
• This course is instructor-facilitated.
• This course does not lead to certification as a stand-alone course.
• This course can be run fully online or in hybrid format.
• The Health Insurance II course is designed as part of the Pearson Workforce Education Core Health Care Curriculum, and can be included with other occupation-specific courses in conjunction with multiple certification programs.
• This course is one part of a five-part course series for the Patient Access Specialist certification program, which fully prepares students to sit for the Certified Healthcare Admissions Association certification exam from NAHAM.
• This course is not a CEU.
• This course is appropriate for entry-level students or incumbent workers.
• This course is a complete, ready-to-deliver, customizable online course, including syllabi, lesson sequences and course objective descriptions.
• The Health Insurance II course content is written to meet specific curriculum and course outcomes and every content item is mapped to a specific course objective.
• This course can be used in any Learning Management System (Blackboard, WebCT, Angel, Moodle, D2L, etc.).
• Interactive classroom lectures are self-contained learning objects.
• The Health Insurance II course includes instructor resources, optional assignments and assessments, and optional book readings, all aligned with course objectives.
• All content has been developed and created by industry leading subject matter experts and instructional designers.
COMPREHENSIVE HEALTH INSURANCE: BILLING, CODING & REIMBURSEMENT, 2/e provides students with the knowledge and skills needed to work in a variety of medical billing and coding positions in the medical field. Comprehensive in approach, it covers the foundations of insurance, billing, coding and reimbursement. Students learn not only the submission of claims to the insurance carrier, but also reviewing medical records, verifying patient benefits, submitting a secondary claim, posting payments and appealing the insurance carrier's decision. This edition includes new chapters devoted to HIPAA and ICD-10-CM Medical Coding, as well as outstanding coverage of electronic records. Numerous case studies and patient files are included throughout and demonstrate refunds and appeals, auditing and compliance, Medicare calculations and professionalism.
SECTION I: A CAREER IN HEALTH CARE
1. Introduction to Professional Billing and Coding Careers
SECTION II: THE RELATIONSHIP BETWEEN THE PATIENT, PROVIDER, AND CARRIER
2. Understanding Managed Care: Insurance Plans
3. Understanding Managed Care: Medical Contracts and Ethics
4. HIPAA: Health Insurance Portability and Accountability Act of 1996
SECTION III: MEDICAL CODING
5. ICD-9-CM Medical Coding
6. ICD-10-CM Medical Coding
7. Introduction to CPT and Place of Service Coding
8. Coding Procedures and Services
9. HCPCS and Coding Compliance
SECTION IV: MEDICAL CLAIMS
11. Physician Medical Billing
12. Hospital Medical Billing
SECTION V: GOVERNMENT MEDICAL BILLING
13. Medicare Medical Billing
14. Medicaid Medical Billing
15. TRICARE Medical Billing
SECTION VI: ACCOUNTS RECEIVABLE
16. Explanation of Benefits and Payment Adjudication
17. Refunds and Appeals
SECTION VII: INJURED EMPLOYEE MEDICAL CLAIM
18. Workers' Compensation
SECTION VIII: USE OF MEDICAL PRACTICE MANAGEMENT SOFTWARE
19. Electronic Medical Claims Processing
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