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MIS 105 - Medical Insurance Applications


Credits: 2
2 Lecture Hours

Prerequisites: MIS 100  

 
Description
This course is designed to study the post-adjudication claims process including patient liability issues, bankruptcy and estate claims. Emphasis is placed on knowledge and skills essential to problem solving rejected or pended medical claims, false claims and Medicare/Medicaid regulation compliance. Case studies involving the Explanation of Benefits Summary are analyzed. Credit and collection laws as they pertain to patient liability situations will also be addressed. This course requires a per credit health career fee; Check the tuition and fee schedule for the current rate.


Learning Outcomes
Upon successful completion of the course, the student will:

  1. Examine current healthcare business trends and healthcare systems.
  2. Analyze rejected medical insurance claims and effect a solution.
  3. Review Explanation of Benefits and formulate an effective appeal for reimbursement.
  4. Apply credit and collection laws to patient liability situations.
Listed Topics
  1. Trends and issues in healthcare delivery systems and reimbursement issues
  2. Medical insurance claim monitoring and the adjudication process
  3. Explanation of Benefits
  4. Credit and collection laws, bankruptcy and estate claims
Reference Materials
Textbook, handouts, guest speakers, etc.
Approved By: Johnson, Alex Date Approved: 04/28/2010


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