MED 150: Medical Billing and Coding I

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Program
Medical Assisting (MED)
Credits 5
Quarter Offered
Fall

This course gives students an introduction to managed care and insurance coverage. Students will learn medical billing practices including electronic submission and computerized billing techniques and includes ICD, HCPCS, and CPT coding. This class may include students from multiple sections.

Prerequisites

Medical Assisting or Medical Office Assisting Program Admittance

Competencies/Objectives/Outcomes/Methods of Assessment/Assignment:
Medical Business Practices
VII. Basic Practice Finances

  • VII.C.1. Define the following bookkeeping terms:
    a. charges
    b. payments
    c. accounts receivable
    d. accounts payable
    e. adjustments
    f. end of day reconciliation
  • VII.C.2. Identify precautions for accepting the following types of payments:
    a. cash
    b. check
    c. credit card
    d. debit card
  • VII.C.3. Identify types of adjustments made to patient accounts, including:
    a. non-sufficient funds (NSF) check
    b. collection agency transaction
    c. credit balance
    d. third party
  • VII.C.4. Identify patient financial obligations for services rendered
  • VII.P.1. Perform accounts receivable procedures to patient accounts including posting:
    a. charges
    b. payments
    c. adjustments
  • VII.P.2. Input accurate patient billing information in an electronic system
  • VII.P.3. Inform a patient of financial obligations for services rendered

VIII. Third Party Reimbursement

  • VIII.C.1. Identify:
    a. types of third party plans
    b. the steps for filing a third-party claim
  • VIII.C.2. Identify managed care requirements for patient referral
  • VIII.C.3. Identify processes for:
    a. verification of eligibility for services
    b. precertification/preauthorization
    c. tracking unpaid claims
    d. claim denials and appeals
  • VIII.C.4. Identify fraud and abuse as they relate to third-party reimbursement
  • VIII.C.5. Define the following:
    a. Bundling and unbundling of codes
    b. Advanced beneficiary notice (ABN)
    c. Allowed amount
    d. Deductible
    e. Co-insurance
    f. Co-pay
  • VIII.C.6. Identify the purpose and components of the Explanation of Benefits (EOB) and Remittance Advice (RA) Statements