MAP 118 - Medical Office Management II

1. Obtain Medicare reimbursement
   1. Define the four parts of Medicare Part A,B, C & D
   2. Identify coverage of Medicare A, B, C & D
   3. State deductible for Medicare Part B
   4. Explain co-insurance requirements for Medicare Part B
   5. Identify eligibility requirements for Medicare Part A & B
   6. Interpret the information on a Medicare Remittance Summary
   7. Adhere to the Requirements of Participating Physicians
   8. Follow Medicare guidelines for completing a CMS 1500 form manually and electronically
   9. State where to mail forms to the fiscal intermediary for Medicare Part B in Iowa
   10. Recognize circumstances that make Medicare the secondary payer
   11. Explain use of an advance beneficiary notice
   12. Explain concept of RBRVS & DRGS
2. Obtain Medicaid (Title XIX) reimbursement
   1. List eligibility requirements for Medicaid recipients
   2. Transfer information foe eligibility care to CMS 1500 form manually and electronically
   3. Follow Medicaid guidelines for completing the CMS 1500 form
   4. Differentiate the Medipass program from the Medicaid program
   5. Identify fiscal intermediary for Medicaid
   6. Interpret the information on a Medicaid Explanation of Benefits Form
3. Obtain other Third Party reimbursement
   1. Differentiate between managed care plans and indemnity plans
   2. Transfer information from identification cards to insurance form
   3. Follow guidelines for obtaining reimbursement
   4. Obtain precertification/referrals, and verify eligibility for managed care
   5. Define terms associated with managed care/insurance plans
   6. Explain billing options and payment options
   7. Explain Fair Debt Collection Act
   8. Explain requirements of Truth In Lending Act
   9. Utilize sensitivity when collecting accounts
   10. Explain Tricare/Chapva guidelines
   11. Explain Worker’s Compensation reimbursement
   12. Complete an insurance claim form
   13. Identify types of third party plans, information required to file a third party claim, the steps for filing a thirs party claim
4. Accurately code diagnoses with appropriate ICD-10 codes
   1. Apply knowledge of medical terminology
   2. Apply knowledge of anatomy and physiology
   3. Demonstrate knowledge on how to use the current ICD-10-CM diagnostic coding system
5. Code procedures and medical services with the current edition Current Procedural Terminology (CPT) and HCPCS codes
   1. Apply knowledge of procedural terminology
   2. Apply knowledge of procedural terminology
   3. Utilize the terminolgy associated with CPT’s evaluation and management code guidelines
   4. Identify correct codes for services and procedures provided
   5. Use appropriate HCPCS codes
   6. Explain the effects of upcoding and downcoding
6. Establish/maintain insurance files
   1. State purpose of professional liability insurance
   2. State types of catastrophic insurance coverage available
   3. Explain purpose of accounts receivable insurance coverage
   4. Explain utilization review principles
7. Electronic Medical Records
   1. Differentiate between electronic medical records (EMR) and a practice management system
   2. Utilize an EMR
   3. Input patient data utilizing a practice management system
   4. Protect the integrity of the medical record
8. Handle incoming telephone calls to the medical office
   1. Demonstrate professional telephone techniques
   2. Document telephone messages accurately
   3. Interact professionally with third party representatives
9. Prepare and manage patient accounts
   1. Post financial data to patient’s accounts manually and electronically
   2. Prepare an age analysis of accounts receivable
   3. Collect delinquent accounts
   4. Follow up on accounts assigned to a collection agency
   5. Post entries to ledger card and computerized patient account system, and describe function of daysheet
   6. Run patient statements and monthly accounting reports
   7. Differentiate between accounting and bookkeeping
   8. Describe types of adjustments made to patient accounts including non-sufficient funds (NSF) check, collection agency transaction, credit balance, third party
   9. Identify types of information contained in patient’s billing record
   10. Explain patient financial obligations for services rendered
   11. Perform accounts receivable procedures to patient accounts including posting charges, payments, adjustments
   12. Obtain accurate patient billing information
   13. Inform patient of financial obligations for services rendered
   14. Interpret information on an insurance card
   15. Demonstrate professionalism when discussing patient’s billing record
   16. Display sensitivity when requesting payment for services rendered
10. Appointment scheduling
    1. State three guidelines for scheduling appointments
    2. Interview patient to obtain appropriate data
    3. Differentiate routine appointments from emergency appointments
    4. Apply time management techniques of wave scheduling, modified wave and grouping procedures
    5. Document missed or failed appointments
    6. Schedule outpatient diagnostic tests
    7. Apply triage criteria
    8. Schedule appointments electronically and manually
    9. Identify different types of appointment scheduling methods
    10. Identify advantages and disadvantages of manual and electronic appointment systems
    11. Identify critical information required for scheduling patient procedures
    12. Manage appointment schedule using established priorities
    13. Schedule a patient procedure
    14. Display sensitivity when managing appointments
11. Prepare a resume and cover letter
12. Use a fax machine
13. Facility and equipment management
    1. Describe methods of inventory management including storage of supplies
    2. Complete purchase order and compare to invoice
    3. Define warranty, service agreement, contract, instruction manual and maintenance agreement
    4. Identify measures to ensure facility safety and to monitor equipment repair, replacement, and maintenance including trouble shooting techniques
    5. State goals of a policy manual, safety manual and procedure manual
    6. Define chart audit and list examples of how this is utilized in the medical office
    7. Identify procedures for ADA compliance in the medical office
    8. Describe quality control/quality assurance resources for the medical office
    9. Explain general office policies
    10. List steps in completing an inventory
    11. Perform an inventory with documentation
14. Utilize critical thinking skills
    1. Formulate questions to determine if important information is lacking
    2. Reject information that is not accurate, relevant, precise or clear
    3. Double check all facts
    4. Examine the situation and evaluate the problem without bias or judgement
    5. Assess the situation for reason and logic
    6. Determine and state the goal to be accomplished
    7. Follow steps for implementation/problem solving
    8. Evaluate outcomes
    9. Show sensitivity when communicating with patients regarding third party requirements