MED 150: Medical Billing and Coding I

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