This course reviews the different types of insurance programs, payer specific guidelines, and reimbursement issues. This will include review of diagnostic and procedural coding and Medicare Severity Diagnosis Related Groups (DRGs), as well as explanation of the Resource Based Relative Value Scale (RBRVS), Ambulatory Payment Classifications (APCs), and the National Correct Coding Initiative (NCCI). Review of insurance claims processing steps, patient billing, payment determinations, and calculations for insurance and private pay payments, and interpretation of the explanation of benefits (EOB) are integral parts of this course. Through application exercises, the student will evaluate and respond to claims denials and site resubmission requirements and will endorse the ability to process appeals. A review of insurance plans and regulations, insurance math, claims administration organizations, billing concepts, and terminology associated with accounts receivable and accounts payable are integrated into the course.
Prerequisites
MOA115