MEA 141. Medical Billing. Course Package

Transcription

1 MEA 141 Medical Billing Course Package Approved: December 3, 2010 EFFECTIVE DATE: Fall 2011

2 COURSE PACKAGE FORM Team Leader and Members Carol Elledge, Lori Howell, Jeff Turner, Lori Hogue Date of proposal to Curriculum Sub-committee: December 2010 Purpose: New _X_Change Retire If this is a change, what is being changed? (Check ALL that apply) Update Prefix Title _X Learning Units _X_ Competencies Format Change Course Description Course Number X Textbook Credits X Prerequisite SOFTWARE CHANGE Effective Semester/Year Fall 2011 Spring 20 Summer 20 COURSE INFORMATION Prefix & Number: MEA 141 Title: Medical Billing Catalog Course Description: An overview of medical insurance programs and the skills needed in handling insurance forms and insurance reports as applied to the medical office. Includes simulated computer data entry for patient records, procedure and diagnostic codes, insurance processing and electronic transmission of claims. Credit Hours: Lecture Hours: 3 Lab Hours: 0 3 Modality: Online: On-Ground: X_ Prerequisite(s) HES 113 Co-requisite(s) Does this course need a separately scheduled lab component? Yes Does this course require additional fees? If so, please explain. Yes _X No _X No Is there a similar course in the course bank? Yes (Please identify.) _X_No Articulation: Is this course or an equivalent offered at other two and four-year universities in Arizona? _X_No Yes (Identify the college, subject, prefix, number and title:

3 Writing Across the Curriculum Rationale: Mohave Community College firmly supports the idea that writing can be used to improve education; students who write in their respective content areas will learn more and retain what they learn better than those who don t. Courses in the core curriculum have been identified as Writing Across the Curriculum courses. Minimum standards for the Writing Across the Curriculum component are: 1. The writing assignments should total words. For example, a single report which is 1500 words in length OR a series of essay questions and short papers (example: four 375-word assignments) which total 1500 words could meet the requirement. 2. The writing component will represent at least 10% of a student s final grade in the course. Is this course identified as a Writing Across the Curriculum course? Yes _X No (See addendum for writing rubrics) Intended Course Goals By the end of the semester, students will be able to: 1. Evaluate the steps needed to complete the medical billing process. 2. Differentiate between the types of medical insurance policies and analyze the impact upon medical billing. 3. Assess the impact of managed care and the referral process on the billing cycle. 4. Perform entry level tasks using the Medisoft medical billing software to process claims. 5. Apply the HIPPA laws and assess their impact upon the medical office. Course Competencies and Objectives By the end of the semester, students will be able to: Competency 1 Describe and analyze the general steps needed to complete the medical billing process. Objective 1.1 Describe the billing and reimbursement cycle in a medical office. Objective 1.2 Discuss the type of information collected from patients. Objective 1.3 Identify the major types of health plans. Objective 1.4 Describe the information recorded about a patient s office visit. Objective 1.5 Describe and discuss the adjudication process. Objective 1.6 Discuss the process required to balance a medical office accounts. Competency 2 Identify and explain the role of information technology to automate medical billing tasks. Objective 2.1 Describe the role in I.T. in the medical office and the features of medical billing systems. Objective 2.2 Describe the advantages of electronic prescribing. Objective 2.3 Explain the role of a clearinghouse in processing electronic claims. Objective 2.4 Explain the purpose of the HIPAA act of Objective 2.5 Describe the safeguards outlined in the HIPAA Security Rule. Competency 3 Perform the basic functions of the automated billing software. Objective 3.1 Demonstrate how to start up the program and login properly.

