AMA205 - Medical Claims Processing

This course provides the student instruction in the processing and management of insurance claims for patients, providers, and insurance companies. The student will analyze and process the insurance claim, all the while checking for accurance and validity. Accurate record keeping and follow-up will be emphasized. HIPAA will be adhered to at all times. This course will be one of several that will summarize the test standards and information in order for the student to pass the National HealthCareer Billing and Coding Certification examination.

Credits: 4

Distribution: Career Training

Outcomes

  1. Identlify major laws, regulations and administrative agencies relevant to medical billing and coding.
  2. Apply procedures for transmitting claims to third-party payers.
  3. Ensure accurate collection of appropriate patient demographic and insurance information.
  4. Compare and contrast government and private insurance.
  5. Adhere to HIPPA, the Stark Law, the Fair Debt Collection Act, and the False Claims Act.
  6. Compare and contrast preauthorized, precertification and predetermination.