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2020-2021 Catalog 
    
2020-2021 Catalog [ARCHIVED CATALOG]

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MDA 208 - Medical Financial Management


Credits: 3
3 Lecture Hours

Prerequisites: Acceptance into the MDA program
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.
Learning Outcomes
At the completion of the course the student will be able to demonstrate compliance with all of the MAERB Core Curriculum objectives as follows:

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
Reference Materials
Textbooks, audio, video, internet and lab equipment.
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
  • Technological Competence
Approved By: Dr. Quintin B. Bullock Date Approved: 09/27/2019


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