MAP 141 - Medical Insurance

Credits: 3
Lecture Hours: 3
Lab Hours: 0
Practicum Hours: 0
Work Experience: 0
Course Type: Voc/Tech

1. Evaluate the revenue cycle management process
   1. Explain the ten steps in the revenue cycle
   2. Examine billing processes and procedures
   3. Discuss the role of utilization review as it applies to the revenue cycle
   4. Use electronic medical records to streamline the revenue cycle
2. Examine diagnostic codes according to current guidelines
   1. Describe the purpose and organization of ICD
   2. Summarize the structure, content, and key conventions of the Alphabetic Index and Tabular List
   3. Assign correct diagnostic codes
   4. Differentiate between CM and PCS
3. Examine procedure codes according to current guidelines
   1. Describe the purpose and organization of CPT
   2. Apply the six steps for selecting procedure codes to patient scenarios
   3. Describe modifiers
   4. Contrast Category II and Category II codes
   5. Discuss the purpose of the HCPCS code set
4. Compare and contrast the different types of medical insurance
   1. Define the three major types of medical insurance payers
   2. Describe the major features of health plans including eligibility, portability, and required coverage
   3. Identify the four major government health care programs: Medicare, Medicaid, TRICARE, and CHAMPVA
   4. Distinguish between major insurers: Blue Cross and Blue Shield, Medicare, Medicaid, Worker’s Compensation, and disability insurance
5. Interpret HIPAA-compliant health care claims
   1. Discuss the content of the CMS-1500 claim
   2. Demonstrate knowledge of filing rules and regulations
   3. Demonstrate medical necessity and code linkage
   4. Process health insurance claim forms for private payers
   5. Process health insurance claim forms for government health care plans
6. Examine HIPAA/HITECH, legal, and ethical considerations with emphasis on confidentiality, protected health information and fraud related to insurance
   1. Compare the intent of HIPAA, HITECH, and ACA laws
   2. Discuss the benefits of a compliance plan
   3. Explain the importance of accurate documentation within medical records
7. Evaluate patient encounters, billing information, processing of payers’ remittance advices, and patient billing/collections
   1. Discuss information required for a new patient
   2. Explain the process for updating established patient information
   3. Describe the fee schedules created for services provided
   4. Summarize coordination of benefits
   5. Calculate RBRVS payments under the Medicare Fee Schedule
   6. Interpret a remittance advice
   7. Identify the purpose and steps of the appeal process
   8. Describe the content found within a patient statement
   9. Compare cycle billing and guarantor billing
8. Demonstrate professionalism, ethics, and etiquette for career growth
   1. Discuss the importance of professional certification
   2. Review professional organizations

 
Competencies Revised Date: 2019