EHR 220 - Medical Billing and Reimbursement
3 Credit Hours
This course provides students with information about major insurance programs, federal healthcare legislation, and medical claims. Students will also gain a knowledge of physician and hospital medical billing and government medical reimbursement methodology. Topics include: understanding insurance plans; physician medical billing, hospital medical billing, and government medical billing (Medicare, Medicaid, Tricare); benefits and payment adjudication, refunds, follow-ups, and appeals; and workers’ compensation.
Prerequisite(s): EHR 100 or concurrent enrollment, MAT 020
RATIONALE OF COURSE
Accurate processing of healthcare claims has become more exacting and rigorous as health insurance plan options have rapidly expanded. These changes, combined with modifications in state and federal regulations affecting the health insurance industry, are a constant challenge to healthcare providers. This course will provide students with the knowledge and skills necessary to meet these challenges.
COURSE COMPETENCIES
Upon successful completion of this course, the student should be able to
- Explain different types of insurance plans and coverage.
- Demonstrate understanding of physician medical billing using the CMS-1500 claim form and hospital medical billing using the UB-04 claim form
- Demonstrate understanding of government medical billing for Medicare, Medicaid, and TRICARE.
- Apply knowledge of the accounts receivable process in medical billing including balance billing, making adjustments to patient accounts, and methods of receiving funds.
- Explain process of completing and filing medical claims including calculating charges, filing appeals, and following-up on claims.
- Demonstrate workers’ compensation program including how to complete and process claims.
- Apply understanding of auditing claims for proper documentation of procedures, services, and medical necessity.
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