BUSN 1015 Syllabus

Subject Code

BUSN

Course Number

1015

Course Title

Introduction to Medical Insurance

Prerequisites

ALHS 1090 with a grade of C or higher

Corequisites

Terms Offered

Offered Fall

Credit Hours

(3-0-3)

Course Description

This course is designed to increase efficiency and streamline administrative procedures for coding and billing. Topics include documentation in the medical record, diagnostic code selections, types of insurance, Medicare compliance policies related to documentation and confidentiality, and HIPAA and other compliance regulations.

Course Outcomes

Career Role and Responsibilities

  • State the job responsibilities, educational, and training requirements, and qualifications of an insurance billing specialist.
  • Discuss medical etiquette and ethics.
  • State what is privileged information vs. non-privileged information.
  • Discuss liabilities of the employer and employee.

The Claims Process

  • Discuss the legal principles of insurance.
  • Discuss the basics of an insurance policy.
  • Discuss the choices of health insurance coverage.
  • Prepare insurance claims.
  • Discuss the documentation process for medical records.
  • Discuss the contents of a medical report.
  • Use Documentation terminology.
  • Review and audit medical records.
  • Discuss legalities of medical records.
  • Discuss the diagnostic coding system.
  • Discuss the methods of payment.
  • Discuss the types of claim forms.
  • Prepare a health insurance claim form.
  • Discuss common reasons why claim forms are rejected.
  • Discuss the history of the electronic claim.
  • Discuss necessary computer components.
  • Discuss confidentiality issues with claim forms.
  • Discuss records management of claim forms.
  • Discuss existing computer claims systems.
  • Discuss claim policy provisions.
  • Discuss explanation of benefits.
  • Discuss the role of the State Insurance Commissioner.
  • Discuss claim management techniques.
  • Discuss dealing with claim inquiries, handling problem claims, rebilling, and the appeal process.
  • Discuss the cash flow cycle, fees, credit arrangements, credit and collection laws with regard to medical insurance.
  • Using a code book.
  • Apply the rules of coding.
  • Use the CPT code book.
  • Use code modifiers.
  • Discuss the importance of procedural coding skills.

Health Care Payers

  • Discuss private insurance vs. managed care systems.
  • Discuss the policies and regulations of the Medicare system.
  • Discuss the utilization of quality control of the Medicare system.
  • Discuss payment, reimbursement, and claim submission with regard to the Medicare system.
  • Discuss the Medicaid program eligibility for the Medicaid program, benefits of the Medicaid program, and Medicaid claim procedures.
  • Discuss the various programs if TRICARE (standard, Extra, Prime, For Life, Plus, etc.).
  • Discuss the CHAMPVA program.
  • Discuss the claims procedure when filing TRICARE and CHAMPVA claims.
  • Discuss the history of worker's compensation, the laws of worker's compensation, eligibility, and coverage.
  • Discuss the types of state claims.
  • Discuss state and federal disability insurance programs.

Inpatient and Outpatient Billing

  • Discuss the admission, coding, reimbursement process, and billing problems when filing inpatient and outpatient claims.

Employment

  • Discuss employment opportunities as a billing specialist.
  • Produce job searches.
  • Discuss self-employment as a billing specialist.