hcr230 | undergraduate

Claims Preparation II: Footing The Bills

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This course continues medical records processing instruction. Topics focus on the background, knowledge and skills related to private payers, Medicare, Medicaid, TRICARE, CHAMPVA, workers compensation and disability. Claims processing includes payments, appeals, and secondary claims; patient billing and collections; hospital billing and reimbursement.

This undergraduate-level course is 9 This course is available as part of a degree or certificate program. To enroll, speak with an Enrollment Representative.

Course details:

Credits: 3
Continuing education units: XX
Professional development units: XX
Duration: 9

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    Hospital Billing and Reimbursement

    • Discuss the importance of written consent.
    • Compare inpatient and outpatient coding.
    • Compare inpatient and outpatient hospital services.

    Policies and Procedures

    • Compose a medical office financial policy.
    • Illustrate the claims adjudication process.

    Private Payers, Blue Cross and Blue Shield

    • Compare cost control strategies of employer-sponsored and self-funded health plans.
    • Summarize group health eligibility, portability and required coverage.
    • Describe participation program compensation and billing.
    • Explain features of private payer and consumer-driven health plans (CDHP).


    • Discuss Medicare eligibility.
    • Discuss the impact of Medicare incentive programs.
    • Summarize Medigap insurance.


    • Describe Medicaid eligibility and coverage.
    • Explain how Medicaid covered charges are determined.
    • Discuss effects of the Welfare Reform Act on Medicaid eligibility.


    • Explain TRICARE eligibility and cost sharing requirements.
    • Describe CHAMPVA coverage.
    • Describe features of TRICARE and its subsidiaries.
    • Explain TRICARE provider and non-provider charges.

    Worker’s Compensation and Disability

    • Describe features of federal and state workers' compensation plans.
    • Categorize work-related injuries.

    Payments, Appeals, and Secondary Claims

    • Evaluate the effectiveness of the RA/EOB in the claim adjudication process.
    • Discuss Medicare post payment audits.
    • Describe the purpose of the general appeals process.

    Patient Billing and Collections

    • Illustrate the collection process.
    • Explain uncollectible accounts and record retention.
    • Determine guidelines for patient accounts.
    • Outline effective financial policies and procedures for medical offices.
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    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.