Download Course Outline - Pima Community College

Course Content Form
PIMA COMMUNITY COLLEGE
Effective Term:
MDA
126
Credit Hours: 2.00
Full Academic Year 2017/18
Medical Billing and Insurance for Medical Assistants
Lecture Periods: 2.00
Lab Periods:
Description:
Introduction to the role of the Medical Assistant to the processes and procedures related to health insurance
plans in an ambulatory care environment. Includes the principles of bookkeeping, billing, accounting, and
banking. Also includes the requirements for completing and submitting claims forms.
Recommendation: Minimum of 25 words per minute word processing skills.
Course Learning Outcomes:
Upon successful completion of the course, the student will be able to:
1.
Identify and understand the different types of medical insurance plans and guidelines associated with each
plan.
2.
Accurately complete and submit claims forms to assure reimbursement from third party payers.
3.
Follow established and accepted guidelines for bookkeeping, accounting, and banking procedures.
Outline:
I.
II.
III.
Third Party Reimbursement
A.
Cognitive
1. Types of third party insurance plans
a. Government funded
1. Medicare
2. Medicaid
b. Commercial
1. HMO Managed Care
2. Indemnity
2. Insurance card information
B.
Psychomotor
1. Process and documentation
a. Eligibility
b. Precertification
c. Preauthorization
d. Patient referrals
2. Third party claim forms
a. Completing a claim form
b. Filing a claim
Concepts of Effective Communications
A.
Cognitive
1. Patient financial obligations for services rendered
2. Relevant information (concise and accurate)
B.
Psychomotor
1. Accurate patient billing information
2. Sensitivity when communicating with patients regarding third party requirements
3. Professional interactions with third party representatives
C.
Affective
1. Tactful behavior when communicating with medical providers regarding third party requirements
2. Sensitivity when requesting payment for services rendered
3. Discussing patient’s billing record professionally
Basic Practice Finances
A.
IV.
Cognitive
1. Patient’s billing record information
2. Bookkeeping terms:
a. Charges
b. Payments
c. Accounts receivable
d. Accounts payable
e. Adjustments
3. Banking related to the ambulatory care setting
4. Bank deposits
B.
Psychomotor
1. Posting accounts receivable to patient accounts
a. Charges
b. Payments
c. Adjustments
2. Adjustments made to patient accounts
a. Non-sufficient funds (NSF) check
b. Collection agency transaction
c. Credit balance
d. Third party
3. Utilize an EMR
Legal Implications
A.
HIPAA rules
B.
Privacy
C.
Release of information
D.
Protect the integrity of the medical record