MEAS 204 - Advanced Insurance Claims Processing

1. List and discuss the responsibilities and skills required for the Health Insurance Specialist.
2. Describe the Health Insurance Portability and Accountability Act of 1996 and how it defines insurance fraud and abuse.
3. Explain the reimbursement methods used by different insurance companies.
4. Code accurately using the ICD-10, CPT, and HCPS coding systems at an advanced level.
5. Complete claim forms accurately using both paper copy and computer.
6. Describe electronic claims processing.
7. Analyze and compare EOB’s from the major insurance carriers.
8. Explain claims tracking and follow-up as they relate to aged accounts.
9. Explain the use of insurance bulletins, journals, and seminar data.
10. Describe the process and importance of obtaining prior authorization (referrals) on behalf of patients.
11. Explain the process of updating patient information and changing a patient’s insurance electronically.
12. List the steps needed when a patient has multiple insurance companies.
13. Describe Medicare and Medicaid processing, appeals, refunds and verification.
14. Write appeals letters to insurance companies with justification of coding applications.
15. Explain what is needed for a contractual write-off.
16. Describe remittance codes.

• Job duties of the Health Insurance Specialist
• Vocabulary used in healthcare insurance and medical billing
• HIPAA and its application to health insurance and medical billing
• Collection of patient information
• Updating patient information
• Medicare guidelines for insurance processing
• Medicaid guidelines for insurance processing
• Currently used coding systems including CPT, ICD-10, and HCPS
• Major insurance companies and their policies and procedures
• Analyzing the insurance members’ ID
• Accurate submission of claims
• Analyzing the EOB and remittance code
• Pre-authorization and referral
• Appeal letters
• Refunds to patient and insurance companies
• Write-offs items

 
Course Addendum - Syllabus (Click to expand)