Health Care Information Management

Medical Insurance - Billing

Instructor-Led 6 Agenda

Description

Learn hands-on skills to enter as an entry level Insurance Biller and Basic Coder and will be prepared for certification as a Certified Billing and Coding Specialist. This course may be taken by itself or with Medical Insurance – Types.

Course Overview

Role Of Insurance Billing Specialist Lesson Id 1

Role Of Insurance Billing Specialist

Basics Of Health Insurance Lesson Id 2

Basics Of Health Insurance

Medical Documentation Lesson Id 3

Medical Documentation

Cms 1500 Form Completion Lesson Id 4

Cms 1500 Form Completion

Receiving Payments & Insurance Problem Solving Lesson Id 5

Receiving Payments & Insurance Problem Solving

Office & Insurance Collection Strategies Lesson Id 6

Office & Insurance Collection Strategies

Lesson Id	Title	Description
1	Role Of Insurance Billing Specialist	Identify the background and importance of accurate insurance claims submission, coding and billing<br />Name at least three skills possessed by insurance billing specialists<br />List personal qualifications and skills to be acquired by an insurance billing specialist<br />Differentiate between medical ethics and medical law<br />
2	Basics Of Health Insurance	Explain the difference between implied, expressed/informed consent (physician/patient contract)<br />Describe in general terms the important Federal State and Private Insurance plans<br />Define common insurance terms<br />Explain the administration life cycle of a physician-based insurance claim from services rendered to completion of payment cycle<br />Determine the appropriate questions to ask a question in order to maintain a complete patient record<br />List the functions of an “aging report” in computerized practices or in a paper environment<br />Record proper information and post to the patient’s ledger after claims submission and payment is received<br />
3	Medical Documentation	Explain reasons medical documentation is required<br />Explain Medical Necessity and why it is required<br />Define common medical diagnostic and legal terms<br />Identify component parts of the SOAP format, used for documentation<br />Understand various methods of mailing and their benefits<br />Learn the component parts of a standard letter and various formats<br />
4	Cms 1500 Form Completion	Know when to use the 1500 claim form<br />Expedite the handling and processing of the 1500 claim form<br />Explain the difference between clean and dirty claims<br />Abstract from the patient record – relevant information for completing the 1500 insurance claim form<br />Describe reasons why claims are rejected<br />Become familiar with guidelines for completing the current CMS 1500 claim form for Federal, State and private payor insurance contracts<br />
5	Receiving Payments & Insurance Problem Solving	Knowledge of timely filing<br />Reimbursement time periods for paper vs electronic billing<br />Define terminology pertinent to insurance claims<br />Identify reasons for rebilling a claim (problem solving)<br />Account follow-up; evaluate unpaid claims/accounts<br />Claim review for denied claims<br />
6	Office & Insurance Collection Strategies	Discuss ways to determine fees<br />Describe an office’s fee policy<br />Define accounts receivables and how it is handled<br />Recite types of adjustments available to patients<br />Perform verbal and written communication collection techniques<br />State the role of a billing service, collection agency and credit bureau in the collection process<br />Identify possible solutions to collection problems<br />Explain the purpose of small claims court, in the collection process<br />Explain handling the SKIP account