4 Objective 3.2 Demonstrate the use of the various options and menus available. Objective 3.3 Demonstrate how to enter, edit, and delete data. Objective 3.4 Demonstrate how to back up, and restore data. Competency 4 Perform data entering of Patient information into an automated billing software program. Objective 4.1 Students will learn how to use record search functions. Objective 4.2 Assign a chart number to a new patient. Objective 4.3 Enter personal ad employer information for a new patient. Objective 4.4 Demonstrate how to locate and change information for a patient. Competency 5 Properly enter insurance, account, and condition information into an automated billing software program. Objective 5.1 Analyze when to create a new case, and set up a new case. Objective 5.2 Correctly determine and input a patient s insurance policy information. Objective 5.3 Accurately enter information regarding a patient s diagnosis, accident, or illness. Objective 5.4 Correctly close a case. Competency 6 Differentiate between the different types of managed care plans, and analyze the implications for billing processes. Objective 6.1 Identify rules and procedures regulated by Blue Cross/ Blue Shield. Objective 6.2 Identify rules and procedures regulated by Medicare Part A and Medicare Part B. Objective 6.3 Identify rules and procedures regulated by Medicaid. Objective 6.4 Identify rules and procedures regulated by Military (Tricare) insurance. Objective 6.5 Identify rules and procedures regulated by Workers Compensation. Objective 6.6 Identify rules and procedures regulated by other regionally applied Insurance Plans. Competency 7 Analyze charge transactions and patient payments and accurately record them in the automated billing software program. Objective 7.1 Input charges for procedures. Objective 7.2 Demonstrate the proper procedure for editing and deleting charge transactions. Objective 7.3 Accurately record and apply payments received from patients, and printout a walkout receipt. Competency 8 Create new claims using automated billing software. Objective 8.1 Create the claims. Objective 8.2 Demonstrate the review of claims for errors or omissions. Objective 8.3 Demonstrate the process for editing claims and adding attachments to electronic claims. Competency 9 Accurately post insurance payments and create patient statements using automated billing software. Objective 9.1 Record and apply payments received from insurance carriers. Objective 9.2 Record insurance adjustments and capitation payments. Objective 9.3 Create, edit and print statements. Competency 10 Analyze the importance of the collection process in the medical office. Objective 10.1 Describe and analyze a typical financial policy for a medical practice. Objective 10.2 Identify the laws that regulate the collection of payments from patients. Objective 10.3 Describe the process for dealing with uncollectible accounts. Objective 10.4 Demonstrate the use of an aging report to identify past due accounts. Objective 10.5 Create a collections report, a collection letter, and accompanying tracer report. Competency 11 Analyze the difference between managed care and non-managed care and the adjust the office policies and procedures. Objective 11.1 Cite advantages and disadvantages of participating and non-participating

5 insurance companies for a physician. Objective 11.2 Correctly fill out managed care referrals. Objective 11.3 Review a managed care manual and develop office policy procedures for acceptance of managed care policies. Objective 11.4 Obtain pre-certification and pre-authorization for a simulated managed care patient. Objective 11.5 Outline the procedure for obtaining a managed care referral for a patient. Objective 11.6 Explain the terms, "usual and customary" and "usual and reasonable". Objective 11.7 Distinguish between Staff, Group, IPA (Individual Practice Association) and PPO (Preferred Provider Organization) models. Competency 12 Complete claim forms for Blue Cross/Blue Shield, Medicare, Medicaid, commercial carriers, military and managed care, using medical insurance billing software. Objective 12.1 Demonstrate an understanding of how to use the CMS Objective 12.2 Demonstrate batch printing. Objective 12.3 Demonstrate electronic submission. Objective 12.4 Ensure that diagnosis and procedure codes link correctly. Objective 12.5 Discuss the significance of signature and PIN numbers. Objective 12.6 Demonstrate appropriate billing procedures when working with primary and secondary carriers. Objective 12.7 Apply co-pays and deductibles. Competency 13 Analyze and explain the purpose of the EOB (explanation of benefits). Objective 13.1 Reconcile payment reflections with a sample EOB form. Objective 13.2 Cite the process for a appeal of an unpaid claim. Objective 13.3 Outline the steps for follow-up claims. Teacher s Guide Course Textbook, Materials and Equipment Textbook(s) Title Health Insurance Billing, 3 rd ed. Author(s) Marie Moisio Publisher Delmar Cengage ISBN Software/ Equipment Textbook Costs Title Computers in the Medical Office, 7 th ed. Author(s) Sanderson Publisher McGraw Hill ISBN MEDISOFT practice management, Version 16. Please indicate how much the textbook would cost if purchased through Barnes & Noble: $ & Total: $ Course Assessments Description of Possible Course Assessments (Essays, multiple choice, etc.) Exams standardized for this course? Midterm Final Other (Please specify): Multiple choice, Essay, True/False, computer projects, etc. Are exams required by the department? Yes _X_No If Yes, please specify:

