Medical Office Insurance – AMOA 204

CG • Section 8WK • 11/08/2019 to 04/16/2020 • Modified 07/28/2020

Course Description

This course acquaints students with billing protocol concerning the various insurance filing demands of commercial group insurance, Medicare, Medicaid, Workman’s compensation claims and other third party billing entities.

Prerequisites

NURS 105

Rationale

This course discusses the many aspects of the billing cycle process. The student will learn the functions of a medical office insurance processor and the importance of submitting claims in a timely manner. Without properly trained insurance processors, companies may not receive the maximum benefits for all services rendered.

Measurable Learning Outcomes

Upon successful completion of this course, the student will be able to:

  1. Explain the billing cycle process.
  2. Discuss the rules and regulations, HIPAA, and OIG.
  3. Differentiate between various types of payers and the processes required to submit a claim.
  4. Prepare a “clean” claim.
  5. Explain an EOB (Explanation of Benefits) for processing payments, denials, rejections, appeals, and secondary claims.
  6. Demonstrate recognition of CPT, ICD-10, and HCPCS codes.
  7. Discuss hospital claim submission.

Course Assignment

After reading the Course Syllabus and Student Expectations, the student will complete the related checklist found in Module/Week 1.

Discussion boards are collaborative learning experiences. Therefore, the student is required to submit a thread in response to the provided prompt for each forum. Each thread must be at least 250 words, demonstrate course-related knowledge, and reference the Reading & Study material. In addition to the thread, the student is required to reply to 2 classmates’ threads. Each reply must be at least 150 words.

For each Self-Reflection Journal, the student will reflect on the Reading & Study material and assignments in the assigned module/week to determine if he or she is experiencing difficulty with any of the content or has learned something that has made a profound impact on him or her. Each Self-Reflection Journal must be at least 200 words to ensure adequate depth of reflection.

Case studies present realistic, complex, and contextually rich situations that involve problems to solve and/or questions to answer. Therefore, the student will read 3 case studies and answer the questions presented in each. The student must thoroughly respond to each question, citing the textbook, journal articles, and/or popular health care publications for support. All non-textbook sources cited must have been published within the last 5 years. The Case Studies Activity must follow current APA format and include in-text citations as well as a reference page.

The student will complete Learning Activities that provide an overview of key concepts from the assigned Reading & Study material. Learning Activities will contain matching exercises, math questions, and short-essay questions. The grade assigned for each Learning Activity will be based on completion.

Research Paper

The student will complete a Research Paper in order to understand the activities and processes of a medical billing specialist. The student will research and write a paper outlining the important functions of a medical billing specialist. This 3-part assignment will consist of the following:

  1. Part 1: Preparation

The student will review the provided list of topics and submit a Resource Page indicating which 5 topics he/she will research. In addition, the student will provide at least 2 academic sources he/she will use to support the paper. Academic references include textbooks, peer-reviewed journals, .edu websites, and .gov websites (no .com, .net, .org, or blog websites for this assignment).

  1. Part 2: Draft

The student will draft a Research Paper addressing the 5 topics chosen in Part 1. The paper must be at least 1,500 words (excluding the title page and reference page).  The report should address the 5 topics chosen with information/citations from 4–5 academic references published within the last 5 years, and follow current APA format. Academic references include textbooks, peer-reviewed journals, .edu websites, and .gov websites (no .com, .net, .org, or blog websites for this assignment).

The student will submit the paper to the instructor for review. In addition, the student will submit the first draft to Discussion Board Forum 2 for classmates to review.

  1. Part 3: Final

After reviewing feedback from the instructor and classmates, the student will make the necessary revisions and adjustments to the first draft of his or her paper. The student must implement any revisions suggested by the instructor. The student will then submit the final version of his /her paper.

Each quiz will cover the Reading & Study material for the assigned module/week, except Quiz 2, which will cover the Reading & Study material for Modules/Weeks 2 and 3. Each quiz will be open-book/open-notes, contain 20 multiple-choice questions, and have a 50-minute time limit.