Standard

Posted: 06/25/07

RState Standard £Institutionally Developed College: n/a

MAS 111 – Reimbursement Management

Course Description

Emphasizes essential skills required for the typical medical office.  Topics include:  Managed care and reimbursement coding. 

Competency Areas	Hours
Managed Care	Class	1
Reimbursement and Coding	D. Lab	2
	P. Lab/O.B.I.	3
	Credit	3

Prerequisite:	MAS 103, MAS 112, MAS 110
Corequisite:

Course Guide

Competency	After completing this section, the student will be able to:	Hours
		Class	D.Lab	P.Lab/ O.B.I.

MANAGED CARE		2	2	5
Insurance vocabulary	Define frequently used insurance terms and abbreviations.
	Describe and define a variety of third party reimbursement methods.
Insurance plans	Identify and describe different types of insurance plans, including but not limited to: Governmental Carriers: Medicare, Medicaid, TRICARE, etc. Managed Care : HMO, PPO, POS Workers Compensation Blue Cross Blue Shield Private Insurance
	Cite advantages of group vs. private health insurance.
Federal regulations	Describes medical necessity and proper documentation required for proper reimbursement.
	Define fraud and abuse.
	Describe the impact of HIPAA and other government regulations on the reimbursement process.
REIMBURSEMENT AND CODING		8	18	25
Diagnostic coding for insurance forms	Demonstrate usage of ICD coding books and CPT coding books.
	Demonstrate usage of the HCPCS manual.
	Demonstrate appropriate use of modifiers.
Apply third party guidelines	Complete precertification form.
	Complete a referral from.
Claims submission	Abstract from patient records to complete insurance claim forms.
	Identify and complete appropriate CMS 1500 claim forms for patients covered by private, group, or government insurance plans.
	Describes process for claims submission.
Claims rejections	List reasons for claims rejections and purpose solutions for rejections.
	Identifies process for resubmitting a claim.

Suggested Resources

Wilburta Q. Lindh; Marilyn S. Pooler; Carol D. Tamparo; Barbara M. Dahl. Thomson Delmar Learning's Comprehensive Medical Assisting, Administrative and Clinical Competencies. 3^rd ed. Albany New York: Thomson Delmar Learning,2006.

Valerius, J, Bayes, N. L, Newby, C., & Seggern, J. I.B. (2006) Medical Insurance: An Integrated Claims Process

Approach. 3^rd ed. New York: Glencoe McGraw-Hill.

Newby, C. (2008) From Patient to Payment: Insurance Procedures for the Medical Office with CD-ROM & Student Data

Disk. 4^th ed. Glencoe McGraw-Hill 2008.

Buck, C. (2006).The Next Step: Medical Coding from Classroom to Practice. Elsevier.

Green, M. (2008) 3-2-1 Code It!. Albany New York: Thomson Delmar Learning.

Rowell, J. C. & Green, M. A. (2006) Understanding Health Insurance, A Guide to Billing and Reimbursement. Albany New York: Thomson Delmar Learning.

Publisher’s Websites

Glencoe/McGraw Hill http://catalogs.mhhe.com/mhhe/home.do

ECM Paradigm http://www.emcp.com/product_catalog/index.php?GroupID=87

Elsevier http://www.elsevier.com/wps/find/simple_search.cws_home?pubtype=Any&boost=true&needs_keyword=true&adv=false&keywords=&action=product_search

FA Davis http://www.fadavis.com/health_profession/index.cfm

Thomson Delmar Learning http://www.delmarlearning.com/healthcare/Index.aspx?cat1ID=HCR

Prentice Hall http://vig.prenhall.com/

CourseSG.081105.Dot