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Claims and Reimbursement (MEDS 1770)
Total Credits:
3
Lecture Credits:
2
Lab Credits:
1
Description:
This course introduces you to medical insurance reimbursement; medical insurance plans and payers; regulations and accreditation in medical insurance; claims processing sequence; collection of patient information; insurance verification; and encounter form preparation. You will also learn about linkage and compliance, provider payment calculations, claims preparation, and claims transmission. You will review coding guidelines, hospital claims and billing process. Must be taken A-F.
Topical Outline:
1. Indemnity and managed care plans
2. Medical records
3. HIPAA Privacy Rule
4. Billing and reimbursement cycle
5. Prepare claims
6. Private payers and government-sponsored payers
Learning Outcomes:
1. Apply health plan regulations
2. Create and transmit clean claims
3. Assess properly linked diagnosis and procedure codes
4. Demonstrate security measures in electronic claims transmission
5. Prepare hospital billing statements
6. Calculate RBRVS payments under the Medicare fee schedule
Prerequisites:
Placement into
READ 0200 or
ESOL 0052 or completion of
READ 0100 or
ESOL 0042