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Note: some or all of the courses in the subjects
marked as "Transfer" can be used towards a transfer degree: Associate of Science
and Arts or Associate of Engineering Science at DACC. Transferability for
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Areas of Study
| PHMB280 syllabus
|COURSE NUMBER: ||PHMB280|
|COURSE TITLE:||Medical Billing and Reimbursement Methods|
|SEMESTER CREDIT HOURS:||4|
|STUDENT ENGAGEMENT HOURS:||188|
This course will cover the tasks and responsibilities of a medical biller. Will define the legal and regulatory role of the Centers for Medicare and Medicaid Services (CMS) in relation to insurance claims and National Correct Coding Initiative (NCCI) edits. The student will learn to verify validity of health information for billing reports (charges, billing reports, and other data sources). Course will examine accounts receivable duties such as posting insurance and patient payments, validating UB-92 forms / HCFA 1500 forms, and how to process denied claims through appeals. Will examine how to verify national and local coverage determination policies to comply with the changing regulations among various payment
systems for healthcare services such as Medicare, Medicaid, and Managed Care etc. Will examine healthcare’s complete revenue cycle to understand the impact medical billing has on reimbursement. There are no prerequisites for this course. This course is available for web registration. The expanded version of objectives is available from the Health Information Technology director.
STUDENT LEARNING OUTCOMES:
Upon completion of this course, students will be able to:
- Explain the responsibilities of a medical biller.
- Recognize the importance of the certification.
- Interpret and define key terms.
- Define what the Affordable Care Act is, and how it impacts health care.
- Interpret the difference between health insurances, and the cards associated with them.
- Explain how health insurance is different than a medical discount card.
- Recognize the difference between an ICD9 and ICD10 code.
- Define the difference between CPT codes and HCPCs.
- Apply modifier usage.
- Interpret data from the superbill and hospital sheet.
- Identify the importance of completed registration sheets.
- Define the requirements for a CMS-1500, and for the different blocks.
- Determine difference between a new visit and established visit office codes.
- Recognize the difference between initial and subsequent visit.
- Recognize the difference between an admitting and consulting code
- Determine the usage of critical care codes.
- Describe the difference between manual and electronic claims.
- Restate what a clearinghouse does.
- Identify the significance of ANSI X12N.
- Clarify Explanation of benefits (EOB) and Electronic funds Transfer (EFT).
- Understand insurance adjustments and the accuracy of posted payments.
- Explain the legal and regulatory role of the Centers for Medicare and Medicaid Services (CMS) in relation to insurance claims.
- Locate National Correct Coding Initiative (NCCI) edits, local coverage determinations and national coverage determinations.
- Recognize a rejected claim vs a denied claim.
- Clarify the necessary actions to be taken when a claim is denied.
- Identify the importance of following up a denied claim.
- Define the role of the state insurance commissioner.
TEXTBOOK / SPECIAL MATERIALS:
- Working as a Provider Based Biller
- Health Insurance Payment System
- Local and national coverage determinations
- ICD-9, ICD-10, CPT, HCPCS Level II
- Patient Registration, Superbill, and Hospital Sheet
- The CMS-1500 Form
- Office Services and Procedures
- Inpatient and Nursing Facility Services
- Electronic Claims and Clearinghouses
- Explanation of Benefits and Payments
- Denials and Appeals
- Accounts Receivable, Aging Reports, and Rebilling
- Collections and the State Insurance Commissioner
See bookstore website for current book(s) at https://www.dacc.edu/bookstore
A point system will be used to determine student's grades.
90-100% = A
80-89% = B
70-79% = C
60-69% = D
59% & below = F
NOTE: Must receive C or better to pass
|STUDENT CONDUCT CODE:||Membership in the DACC community brings both rights and responsibility. As a student at DACC, you are expected to exhibit conduct compatible with the educational mission of the College. Academic dishonesty, including but not limited to, cheating and plagiarism, is not tolerated. A DACC student is also required to abide by the acceptable use policies of copyright and peer-to-peer file sharing. It is the student’s responsibility to become familiar with and adhere to the Student Code of Conduct as contained in the DACC Student Handbook. The Student Handbook is available in the Information Office in Vermilion Hall and online at: https://www.dacc.edu/student-handbook|
|DISABILITY SERVICES:||Any student who feels s/he may need an accommodation based on the impact of a disability should contact the Testing & Academic Services Center at 217-443-8708 (TTY 217-443-8701) or stop by Cannon Hall Room 103. Please speak with your instructor privately to discuss your specific accommodation needs in this course.|