OAT 254 - Medical Insurance I

Credits: 3
Instructional Contact Hours: 3

Includes diagnostic and procedure coding, basic insurance concepts, electronic medical records, terminology used by health insurance carriers, and application of the medical office revenue cycle for reimbursement. Includes insurance claims for the major insurance carriers.

Prerequisite(s): OAT 116, OAT 243, and OAT 244 all with a grade of "C" or higher; OR OAT 116 and CMA 245 with a grade of "C" or higher if taking the course as a CMA cohort student.
Corequisite(s): None
Lecture Hours: 45 Lab Hours: 0
Meets MTA Requirement: None
Pass/NoCredit: Yes

Outcomes and Objectives

Gather information necessary to process health insurance claims.
1. Abstract necessary patient information from medical records.
2. Determine accurate diagnostic code(s).
3. Determine accurate procedure code(s).
4. Explain the critical relationship between diagnosis and procedure.
5. Identify the appropriate health insurance claim format as determined by the patient's health insurance carrier.
Complete single-carrier claims for major health insurance carriers.
1. Explain and use common insurance terminology.
2. Identify insurance coverage and complete payable insurance claims for the commercial health insurers.
3. Identify insurance coverage and complete payable claims for Michigan Blue Cross Blue Shield.
4. Identify insurance coverage and complete payable claims for Medicare.
5. Identify insurance coverage and complete payable claims for the Medical Assistance Program (Medicaid).
Demonstrate an understanding of the revenue process as it applies to the medical office.
1. Explain the critical relationship between steps in the medical office revenue cycle.
2. Apply the steps of the medical office revenue cycle to a patient encounter.
3. Identify the role of the claims processor.
4. Define the role of a chargemaster in the revenue cycle.
Demonstrate an understanding of electronic medical records.
1. Identify and describe the components of an electronic medical record.
2. Navigate within electronic medical records.
3. Enter patient information into an electronic medical database.
4. Modify patient records.
Demonstrate professionalism appropriate for the workplace.
1. Participate in class.
2. Follow written and oral directions.
3. Complete and submit assignments on time.
4. Participate constructively in activities.
5. Display civility toward other class members and the instructor.
6. Demonstrate academic integrity.