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AHE 223 - Advanced Medical Insurance Billing
Credits: 6
Variable Credit Course: No
Lecture Hours: 44
Lab Hours: 44
Worksite/Clinical Hours: 0
Other Hours (LIA/Internships): 0
Course Description: Application of professional skills in evaluating medical records for accuracy and completeness in various health care settings. Preparing UB-04 and CMS-1500 claims for health insurance plans.
Prerequisite: AHE 221 and AHE 222 with a C or higher.
Strongly Recommended:
Special Requirements:
Meets FQE Requirement: No
Integrative Experience Requirement: No
Student Learning Outcomes
- Describe the billing guidelines for medical/surgical services and procedures provided in the inpatient and outpatient setting.
- Summarize the life cycle of an insurance claim and explain the processing steps to be completed before submitting to the insurance company.
- Accurately prepare UB-04 and CMS-1500 claim forms utilizing third-party payer guidelines to minimize rejection by insurance companies.
- Calculate patients’ reimbursement and payment methods to determine if the payment is correct.
- Assess the billing rules for a variety of insurance systems and scenarios (Medicare, Medicaid, commercial insurance, Blue Cross Blue Shield, VA).
- Analyze the financial impact of correct vs. incorrect coding on reimbursement outcomes.
- Demonstrate sensitivity in communicating with both providers and patients.
- Discuss comprehension of legal and ethical issues related to medical insurance.
Course Contents
- Organizing, analyzing, and technically evaluating a variety of health care records for billing purposes.
- Assignment of correct codes to diagnoses.
- Assignment of correct codes to procedures.
- Completion of UB-04 and CMS-1500 claim forms.
Instructional Units: 7
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