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Understanding Health Insurance:
A Guide to Professional Billing

Online Courseware

Introduction

The accurate processing of health insurance claims has become more exacting, while at the same time health insurance plan options have rapidly expanded. These changes, combined with modifications in state and federal regulations affecting the health insurance industry, are a constant challenge to medical office personnel. Those responsible for processing health insurance claims require thorough instruction in all aspects of medical insurance, including:

  • plan options
  • carrier requirements
  • state and federal regulations
  • abstracting relevant information from source documents
  • completing claim forms accurately
  • coding diagnoses and procedures.

This online course, Understanding Health Insurance, A Guide to Professional Billing, provides the required information in a clear and comprehensive manner.

Objectives

The objectives of the online course are to:

  1. Introduce information about major insurance programs and federal health care legislation.
  2. Provide a basic knowledge of national diagnosis and procedure coding systems.
  3. Simplify the process of completing claim forms

This online course is designed for use by college and vocational school programs to help medical assistants, medical insurance specialists, and health information technicians acquire basic skills in health insurance claims preparation. It can also be used as an in-service training tool for new medical office personnel and independent billing services, or individually by claims processors in the health care field.

Features of the Course Content

Major features of this online course include:

  • Content that is divided into seventeen modules identified in the Main Menu.
  • The Table of Contents for each module orients the learner to the major divisions of content covered. Each content topic links to the related head in the Module.
  • Learning objectives at the beginning of each module help organize the material. The objectives can be used as a self-test for checking comprehension and mastery of the content.
  • Key terms and abbreviations, highlighted throughout the module, are defined in the module glossary to help learners master the technical vocabulary associated with claims processing. Clicking on a key term or abbreviation takes the learner to the glossary term. Terms from all modules are also provided in a comprehensive course glossary. A comprehensive list of abbreviations is also provided as a resource.
  • At the conclusion of each module topic head, a "Check Your Understanding" section contains exercises with various types of questions that provide an opportunity to apply concepts and skills immediately. The learner will see results/feedback for all questions.
  • Numerous examples are provided in each module to illustrate the correct application of rules and guidelines.
  • Audio-vignettes (Commonly Asked Questions) in each module provide clarification about key concepts. The learner can listen to the Q & A session as well as read the content in a pop-up text box.
  • Coding exercises are located within the respective coding modules: ICD-9-CM Coding, CPT Coding, and HCPCS Coding.
  • Coding Tips provide practical suggestions for mastering the use of the CPT and the coding manuals.
  • Module Reviews reinforce learning and identify topics requiring further study. The learner will answer each question, see feedback, and will be able to review content by linking to the topic head. No score is provided.
  • Web links are included in each Module so that learners can research the latest information about insurance claims processing. A comprehensive Web links resource lists links in alphabetic order and by module for easy access to information.
  • A Practice Section includes Quizzes and Games for each Module.
    • Two standard quizzes are provided per Module. For each question answered, the learner will see feedback for correct and incorrect answers. A score will be provided and recorded in the grade book.
    • CMS Quizzes (for Modules 11-17) give learners the opportunity to complete CMS-1500 claim forms by abstracting information from patient encounter forms and medical reports. Two levels of application (case studies) are provided: (1) patient encounter forms include all information required to complete the CMS-1500 form (including diagnosis and procedure codes); (2) patient encounter forms and medical reports provide all information needed, except the actual diagnosis and procedure codes. Learners use information provided to locate the proper codes in the ICD-9-CM and CPT-4 coding manuals.
    • Several types of games are provided to help learners master vocabulary and key concepts. Games include Tic-Tac-Toe,Hangman, Flashcards, and Crossword Puzzles
  • An Exam Section includes exams for each Module. Feedback is not provided for the exam; learners receive a grade at the conclusion of the exam. The grade is recorded in the grade book.

Special appreciation is expressed to Medicode, St. Anthony Publishing, and Ingenix Publishing for granting permission to reprint selected tables and pages from:

  • Medicode HCPCS
  • St. Anthony Publishing Illustrated ICD-9-CM Code Book for Physician Payment
  • St. Anthony Publishing Medicare Correct Coding & Payment Manual

 


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