Unit One: Insurance Handbook for the Medical Office (Chapters 1-3) (revie for this eek)

Lecture Notes for October 1, 2013 (Side notes: library- use online library search, proquest use apa hen citin! al ays ha"e a han!in! indent for apa teacher is "ery particular about doin! assi!n#ents she doesn$t people ho slac% off, if there is ti#e at the end of each ee% she ill !o o"er qui&es'

!ole of "illin# $pecialists "ack#round of insurance clai%s& codin#& and billin#

Medical insurance professionals deal ith all aspects of clai% sub%ission ' o %ain t(pes of billin# )acilit( billin# Hospitals rehabilitation centers ect

*on +h(sician +roviders (*++ aka +, or ph(sician assistance) +a(%ent schedules are based on pa(er t(pe Man#er care

-orkers co%pensation Medicare Under Medicare ph(sicians are based on relative value units (!.$)

!ole of the insurance billin# specialist "illin# specialist /lectronic clai%s processor Medical biller !ei%burse%ent specialist Medical billin# representative $enior billin# representative Multi skilled Health +ractioners (M$H+s) Cross trained to provide %ore than one function

Office procedures $chedulin# appoint%ents

 !e#isterin# patients 0ocu%entin# encounter /nterin# char#es )ilin# infor%ation "ookkeepin# accountin# /ducation and trainin# re1uire%ents

Career advanta#es $elf e%plo(%ent or independent contractin# )le2ible hours 0isabled orkers !ehabilitation ,ct ensures access to infor%ation technolo#(

3ualifications& personal i%a#e& behavior $kills

 Medical ter%inolo#( and abbreviations anato%( ph(siolo#( disease and treat%ent ter%s Codin# readin# skills "asic %athe%atics %edico le#al rules and re#ulations of various insurance pro#ra%s '(pin# and ke(boardin# skills proficienc( and speed

Medical eti1uette and %edical ethics /ti1uette- ho professionals conduct the%selves /thics- standards of conduct #enerall( accepted as %oral #uides for behavior ,M, principles of Medical ethics +h(sicians should be dedicated to providin# co%petent %edical service +h(sicians should deal ith patients and colle#es ith honest( and di#nit( and ill e2pose and collea#ues ho en#a#e in fraud or deception , ph(sician shall respect the ri#hts of the patients

,HIM, code of ethics

/%plo(er liabilit(& e%plo(ee liabilit(& and scope of practice +h(sicians are le#all( responsible for staff actions .icarious liabilit( or respondeat superior ,ction of the insurance biller %a( be le#al ra%ifications /%plo(er liabilit( 4 billers and coders can be held personall( responsible for billin# errors /rrors and o%issions insurance is protections for errors and unintentional o%issions $cope of practice C,+: clai%s assistance professional Infor%al representative of patients ,ssist in obtainin# rei%burse%ent

 )uture challen#es 5no re#ulations 5no co%plice rules Understand state re#ulations about patient treat%ents and referrals "e proficient in co%puter skills 6earn electronic billin# soft are for each pa(er 5no ho to interpret insurance docu%ents

HI+,, Co%pliance and +rivac( in Insurance "illin# Co%pliance defined& health infor%ation usin# electronic technolo#ies Co%pliance- all re#ulations reco%%endations and e2pectations of re#ulatin# a#encies %ust %et to be in co%pliance 'he professional ele%ents of the principles and practice

 Health infor%ation %ana#e%ent (eHIM) *ational Health Infor%ation infrastructure(*HII) Health 6evel seven(H67) $(ste%i8ed no%enclature of Hu%an and .eterinar( Medicine ($*OM/0)

Health Insurance +ortabilit( and ,ccountabilit( ,ct (HI+,,)

'he privac( rule: confidentialit( and protected health infor%ation Cosines ith HI+,, +rotected Health Infor%ation (+HI) Consent for%s +atients have a ri#ht to their charts but not ri#hts to therap( treat%ent notes or infor%ation fro% le#al proceedin#s

 'ransactions and code set re#ulations Medical code sets C+'-9& IC0-:-CM& HC+C$ !e1uired for /0I $tandard Uni1ue Identifiers

'he securit( rule 'hree safe#uards Conse1uences of non-co%pliance ith HI+,, Civil Monetar( penalties(CM+) 6a Monetar( fines (civil and or cri%inal) I%prison%ent (cri%inal)

)raud and ,buse 6a s )ederal )alse Clai%s ,ct 3ui 'a% +rovision Cri%inal )alse Clai%s ,ct

 Office of Inspector ;eneral (OI;)

Introduction to Health Insurance Histor( 4 one of the orld<s lar#est businesses Health insurance offsets the cost of illness and or in=ur( /scalatin# %edical costs have li%ited insurance

($he left off on the Insurance +olic()

,ssi#n%ent 4 chapter 1 of insurance handbook for the %edical office te2tbook

0escribe the ke( =ob responsibilities of and insurance billin# specialist includin# educational and trainin# re1uire%ents in addition to %edical office eti1uette (our response should be at least >?@-3@@ ords apa for%at

'itle pa#e 3 sentence introduction 1>pt and ti%es ne ro%an or arial 0o not use italics

,ctivit( > 4 based on (our readin#s of chapter > provide a definition of HI+,, include discussion ot the e2pectations

6ibrar( !esearch of the Hi'/CH ,C' O) >@@: and its %ain AAAAAAAA provide > sources usin# librar( in apa for%at

'hin#s to re%e%ber 1B Co%plete unit 1 instruction >B Co%plete discussion and su%%ar( 1uestion and respond to another class%ate 3B Co%plete assi#n%ents *e2t class 1@CD at 9:9?