Catalog 2017-2018 
    
    Oct 17, 2018  
Catalog 2017-2018 [ARCHIVED CATALOG]

MEDA 136 Coding/Billing/Insurance

5 credits


Introduction of insurance terminology, terms, phrases and abbreviations. Learn ICD-10 coding, CPT coding, and HCFA-1500 billing forms, and basics of claims management.

Prerequisites: MEDA 121  and MATH 087  (or placement into MATH 098  or higher)  

Quarters Offered: Fall, Winter, Spring

Global Outcomes:
This course teaches to the global outcome of Critical Thinking.

This course teaches to the global outcome of Teamwork.

Student Outcomes/Competencies:
Upon successful completion of this course students will be able to:

  • Analyze the different types of managed care plans in local area
  • Differentiate between Medicare Part A and Part B
  • Review a managed care manual and develop an office policy and procedure for the acceptance of managed care patients
  • Obtain pre-certification and pre-authorization for a simulated managed care patient
  • Cite advantages and disadvantages of participating and non-participating insurance companies for a physician
  • Complete HCFA-1500 forms for a government plan and a commercial carrier
  • Outline the procedure for obtaining a managed care referral for a patient
  • Outline the procedure for obtaining a pre-certification approval for a patient
  • Explain the importance of coding statistics to a utilization study
  • Locate codes with modifiers and symbols in the CPT book
  • Explain how to locate codes in the HCPCS manual
  • Extract procedures from sample charts and match the procedure with the correct code from the CPT book
  • Create a master list of the most common diagnostic codes for a specific practice
  • Cite which volumes are used primarily by coders in ambulatory care settings
  • Extract diagnosis from sample medical charts
  • Locate correct diagnostic code in ICD-9 CM coding books
  • Complete claim forms using a medical insurance billing software
  • Complete claim forms for Blue Cross/Blue Shield, Medicare, Medicaid, commercial carriers, military and managed care
  • Reconcile payment rejections with a sample explanation of benefits form
  • Cite the process for an appeal of an unpaid claim
  • Outline the steps for follow-up on claims
  • Review a sample fee schedule for a physician
  • Explain the terms, “usual and customary” and “usual and reasonable”
  • Define diagnosis-related groups
  • Explain the doctor’s fee schedule to the patient
  • Understand the correlation of the CPS code(s) to the ICD-9 CM code(s) and the medical necessity for reimbursement of the procedure/service
  • Work effectively as a team member in the medical office setting


Total Hours: 60 Lecture Hours: 40 Lab or Clinical Hours: 20