MCCCD Official Course Competencies:

HSM128  20022-20024

Medical Billing for Practice Management

1.

Describe the responsibilities of medical office management relating to medical billing and reimbursement. (I)

2.

Identify professional certifications and affiliations available to the medical biller. (I)

3.

Define specific medical billing terminology. (II)

4.

Explain provider compliance plan review, governmental regulations, and penalties specific to medical billing fraud and abuse. (III)

5.

Explain patient eligibility and benefit verification processes. (II, IV).

6.

Describe specific insurance contract provisions and coverages. (II, IV)

7.

Identify the most common reimbursement methods utilized by insurance payers. (IV)

MCCCD Official Course Outline:

HSM128  20022-20024

Medical Billing for Practice Management

I. Medical Billing Management

A. Utilization of staff

B. Accurate job descriptions

C. Professional affiliations

D. Professional certifications

II. Billing Process

A. Terminology

B. Contractual components

C. Eligibility verification

D. Benefits verification

E. Claim forms

F. Explanation of benefits

III. Fraud and Abuse Concerns

A. Federal government requirements and sanctions

B. Compliance review programs

IV. Health Care Insurance Payers

A. Benefits/Programs

B. Eligibility and identification

C. Reimbursement methods