MCOD1370 — Medical Revenue Cycle
MCOD 1370 - Medical Revenue Cycle MCOD 1370 - Medical Revenue Cycle 3 Credits The course emphasizes the medical revenue cycle’s ten steps that clearly identify all the components needed to successfully manage the medical insurance claims process. Students will learn how broad pressure to control costs in the healthcare industry creates a complex billing environment, including: How payment has shifted from straightforward fee-for-service insurance to a complex mixture of contracts with payers. Why providers must ensure patient satisfaction and also use health information technology effectively and efficiently to receive maximum appropriate payment for their services.Examine additional pressure results from federal government prosecution of health care fraud and abuse as a top policy objective. HIPAA and HITECH hae also created new privacy, security, transactions, and code sets laws, including the transition to ICD-10-CM/PCS, that must be implemented. Failure to comply with proper billing and coding procedures can have significant financial and legal consequeces. Major Content Areas Medical Insurance and Billing:Major types of medical insurance, payers and regulations.HIPAA,HITECH Privacy, Security and Electronic Health Care Transactions, Code Sets, Breach Notification Rules. Claims:General Procedures for calculating reimbursement, how to bill compliantly, and preparing and transmitting claims Claim Follow-Up and Payment Processing:Major third party private and government spons