Course Description

In this course, the student will be provided information on managing the “inner core of the office” with particular emphasis on filing insurance claims, maintaining facilities and supplies and managing payroll, utilizing a didactic method of instruction.

Learner Outcomes

Student Learning Objectives (SLOs):
A. Identify and accurately complete various private medical insurance plans used in Hawaii in addition to Medicaid, Worker’s Compensations, and Medicare forms.
C. Perform point-of-service collection.
D. Comprehend billing indicators for the UB-04 and CMS 1500 billing forms.
E. Perform accounts payable and receivables procedures.
F. Verify payer plan coverage (e.g. governmental payers, third party liability, and insurance eligibility).
G. Identify data elements necessary for accurate billing (e.g. occurrence codes, condition codes, diagnosis, CPT).
H. Post adjustments and non-sufficient funds (NSF).
I. Process credit balances and refunds.
J. Comprehend the effect of the Affordable Care Act (e.g. HMO, PPO, POS, the exchange).
K. Determine coordination of benefits.
L. Apply third-party guidelines.
M. Obtain managed care referrals and pre-certification.
N. Perform diagnostic and procedural coding.
O. Prepare and submit insurance claims.
P. Use physician fee schedule.
Q. Collaborate with health information management (e.g. billing accounts, accounts receivable).
R. Provide and coordinate financial counseling.
S. Mitigate denials.

Applies Towards the Following Certificates

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