Jun 13, 2024  
2023-2024 Academic Catalog 
2023-2024 Academic Catalog Archived Catalog

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AHMS 156 - Medical Billing Fundamentals

Credit(s): 3

The most common commercial, managed care and federal health insurance plans in the U.S. will be discussed. Billing processes and procedures as well as legal, regulatory, and ethical issues in health insurance will also be covered. (Fall Semester)

Course Learning Outcomes: Upon completion of the course, students will be able to
  • 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.

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