Medical Billing

Course Number: SAH-008
Course Hours: 75
Assigned Course Preparation Hours: 19

Course Description

This course explores various aspects of health insurance in the United States including origin, legal and ethical considerations, types, claim submission, fee-for-service, managed care, Medicaid, Medicare, military carriers, workers’ compensation, disability, diagnostic and procedural coding, HIPAA, claims management, electronic claims process, reimbursement, and billing related to the hospital environment.

Learning Objectives

  1. Describe various aspects of health insurance in the United States.
  2. Demonstrate best practices for billing in a medical office.
  3. Demonstrate proper patient interaction related to insurance and billing.

Educational Resources

This course is based on Health Insurance Today. It is delivered via the NTI Canvas LMS.

Policies

Refer to the Student Catalog and Handbook for the full list of policies.

Assessment Weights

Class Participation & Discussions: 20%
Quizzes: 30%
Midterm Exam: 20%
Final Exam: 30%

Outline

ModuleTopicDuration (hours)
1The Health Care Reimbursement4
2Reimbursement for Managed Care4
3Skilled Nursing Facilities4
4Outpatient Prospective Payment System4
5The IRF PPS, Claim Forms, and Reimbursement Support4
6Health Insurance4
7Universal Insurance Forms4
8Claims Processing4
9Policies and Providers4
Midterm Exam1
10Commercial Insurance4
11Miscellaneous Carriers: Workers' Compensation and Disability Insurance4
12Diagnostic Coding4
13Procedural, Evaluation and Management, and HCPCS Coding4
14The Patient4
15Keys to Successful Claims Management4
16The Role of Computers in Health Insurance4
17Reimbursement Procedures: Getting Paid4
18Hospital Billing and the UB-044
Final Exam2
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