HLTH-8008D Medical Billing

Prerequisites CSFT-8063B with minimum grade CR and HLTH-8010A or equivalent with minimum grade CR
Obtain the knowledge and skills associated with insurance billing. Examine third party reimbursement including Medicare, Medicaid, Blue Cross Blue Shield, Workers’ Compensation and TRICARE. Become familiar with diagnostic and procedural coding needed to submit claims in compliance with third party payer’s requirements. Become familiar with actual medical billing processes utilizing the CMS-1500 form, Electronic Health Record (EHR) Clinic found in Connect and the knowledge obtained throughout the course.

Contact Hours: 45
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1. Define medical billing terms and concepts
2. Identify diagnostic codes, procedure codes and HCPCS codes used to bill medical claims.
3. Utilize medical billing software used to submit medical claims by way of preparing CMS-1500 forms for various insurance carriers and electronic data interchange (EDI) via EHR Clinic simulations in McGraw-Hill Connect.

EHR, HIPAA, HITECH

Patient Encounters & Billing Information

Diagnostic Coding: ICD-10-CM

Procedural Coding: CPT and HCPCS

Visit Charges and Compliant Billing

Healthcare Claim Preparation & Transmission

Private Payers/ACA Plans

Medicare, Medicaid, TRICARE & CHAMPVA

Workers’ Compensation & Disability/Auto   

Payments, Appeals, & Secondary Claims

Patient Billing & Collections

 Primary & Secondary Case Studies

Analyzing Insurance Benefits & Insurance Math               
Activities/Resources
Completion of homework assignments in textbook and online; hands-on demonstration of medical billing software proficiency; support learned skills set by means of successfully completing tests and exams.

Evaluation
Students will confidentially evaluate this course by completing the Student Evaluation of Class form distributed at the last class session.

Successful Completion
The instructor will evaluate the student’s skills learned using attendance, participation, feedback, testing where appropriate, and projects completed.

100% attendance is recommended, as no special arrangements will be made for missing class.

100% = 45 hours.

Upon successful completion, this course will appear on the student’s Macomb Community College non-credit transcript.

Textbook
Medical Insurance, A Revenue Cycle Process Approach; by: Valerius, Bayes, Newby and Blochowiak, 8th edition, TEXTBOOK + CONNECT ACCESS CARD (BUNDLE)*: ISBN 978-1-260-69214-3

*I would highly recommend not purchasing a used book as the Connect Access changes yearly and you would need to purchase access for an additional $90.00.

Medical Insurance, A Revenue Cycle Process Approach; by: Valerius, Bayes, Newby and Blochowiak, 8th edition, WORKBOOK: ISBN 978-1-260-48914-9