MDA 208 - Medical Financial Management

 
Co-requisites:  ALH 140 , CIT 100 , MDA 104 , MDA 105 ,  

Description
This course introduces the knowledge, behavior and skills used by the medical assistant in the performance of medical business practices. Areas of concentration are basic bookkeeping computations, accounts receivable procedures, computerized office billing systems, managed-care insurance and procedural and diagnostic coding. This course requires a per credit health career fee; check the tuition and fee schedule for the current rate.

1. MAERB Standard VII.C, Basic Practice Finances: VII.C.1 Define charges, payments, accounts receivable, accounts payable, adjustments, end of day reconciliation, VII.C.2 Identify precautions for accepting the following types of payments: cash, check, credit card, debit card, VII.C.3 Identify types of adjustments made to patient accounts to include: non-sufficient funds (NSF) check, collections agency transaction, credit balance, third party, VII.C.4 Identify patient financial obligations for services rendered.
2. MAERB Standard VII.P: VII.P.1 Perform accounts receivable procedures to patient accounts including posting: charges, payments and adjustments, VII.P.2 Input accurate billing information in an electronic system, VII.P.3 Inform a patient of financial obligations for services rendered.
3. MAERB Standard VIII. Third Party Reimbursement: VIII.C.1 Identify the types of third-party plans and steps for filing a third-party claim, VIII.C.2 Identify managed care requirements for patient referral, VIII.C.3 Identify processes for: verification of eligibility for services, precertification/preauthorization, tracking unpaid claims, claim denials and appeals, VIII.C.4 Identify fraud and abuse as they relate to third-party reimbursement, VIII.C.5 Define the following: bundling and unbundling of codes, advanced beneficiary notice (ABN), allowed amount, deductible, co-insurance, co-pay, VIII.C.6 Identify the purpose and components of the Explanation of Benefits (EOB) and Remittance Advice (RA) statements.
4. MAERB Standard VIII.P:  VIII.P.1 Interpret information on an insurance card, VIII.P.2 Verify eligibility for services, VIII.P.3 Obtain precertification or preauthorization with documentation, VIII.P.4 Complete an insurance claim form, VIII.P.5 Assist a patient in understanding an Explanation of Benefits (EOB).
5. MAERB Standard IX. Procedural and Diagnostic Coding: IX.C.1 Identify the current procedural and diagnostic coding systems, including Healthcare Common Procedure Coding Systems II (HCPCS Level II), IX.C.2 Identify the effects of upcoding and downcoding, IX.C.3 Define medical necessity, IX.P.1 Perform procedural coding, IX.P.2 Perform diagnostic coding, IX.P.3 Utilize medical necessity guidelines.
6. MAERB Standard V. Concepts of Effective Communication Psychomotor: V.P.3 Coach patients regarding office policies and medical encounters.
7. MAERB Standard A:  A.2 Demonstrate active listening, A.3 Demonstrate empathy for patients concerns, A.7 Demonstrate tactfulness.

1. Medical care expenses
2. Credit arrangements
3. Bookkeeping procedures
4. Computer billing
5. Overdue payments
6. Fundamentals of managed care
7. Health care plans
8. Preparing claims
9. Professional manner and image
10. Ethical principles
11. Initiative and responsibility
12. Demonstrate knowledge of basic math computation
13. Adapting communication to the individual’s ability to understand
14. Perform accounts receivable
15. Obtain correct billing information
16. Computer techniques to support office operations
17. Confidentiality
18. Federal, state and local legal guidelines
19. Documentation
20. Appropriate guidelines when releasing information
21. Employer’s established policies dealing with the health care contract

• Communication
• Technological Competence

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