Catalog Course Search Details

 Department:    AHE

 Course #:    223

 Credits:    6

 Variable:     No

 IUs:    7

 CIP:    51.0713

 EPC:    313

 REV:    2024

 Course Description  

Application of professional skills in evaluating medical records for accuracy and completeness in various health care settings. Preparing UB-04 and CMS-1500 claims for health insurance plans.

 Prerequisite  

Prerequisites: AHE 221 and AHE 222 with a grade of C or higher.

Contact Hours (based on 11 week quarter)

Lecture: 44

Lab: 44

Other: 0

Systems: 0

Clinical: 0

Intent: Distribution Requirement(s) Status:  

Vocational Preparatory Required for ATA degree, Required for certificate  

Equivalencies At Other Institutions

Learning Outcomes

After completing this course, the student will be able to:

1. Describe the billing guidelines for medical/surgical services and procedures provided in the inpatient and outpatient setting.
2. Summarize the life cycle of an insurance claim and explain the processing steps to be completed before submitting to the insurance company.
3. Accurately prepare UB-04 and CMS-1500 claim forms utilizing third-party payer guidelines to minimize rejection by insurance companies.
4. Calculate patients' reimbursement and payment methods to determine if the payment is correct.
5. Assess the billing rules for a variety of insurance systems and scenarios (Medicare, Medicaid, commercial insurance, Blue Cross Blue Shield, VA).
6. Analyze the financial impact of correct vs. incorrect coding on reimbursement outcomes.
7. Demonstrate sensitivity in communicating with both providers and patients.
8. Discuss comprehension of legal and ethical issues related to medical insurance.

General Education Learning Values & Outcomes

Revised August 2008 and affects outlines for 2008 year 1 and later.

Course Contents

1. Organizing, analyzing, and technically evaluating a variety of health care records for billing purposes.
2. Assignment of correct codes to diagnoses.
3. Assignment of correct codes to procedures.
4. Completion of UB-04 and CMS-1500 claim forms.