6 Where can faculty members locate or access the required standardized exams for this course? N/A Student Outcomes: Identify the general education goals for student learning that is a component of this course. Check all that apply: 1. Communicate effectively. a. Read and comprehend at a college level. X b. Write effectively in a college setting. 2. Demonstrate effective quantitative reasoning and X problem solving skills. Method of Assessment Examinations Computer projects and examination. 3. Demonstrate effective qualitative reasoning skills. X Computer projects and examination. 4. Apply effective methods of inquiry. a. Generate research paper by gathering information from varied sources, analyzing data and organizing information into a coherent structure. X b. Employ the scientific method. Generate reports from computer program. 5. Demonstrate sensitivity to diversity a. Experience the creative products of humanity. b. Describe alternate historical, cultural, global perspectives. Learning Units Learning Unit Topic 1: The Insurance Billing Specialist Competency: 1 Objectives: , 1.6 Activities/ Assignments: Read Chapter 1. Complete the reinforcement Exercises on pages Choose from the comprehension exercises on page 13. Group activity: Choose from the critical thinking exercises on page 14. Learning Unit Topic 2: The Legal Aspects of Insurance Billing Competency: 1, 2, 7 Objectives: 1.5, , , 13.2, 13.3 Activities/ Assignments: Read Chapter 2. Complete review exercise on pages Choose from the Internet and Critical Thinking Exercises on page 45 for group activities. Learning Unit Topic 3: Health Insurance Basics Competency: 1, 5,6 Objectives: 1.3, 1.6, , Activities/ Assignments: Read Chapter 3. Complete the identification questions and short answer questions on pages 75. Select one of the three case studies for in class group activities. Learning Unit Topic 4: Developing an Insurance Claim Competency: 7,8,9 Objectives: , , Activities/ Assignments: Read Chapter 7. Complete Review Exercises on pages Select the Challenge Exercises on page 266 for group activity. Learning Unit Topic 5: Common CMS-1500 and CMS 1450 Completion Guidelines

7 Competency: 12 Objectives: Activities/ Assignments: Read Chapter 8. Complete Review Exercises on page 285. Use challenge exercise on page 285 for in-class activity. Read Chapter 9. Complete Review Exercises on pages Complete application exercise on page 327 as in-class activity. Learning Unit Topic 6: Electronic Data Interchange (EDI) Competency: 1, 2, 3, 4 Objectives: 1.2, , , Activities/ Assignments: Read Chapter 10. Complete review exercises pages Assign challenge activity on page 340 for in-class assignment. Learning Unit Topic 7: Blue Cross/ Blue Shield Competency: 2, 3, 6, 12 Objectives: , 6.1, 2.3,2.4, 3.3, 3.4 Activities/ Assignments: Read Chap 11 and complete review exercises page Assign challenge activity on page 357 as in-class assignment. Learning Unit Topic 8: Medicare Competency: 2,3, 6, 11, 12 Objectives: 6.2, , Activities/ Assignments: Read Chapter 12. Complete review exercises on pages Assign challenge activities on page 407 as group projects. Prepare a CMS 1500 for Primary payer by Medicare and a CMS-1500 for Medicare as secondary payer. Learning Unit Topic 9: Medicaid Competency:2, 3, 6, 11, 12 Objectives: 6.3, , Activities/ Assignments: Read Chapter 13. Complete CMS 1500 for Medicaid. Display and discuss a Medicaid Remittance Advice Form. Complete review exercises on pages Use Challenge Activities on page 422 as group projects. Learning Unit Topic 10: Tricare and ChampVA Competency: 2, 3, 6, 11, 12 Objectives: 6.4, , Activities/ Assignments: Read Chapter 14. Discuss procedures requiring TRICARE Preauthorization. Discuss claims regarding DME s. Complete a TRICARE CMS Complete Review Exercises on pages Assign Challenge Activities on page 453 as time permits. Learning Unit Topic 11: Worker s Compensation Competency: 2, 3, 6, 11, 12 Objectives: 6.5, , Activities/ Assignments: Read Chapter 15. Discuss First Report of Injury Form. Complete CMS-1500 for Worker s Compensation. Complete Review Exercises on pages Assign challenge activities on page 468 as in-class activities. Learning Unit Topic 12: Clinical Case Studies Competency: 1-13 Objectives: All Activities/ Assignments: Complete the Superiorland Clinic Practice Case Study on pages This project will take several weeks to complete, and can be assigned individually or in groups. Complete Case Studies