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MBC211 - Health Insurance Claims/Medical Software
This hands–on course introduces students to the relationship among patient, health care provider, and insurance carrier specifically as it relates to fee–for–service and capitation payment reimbursement systems. Students acquire and practice the skills necessary to process insurance claims forms and related forms such as referrals, pre–authorizations, registrations, and the CMS–1500 Provider Billing Claim form. Students study the difference between health care and medical care and learn the different managed care models. They facilitate the registration insurance claims process for a new or established patient and differentiate between manual and electronic claims processing procedures. Students also learn to understand the remittance advice process and explanation of benefits. This course also provides students with the skills required to accurately bill Medicare, Medicaid, and TRICARE for health care provider reimbursement. Students learn the health care coverage offered by Medicare Parts A–D and the integral requirements for reimbursement.