MAST 1230 - Financial Medical Business Practices

Objectives:

1. Define:
   1. Charges
   2. Payments
   3. Accounts receivable
   4. Accounts payable
   5. Adjustments
2. Describe banking procedure as related to the ambulatory care seting
3. Identify precautions for accepting the following types of payments:
   1. Cash
   2. Check
   3. Credit card
   4. Debit card
4. Describe types of adjustments made to patient accounts including:
   1. Non-sufficient funds (NSF) check
   2. Collection agency transaction
   3. Credit balance
   4. Third party
5. Identify types of information contained in the patient’s billing record
6. Explain patient financial obligations for services rendered

Outcome 2: Upon completion of this course, student will be able to perform accounts receivable procedures.

Objectives:

1. Perform accounts receivable procedures to patient accounts including posting:
   1. Charges
   2. Payments
   3. Adjustments
2. Prepare a bank deposit
3. Obtain accurate patient billing information
4. Inform a patient of financial obligations for services rendered.

Outcome 3: Upon completion of this course, student will be able to apply third party reimbursement procedures.

Objectives:

1. Identify:
   1. Types of third party plans
   2. Information required to file a third party claim
   3. The steps for filing a third party claim
2. Outline managed care requirements for patient referral
3. Describe processes for:
   1. Verification of eligibility for services
   2. Precertification
   3. Preauthorization
4. Define a patient-centered medical home (PCMH)
5. Differentiate between fraud and abuse
6. Interpret information on an insurance card
7. Verify eligibility for services including documentation
8. Obtain precertification for preauthorization including documentation
9. Complete an insurance claim form

Outcome 4: Upon completion of this course, student will be able to identify procedural and diagnostic coding:

Objectives:

1. Describe how to use the most current procedural coding system
2. Describe how to use the most current diagnostic coding classification system
3. Describe how to use the most current HCPCS level II coding system
4. Discuss the effects of
   1. Upcoding
   2. Downcoding
5. Define medical necessity as it applies to procedural and diagnostic coding
6. Perform procedural coding
7. Perform diagnostic coding
8. Utilize medical necessity guidelines

1. Bookkeeping terms
2. Accounts receivable procedures
3. Third party reimbursement procedures
4. Procedural and diagnostic coding