MDA 208 - Medical Financial Management

1.   MAERB Appendix B CORE Curriculum 2015 Standards

2.   Demonstrate knowledge of basic math computations II.C.1.

3.   Apply mathematical computations to solve equations II.C.2.

4.   Define the following bookkeeping terms:

• Charges VII.C.1.a.
• Payments VII.C.1.b.
• Accounts receivable VII.C.1.c.
• Accounts payable VII.C.1.d.
• Adjustments VII.C.1.e.

5.   Describe banking procedures as related to the ambulatory care setting VII.C.2.

6.   Identify precautions for accepting the following types of payments:

• Cash VII.C.3.a.
• Check VII.C.3.b.
• Credit card VII.C.3.c.
• Debit card VII.C.3.d.

7.   Describe types of adjustments made to patient accounts including:

• Non-sufficient funds (NSF) check VII.C.4.a.
• Collection agency transaction VII.C.4.b.
• Credit balance VII.C.4.c.
• Third party VII.C.4.d.

8.   Identify types of information contained in the patient’s billing record VII.C.5.

9.   Explain patient financial obligations for services rendered VII.C.6.

10. Perform accounts receivable procedures to patient accounts including posting:

•  Charges VII.P.1.a.
•  Payments VII.P.1.b.
•  Adjustments VII.P.1.c.

11. Prepare a bank deposit VII.P.2.

12. Obtain accurate patient billing information VII.P.3.

13. Inform a patient of financial obligations for services rendered VII.P.4.

14. Demonstrate professionalism when discussing patient’s billing record VII.A.1.

15. Display sensitivity when requesting payment for services rendered VII.A.2. 

16. Identify:

• Types of third party plans VIII.C.1.a.
• Information required to file a third party claim VIII.C.1.b.
• The steps for filing a third party claim VIII.C.1.c.

17. Outline managed care requirements for patient referral VIII.C.2.

18. Describe processes for:

• Verification of eligibility for services VIII.C.3.a.
• Precertification VIII.C.3.b.
• Preauthorization VIII.C.3.c.

19. Define a patient-centered medical home (PCMH) VIII.C.4.

20. Differentiate between fraud and abuse VIII.C.5.

21. Interpret information on an insurance card VIII.P.1.

22. Verify eligibility for services including documentation VIII.P.2.

23. Obtain precertification or preauthorization including documentation VIII.P.3.

24. Complete an insurance claim form VIII.P.4.

25. Interact professionally with third party representatives VIII.A.1.

26. Display tactful behavior when communicating with medical providers regarding third party requirements VIII.A.2.

27. Show sensitivity when communicating with patients regarding third party requirements VIII.A.3.

28. Describe how to use the most current procedural coding system IX.C.1.

29. Describe how to use the most current diagnostic coding classification system IX.C.2.

30. Describe how to use the most current HCPCS level II coding system IX.C.3.

31. Discuss the effects of:

• upcoding IX.C.4.a.
• downcoding IX.C.4.b.

32. Define medical necessity as it applies to procedural and diagnostic coding IX.C.5.

33. Perform procedural coding IX.P.1

34. Perform diagnostic coding IX.P.2.

35. Utilize medical necessity guidelines IX.P.3.

36. Utilize tactful communication skills with medical providers to ensure accurate code selection IX.A.1.

 Listed Topics

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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