Health Care Information Management
Medical Insurance – Billing
Learn hands-on skills to enter as an entry level Insurance Biller and Basic Coder and will be prepared for certification as a Certified Billing and Coding Specialist. This course may be taken by itself or with Medical Insurance – Types.
16 Days
64 Hrs
6 Lessons
Agenda
- Identify the background and importance of accurate insurance claims submission, coding and billing
- Name at least three skills possessed by insurance billing specialists
- List personal qualifications and skills to be acquired by an insurance billing specialist
- Differentiate between medical ethics and medical law
- Explain the difference between implied, expressed/informed consent (physician/patient contract)
- Describe in general terms the important Federal State and Private Insurance plans
- Define common insurance terms
- Explain the administration life cycle of a physician-based insurance claim from services rendered to completion of payment cycle
- Determine the appropriate questions to ask a question in order to maintain a complete patient record
- List the functions of an “aging report” in computerized practices or in a paper environment
- Record proper information and post to the patient’s ledger after claims submission and payment is received
- Explain reasons medical documentation is required
- Explain Medical Necessity and why it is required
- Define common medical diagnostic and legal terms
- Identify component parts of the SOAP format, used for documentation
- Understand various methods of mailing and their benefits
- Learn the component parts of a standard letter and various formats
- Know when to use the 1500 claim form
- Expedite the handling and processing of the 1500 claim form
- Explain the difference between clean and dirty claims
- Abstract from the patient record – relevant information for completing the 1500 insurance claim form
- Describe reasons why claims are rejected
- Become familiar with guidelines for completing the current CMS 1500 claim form for Federal, State and private payor insurance contracts
- Knowledge of timely filing
- Reimbursement time periods for paper vs electronic billing
- Define terminology pertinent to insurance claims
- Identify reasons for rebilling a claim (problem solving)
- Account follow-up; evaluate unpaid claims/accounts
- Claim review for denied claims
- Discuss ways to determine fees
- Describe an office’s fee policy
- Define accounts receivables and how it is handled
- Recite types of adjustments available to patients
- Perform verbal and written communication collection techniques
- State the role of a billing service, collection agency and credit bureau in the collection process
- Identify possible solutions to collection problems
- Explain the purpose of small claims court, in the collection process
- Explain handling the SKIP account
FREE
Interested in course?
Course Type: Instructor Led