Maricopa Community Colleges  HSE107   20032-99999 
Official Course Description: MCCCD Approval: 11/26/02
HSE107 20032-99999 LEC 3 Credit(s) 3 Period(s)
Medical Billing for Practice Management II
Expanded examination of medical office staff responsibilities related to medical service coding, billing and reimbursement. Utilization of medical billing software to organize provider information, create billing tables, and enter patient demographics, charges, and payments. Application of grievance and appeals processes. Prerequisites: Employment in a health services setting is suggested but not required, or permission of instructor.
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MCCCD Official Course Competencies:
 
HSE107   20032-99999 Medical Billing for Practice Management II
1. Describe the responsibilities related to medical office staff and their performance of duties related to medical billing and reimbursement. (I)
2. Identify common medical billing terminology and practices. (II)
3. Explain patient eligibility and benefit verification processes. (II)
4. Describe and utilize patient demographic information, medical account related waivers, insurance contract information, provisions and coverage. (II)
5. Select appropriate complex codes and modifiers for specialty medical coding. (II, III)
6. Describe provider compliance plans, governmental regulations, Health Insurance Portability and Accountability Act (HIPAA), and penalties specific to medical billing fraud and abuse issues. (III)
7. Explain the grievance and appeals process. (III)
8. Use medical service billing software to create data tables and enter provider information. (IV)
9. Utilize patient demographics, service charge data, insurance information, and payment data. (IV)
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MCCCD Official Course Outline:
 
HSE107   20032-99999 Medical Billing for Practice Management II
    I. Medical Office Staff Management
        A. Positions & Responsibilities
        B. Utilization and Job Descriptions
        C. Professional Certification, Affiliations and Networks
      II. Medical Insurance & Billing Information
          A. Common Billing Terminology
          B. Patient Eligibility
          C. Benefit Verification Processes
          D. Insurance Contract Information, Provisions and Coverage
          E. Patient Demographics
          F. Medical Account Waivers
        III. Compliance Issues
            A. Provider Compliance Plans
            B. HIPAA Regulations
            C. Medical Billing Fraud and Abuse
            D. Grievance and Appeals Process
          IV. Medical Billing Software Application
              A. Creation of Individual Data Tables
              B. Provider Information
              C. Patient Demographics
              D. Service Charge Data
              E. Insurance Information
              F. Payment Data
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