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Health Care Information Management
Medical Insurance - Types
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.
Course Overview
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.
Course Prerequisites
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Course Agenda
7 Title
Course Agenda
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
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)
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
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
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
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
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)
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)