BUSINESS ADMINISTRATION AND INFORMATION TECHNOLOGY
COURSE: BT00106
Medical Insurance
SYLLABUS
AND
LEARNING ACTIVITY PACKET
NAME: ______
DATE COURSE STARTED: ______
DATE COURSE COMPLETED: ______
INSTRUCTOR'S SIGNATURE REQUIRED (on completion of course):
______
*Please submit this signed sheet to your Instructor upon completion of the course. It will be placed in your file as documentation showing you completed the course.
ATTENTION: This packet serves as an overall directive for the above course. It includes information on everything you need to do to successfully complete the course. Please read everything in it and complete all assignments. If you have any questions, please do not hesitate to consult the classroom manager or your instructor.
Business, Management, & Administration Cluster
Medical Insurance Syllabus
Course Title: Medical Insurance
Course Number: 8424
Pre-requisite: Patient Billing
Locations: Various Technology Centers across Oklahoma
Length: 180 hours (55 hours theory/125 lab hours)
Instructor: Penny Lovell
Possible Career Outcome: Medical Office Assistant, Medical Administrative Assistance, and/or Medical Secretary Certification
Course Description: Basic functions of processing medical insurance claims. A computer-based training program guides students through the insurance claim form cycle and focuses on the areas in which medical office assistants encounter the greatest difficulties. Students are introduced to information about major insurance programs and federal health care legislation.
Specific Learning Competencies - Upon successful completion of this course, the student will be able to:
Medical Insurance Concepts
· Discuss the major types of health plans and how the various structures affect the payments that patients owe for medical services.· Define the following terms: referral, deductible, pre-certification, capitation fee, and Medicare Part A.
· Identify the provisions of HIPAA that makes it illegal for group health plans to knowingly discriminate against individuals based on health-related factors
· Determine which types of insurance require pre-authorization
· Determine which groups are excluded from Medicaid cost sharing
· Identify the procedures for predetermination of benefits for dental plans
· Determine which type of medical plans are designed to make the greatest use of managed care
· Determine what groups are Medicaid eligible
· Identify the advantages of HMO and PPO plans
· Identify what group of doctors are typically primary care physicians
· Explain how diagnostic coding affects the payment process.
· Explain the main difference between indemnity plans and managed care plans.
General Knowledge
· Determine individual identifiers
· Determine reasonable safeguards to protect privacy of individual’s medical information in either electronic or paper form
· Identify the actions a covered entity must take to de-identify a dataset that contains protected health information
Impacted Areas
· Define covered entities including software companies
· Identify items contained in a covered entity’s notice of privacy practices
· Define policy and procedures for hybrid entities
· Determine the transition period for existing written business associate agreements
· Define business associates agreements
· Define minimum necessary guidelines in the HIPAA Privacy Regulations
· Identify the safeguards necessary for protected health information
· Determine the appropriate disclosure of patient information when contacting patients regarding lab results
· Determine which information is exempt from inclusion in a patient authorization or consent form
· Identify the Protected Health Information guidelines, timeframes, and restrictions in marketing and in research
Implementation
· Identify which agency is responsible for enforcement of HIPAA Privacy Regulations· Determine which members of the workforce are required to participate in HIPAA training
· Determine which type of legal organizations are exempt from HIPAA regulations
· Identify the procedures and timeline for documenting HIPAA compliance
· Identify the compliance date for HIPAA Privacy Rules for various the types of organizations
· Determine how the Office of Civil Rights is notified of HIPAA violations
· Determine the resources available for implementing compliance
· Determine which training approaches meet HIPAA compliance
· Identify health care organizations as defined by HIPAA
· Determine when incidental disclosures of protected health information are permissible
· Identify a hybrid organization
· Determine which position must be created in the HIPAA privacy regulations
Regulatory Environment
· Identify how often the Department of Health and Human Services is permitted to change or update the regulations once the effective date of HIPAA privacy regulations have passed
· Determine which privacy rules prevail based on which state provides more patient protection and what state prevails when multiple states are involved
· Identify which federal organization the Office of Civil Rights falls under
· Determine what qualifies a provider as a covered entity
· Identify egregious violations of the HIPAA statue that have criminal penalties
Workplace Privacy
· Define the Final Privacy Rule
· Determine organizations that are exempt from developing notice of privacy practices or having to track disclosures of patient information
· Define non-routine disclosure of personal health information
· Identify the primary purpose of the disclosure accounting provisions
· Determine the procedures for developing a notice of privacy practices to include emergency treatment situations
· Determine the minimum necessary HIPAA privacy regulations for medical professionals to access patient records
· Determine if utilizing funding raising databases for previous fundraising history fall under the HIPAA rules
· Define incidental release
· Determine which situations are covered under release of information for public health purposes
· Identify how to make sign-in sheets HIPPA complaint
Instruction:
55 Hours Theory/ Certification Preparation and Attainment
125 Hours Lab
Methods of Instruction include:
(Choose method(s) of instruction – examples are: lectures, Medical Terminology software, class discussions, hands-on training, demonstrations, projects and performance evaluation.)
Required Brainbench Certifications (or equivalent industry certification):
§ Health Insurance
Recommended Additional Competency Testing:
§ Health Care Industry Knowledge
Textbook
Medical Insurance: An Integrated Claims Approach ISBN 10: 0-07-340203-6
Learning Activities
You will be completing the chapters featured in this book under the Contents featured on pages iii-x of this book.
Welcome to the fourth edition of Medical Insurance. This program introduces you to the concepts, knowledge, and skills you will need for a successful career in medical insurance. Medical billing is one of the 10 fastest-growing allied health occupations. This employment growth is the result of the increased medical needs of an aging population, advances in technology, and the growing number of health practitioners.
There are three objectives to keep in mind as you study Medical Insurance:
1. Knowledge of procedures—including the administrative duties important in medical practices and an understanding of how to bill both payers and patients.
2. Communication skills—effectively working with physicians, patients, other members of the health care team, and payers using written and oral communications.
3. Health information management skills—using computer technology, both software programs and the Internet, to manage patients’ records and the billing/collections process, electronically transmit claims, conduct research, and for communications.
Evaluation
· Performance Objective: The student will demonstrate competency in electronic spreadsheet theory and applications by correctly completing the assignments listed in the LAP and scoring 85% or above on all exams and projects.
The student will be evaluated on the completion of each stated assignment in the LAP. Test and project grades will be recorded and combined with other scores for the grading period. These grades are weighted at 100% of student's final grade for each nine-week period. (See Program Handbook)
NOTE: The student must score 85% or above on each test and project to proceed to the next section of the course.
Medical Insurance Syllabus
Revised January 9, 2012 Page 1