CourseInfo | SimpliTrain

Medical Insurance - Types

E-Learning

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 – Billing.

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 – Billing.

Lesson Id	Title	Description
1	HIPAA	Describe the Federal Standards under HIPAA (Health Insurance Portability and Accountability Act) Explain the privacy rule as it pertains to protected health information Illustrate the difference between privileged and non-privileged information Explain the difference between a notice, a consent and an authorization List various types of insurance fraud Define abuse as it relates to the subject of billing and insurance claims State the guidelines for HIPAA privacy compliance
2	Managed Care	Define a prepaid health plan Identify types of managed care health plans Explain health maintenance organization benefits and eligibility requirements (HMO) Define independent practice associations (IPA) Name the elements of preferred provider organizations (PPO)
3	Medicare	Explain eligibility criteria for Medicare Name important information to abstract from a patient’s Medicare card Explain an ABN (advanced beneficiary notice) State the benefits and drawbacks for participating vs non-participating physicians Calculate a payment for a procedure using a conversion factors (RBRVS) Determine the time limit for submitting a Medicare Claim Know whether Medicare is primary or secondary when there is more than one insurance List CMS-1500 block numbers that require information when submitting Medicare/Medi-Gap claims Post information on the patient’s financial accounting record from a Medicare EOMB
4	Medicaid	Define terminology relating to Medicaid Interpret Medicaid abbreviations Name Medicaid eligibility classifications List important information to abstract from the patient’s Medicaid card File claims for patients who have Medicaid and other coverage
5	Tricare And Champva	State who is eligible for Tricare and ChampVA Define pertinent Tricare and ChampVA terminology and abbreviations Enumerate the differences between the various Tricare programs Identify the difference between the Tricare and ChampVA programs List the circumstances when a Non-Availability statement is necessary Describe how to process claims for individuals who are covered by Tricare and ChampVA
6	Workers Compensation	State the purpose of workers compensation laws Describe the types of compensation benefits Define the different stages of disability under the workers compensation system Complete a Doctor’s First Report of Occupational Injury or Illness Realize that workers compensation differs from state to state
7	Hospital Related Claims	State the role of ICD-9-CM – Volume 3 – in regard to hospital billing Identify categories in ICD-9-CM Volume 3 State when the Uniform Bill (UB-92) paper and electronic claim forms may or may not be used State the general guidelines for completion of the paper UB-92 and transmission of electronic claims Identify how payment is made based on DRGs (Diagnosis Related Groups) Express knowledge of APCs (Ambulatory Payment Classifications)

Medical Insurance - Types

E-Learning

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 – Billing.

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 – Billing.

Lesson Id	Title	Description
1	HIPAA	Describe the Federal Standards under HIPAA (Health Insurance Portability and Accountability Act) Explain the privacy rule as it pertains to protected health information Illustrate the difference between privileged and non-privileged information Explain the difference between a notice, a consent and an authorization List various types of insurance fraud Define abuse as it relates to the subject of billing and insurance claims State the guidelines for HIPAA privacy compliance
2	Managed Care	Define a prepaid health plan Identify types of managed care health plans Explain health maintenance organization benefits and eligibility requirements (HMO) Define independent practice associations (IPA) Name the elements of preferred provider organizations (PPO)
3	Medicare	Explain eligibility criteria for Medicare Name important information to abstract from a patient’s Medicare card Explain an ABN (advanced beneficiary notice) State the benefits and drawbacks for participating vs non-participating physicians Calculate a payment for a procedure using a conversion factors (RBRVS) Determine the time limit for submitting a Medicare Claim Know whether Medicare is primary or secondary when there is more than one insurance List CMS-1500 block numbers that require information when submitting Medicare/Medi-Gap claims Post information on the patient’s financial accounting record from a Medicare EOMB
4	Medicaid	Define terminology relating to Medicaid Interpret Medicaid abbreviations Name Medicaid eligibility classifications List important information to abstract from the patient’s Medicaid card File claims for patients who have Medicaid and other coverage
5	Tricare And Champva	State who is eligible for Tricare and ChampVA Define pertinent Tricare and ChampVA terminology and abbreviations Enumerate the differences between the various Tricare programs Identify the difference between the Tricare and ChampVA programs List the circumstances when a Non-Availability statement is necessary Describe how to process claims for individuals who are covered by Tricare and ChampVA
6	Workers Compensation	State the purpose of workers compensation laws Describe the types of compensation benefits Define the different stages of disability under the workers compensation system Complete a Doctor’s First Report of Occupational Injury or Illness Realize that workers compensation differs from state to state
7	Hospital Related Claims	State the role of ICD-9-CM – Volume 3 – in regard to hospital billing Identify categories in ICD-9-CM Volume 3 State when the Uniform Bill (UB-92) paper and electronic claim forms may or may not be used State the general guidelines for completion of the paper UB-92 and transmission of electronic claims Identify how payment is made based on DRGs (Diagnosis Related Groups) Express knowledge of APCs (Ambulatory Payment Classifications)

Free