HIT 112 - Health Insurance and Medical Billing

3 Contact Hours, 3 Credits
3 lecture periods 0 lab periods

Overview of health insurance and medical billing. Includes principles of health insurance and medical billing, health insurance contracts, claim processes, insurance terminology, CMS-approved abbreviations, and symbols. Also includes case studies for the completion of CMS-1500 and UB-04 billing claim forms.

Recommendation: Completion of HIT 100 and HIT 105 are recommended before enrolling in the course. If any recommended course is taken, see a financial aid or Veteran’s Affairs advisor to determine funding eligibility as appropriate.

Course Learning Outcomes

Apply policies and procedures for the use of data required in healthcare reimbursement.
Evaluate the revenue cycle management process.
Describe inter-organizational relationships across the healthcare delivery system.
Employ ethical standards of practice.

Outline:

Principles of Health Insurance and Medical Billing
1. Introduction to health insurance
2. Overview of medical billing and HIPAA
Health Insurance Contracts
1. Characteristics of a valid insurance contract
2. Federal, State, and private insurance plans
3. Importance of insurance claims completion, coding, and billing
4. Insurance problem solving
5. Common insurance terms
Claims Process
1. Insurance claims register or log
2. Submit claims and know time limits for submitting claims
3. Claims forms preparation
4. CMS claim forms
5. Importance of documentation
Insurance Terminology, Abbreviations, and Symbols
1. Common insurance terms
2. Common diagnostic and legal terms
3. Abbreviations
Client Eligibility and Reimbursement Processes
1. Medical billing software
2. Medical billing procedures
3. Encounter forms and updates
4. Submitting claims and EDI
5. Collection processes and strategies
6. Charge, bill, and receive
7. Co-payments