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. Students analyze case studies involving the Explanation of Benefits Summary. Also addressed are credit and collection laws as they pertain to patient liability situations. 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:

Examine current healthcare business trends and healthcare systems.
Review Explanation of Benefits for accuracy.
Analyze rejected medical insurance claims to prepare an appeal.
Apply credit and collection laws to patient liability situations.

Listed Topics

Trends and issues in healthcare delivery systems and reimbursement issues
Medical insurance claim monitoring and the adjudication process
Explanation of Benefits
Credit and collection laws

Reference Materials
Cueewnt textbook, handouts, guest speakers, etc.

Students who successfully complete this course acquire general knowledge, skills and abilities that align with CCAC’s definition of an educated person. Specifically, this course fulfills these General Education Goals:

Communication

Approved By: Dr. Quintin B. Bullock Date Approved: 05/14/2025
Last Reviewed: 05/14/2025

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