Official Course Description: MCCCD Approval: 05/25/04
HSE122 20046-99999	LEC	1 Credit(s)	1 Period(s)
Medical Office Referral/Authorization Coordination
Duties and responsibilities of referral/authorization staff in the medical practice setting. Patient and insurance carrier contacts and pre-certification processes. Patient data management as it relates to obtaining service approvals, medical service billing and collections activities. Certifications and affiliations in medical reception/admissions. Governmental regulations related to national Patient Privacy Act and penalties for inappropriate disclosure. Prerequisites: None.

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MCCCD Official Course Competencies:
HSE122   20046-99999	Medical Office Referral/Authorization Coordination

1.	Describe the job description and areas of responsibility of referral/authorization medical office staff. (I)
2.	Identify certifications and professional affiliations in medical reception/admissions. (I)
3.	Describe phone management practices with patients and insurance carriers. (II)
4.	Describe methods of verifying patient eligibility and coverage. (II)
5.	Discuss insurance carrier contract provisions. (II)
6.	Discuss surgery scheduling forms and patient consent forms. (II)
7.	Discuss medical documentation forms, templates and electronic medical records. (II)
8.	Describe the role of the referral coordinator in patient chart management. (II)
9.	Define medical terminology as it relates to pre- certification/authorization process. (II)
10.	Explain diagnosis coding in the pre- certification/authorization process. (II)
11.	Discuss HIPAA (Health Insurance Portability and Accountability Ac), and the Patient Privacy Act and penalties for inappropriate data disclosure. (II)

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MCCCD Official Course Outline:
HSE122   20046-99999	Medical Office Referral/Authorization Coordination

I. Employee Status A. Employee documentation forms B. Job descriptions C. Certifications and professional affiliations II. Medical information and contact with the public A. Phone contact with the insurance carrier and patients B. Patient eligibility and verification of coverage C. Insurance carrier contract provisions D. Patient consent forms E. Forms, templates and electronic medical records F. Referral coordination/patient chart management G. Medical terminology and diagnosis codes H. HIPAA, Patient Privacy Act and Data/Chart Management

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