CMA 143 Reimbursement in Healthcare

Covers the evolution and function of health insurance. Includes Medicare, Medicaid, commercial, and managed care. Develops knowledge of coding including HCPCS (Healthcare Common Procedure Coding System), CPT (Current Procedural Terminology), and ICD-10 (International Statistical Classification of Diseases). Covers how to understand, prepare, and process claims. Emphasizes computation skills necessary for payment and reimbursement.

Credits

Notes

Career Technical Education (CTE) Course

General Education Requirements

AAS Math/Computation

Outcomes

Identify types of insurance plans and models of managed care currently deployed in the health related insurance field. Apply third party insurance guidelines to complete and process insurance claim forms after performing basic mathematical calculations, obtaining exact answers to claims processing functions, and determining whether those answers are reasonable. Communicate results of claims processing using mathematical processes and concepts that demonstrate the following: copay, coinsurance, write-off/discount, primary insurance payment, secondary insurance payment, patient responsibility. Demonstrate competency in applying RVUs (Relative Value Units), RBRVS (Resource Based Relative Value System), and DRGs (Diagnostic Related Groups). Describe how to use the most current procedural, HCPCS level II and diagnostic coding classification system. Perform procedural and diagnostic coding.