hcr203 | undergraduate

Medical Claims Processing And Compliance

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This course is designed to provide students with an understanding of the management of patient records through the practices and processes of filing claims. Students will focus on the knowledge and skills essential for completing insurance claim forms in the health care setting. HIPAA and compliance requirements will also be covered.

This undergraduate-level course is 5 weeks To enroll, speak with an Enrollment Representative.

Course details:

Credits: 3
Continuing education units: XX
Professional development units: XX
Duration: 5 weeks

topic title goes here

    Patient Billing and Collections

    • Explain uncollectible accounts and record retention.
    • Describe effective financial policies and procedures for patient accounts in medical offices.
    • Explain the collection process.

    HIPAA and Compliance

    • Describe the purposes and provisions of HIPAA.
    • Identify HIPAA requirements for electronic claims.
    • Discuss social, legal, and ethical ramifications of HIPAA violations.
    • Discuss how medical compliance plans limit liability.

    Health Care Claim Preparation and Transmission

    • Review the basic steps in the medical billing process.
    • Explain the importance of preparing and submitting “clean claims.”
    • Compare papers versus electronic claims submission.

    Claims Submission

    • Compare the role of HIPAA 837 with CMS-1500 in the claim process.
    • Complete a CMS-1500 claim form.
    • Discuss the UB-04 form.

    Claims Denials and Appeals

    • Evaluate the effectiveness of the RA/EOB in the claim adjudication process.
    • Identify reasons for claims denials.
    • Describe the purpose of the general appeals process.
    Tuition for individual courses varies. For more information, please call or chat live with an Enrollment Representative.

    Please ask about these special rates:

    Teacher Rate: For some courses, special tuition rates are available for current, certified P-12 teachers and administrators. Please speak with an Enrollment Representative today for more details.

    Military Rate: For some courses, special tuition rates are available for active duty military members and their spouses. Please speak with an Enrollment Representative today for more details.

    The University of Phoenix reserves the right to modify courses.

    While widely available, not all programs are available in all locations or in both online and on-campus formats. Please check with a University Enrollment Representative.

    Transferability of credit is at the discretion of the receiving institution. It is the student’s responsibility to confirm whether or not credits earned at University of Phoenix will be accepted by another institution of the student’s choice.