AHMS 156 - Medical Billing Fundamentals

• Apply legal, ethical and regulatory guidelines in health insurance and patient billing.
• Summarize the importance of HIPAA and other compliance strategies and the applications in medical billing and reporting, including confidentiality, information security, and privacy.
• Complete CMS-1500 claim forms accurately for commercial, managed care, and federal health insurance plans such as Medicare, Medicaid, TRICARE, Worker’s Compensation, and BlueCross/Blue Shield.
• Evaluate and perform billing processes and procedures with claims, EOB, ABN, and electronic data interchange.
• Reflect the complexities of managed care programs, reimbursement monitoring and reporting.
• Accurately calculate expected payments using payment methodologies and systems such as capitation, prospective payment systems, fee schedules, deductible, RBRVS, and DRGs.
• Use appropriate, effective techniques to trace delinquent claims and file appeals for denied claims.
• Outline the process of hospital billing and the forms and fee structures.
• Apply and interpret medical language appropriately in all areas of medical billing and electronic health records.
• Maintain charge master records to ensure complete, accurate, and compliant billing services.