MDA 128 - Medical Billing and Insurance for Medical Assistants

1. Identify and understand the different types of medical insurance plans and guidelines associated with each plan.
2. Accurately complete and submit claims forms to assure reimbursement from third party payers.
3. Follow established and accepted guidelines for bookkeeping, accounting, and banking procedures.

1. Third Party Reimbursement
   1. Cognitive
      1. Types of third party insurance plans
         1. Government funded
            1. Medicare
            2. Medicaid
         2. Commercial
            1. HMO Managed Care
            2. Indemnity
      2. Insurance card information
   2. Psychomotor
      1. Process and documentation
         1. Eligibility
         2. Precertification
         3. Preauthorization
         4. Patient referrals
      2. Third party claim forms
         1. Completing a claim form
         2. Filing a claim
2. Concepts of Effective Communications
   1. Cognitive
      1. Patient financial obligations for services rendered
      2. Relevant information (concise and accurate)
   2. Psychomotor
      1. Accurate patient billing information
      2. Sensitivity when communicating with patients regarding third party requirements
      3. Professional interactions with third party representatives
   3. Affective
      1. Tactful behavior when communicating with medical providers regarding third party requirements
      2. Sensitivity when requesting payment for services rendered
      3. Discussing patient’s billing record professionally
3. Basic Practice Finances
   1. Cognitive
      1. Patient’s billing record information
      2. Bookkeeping terms:
         1. Charges
         2. Payments
         3. Accounts receivable
         4. Accounts payable
         5. Adjustments
      3. Banking related to the ambulatory care setting
      4. Bank deposits
   2. Psychomotor
      1. Posting accounts receivable to patient accounts
         1. Charges
         2. Payments
         3. Adjustments
      2. Adjustments made to patient accounts
         1. Non-sufficient funds (NSF) check
         2. Collection agency transaction
         3. Credit balance
         4. Third party
      3. Utilize an EMR
4. Legal Implications
   1. HIPAA rules
   2. Privacy
   3. Release of information
   4. Protect the integrity of the medical record