This is a basic class in managing the information required for billing medical insurance in clinic and hospital settings. This class will cover coding, specific form requirements, account aging, posting payments and adjustments to patient accounts, and medical coverage plans, including government plans. Issues related to overall medical business offices will also be part of the class, including correct patient billing and collection procedures. (Formerly: BIM 107 & BIM 111).
Prerequisites
Quarters Offered
Spring
Course Outcomes
Upon successful completion of the course, students should be able to demonstrate the following knowledge or skills:
- Explain the variety of insurance companies and plans that are offered to patients.
- Explain the term electronic health records (EHR) and health information management (HIM).
- Communicate with insurance companies to determine patients’ insurance coverage.
- Apply diagnosis codes, procedure codes, and fee schedules.
- Enumerate the differences between electronic billing and paper billing to insurance companies.
- Communicate with insurance companies when billing is denied.
- Communicate with patients when there are billing questions.
- Read and apply insurance remittance advice or explanation of benefits to patient accounts.
- Explain correct patient billing and collection procedures
Institutional Outcomes
IO3 Human Relations/Workplace Skills: Students will be able to demonstrate teamwork, professionalism, and/or workplace specific skills.
Course Content Outline
- Electronic Health Records (EHR)
- Types of insurance companies and plans
- Insurance verification
- Correct billing procedures
- Coding (diagnosis and procedure codes)
- Fee schedules
- Electronic Billing (EDI)
- Insurance remittance advice (RA, EOB), electronic remittance advice, electronic funds transfer
- Communicate with 3rd party payers
- Collect and apply patient payments
- Patient statements
- Collection rules and regulations