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Course Information
Business and Information Technology Education
Medical Insurance
Basic functions of processing medical insurance claims. A computer-based training program guides students through the insurance claim form cycle and focuses on the areas in which medical office assistants encounter the greatest difficulties. Students are introduced to information about major insurance programs and federal health care legislation.
Blake McCrabb
Patient Billing
Medical Insurance Concepts
-Define the following terms: referral, deductible, pre-certification, capitation fee, and Medicare Part A.
-Identify the provisions of HIPAA that makes it illegal for group health plans to knowingly discriminate against individuals based on health-related factors
-Determine which types of insurance require pre-authorization
-Determine which groups are excluded from Medicaid cost sharing
-Identify the procedures for predetermination of benefits for dental plans
-Determine which type of medical plans are designed to make the greatest use of managed care
-Determine what groups are Medicaid eligible
-Identify the advantages of HMO and PPO plans
-Identify what group of doctors are typically primary care physicians

General Knowledge
-Determine individual identifiers
-Determine reasonable safeguards to protect privacy of individual's medical information in either electronic or paper form
-Identify the actions a covered entity must take to de-identify a dataset that contains protected health information

Impacted Areas
-Define covered entities including software companies
-Identify items contained in a covered entity's notice of privacy practices
-Define policy and procedures for hybrid entities
-Determine the transition period for existing written business associate agreements
-Define business associates agreements
-Define minimum necessary guidelines in the HIPAA Privacy Regulations
-Identify the safeguards necessary for protected health information
-Determine the appropriate disclosure of patient information when contacting patients regarding lab results
-Determine which information is exempt from inclusion in a patient authorization or consent form
-Identify the Protected Health Information guidelines, timeframes, and restrictions in marketing and in research

-Identify which agency is responsible for enforcement of HIPAA Privacy Regulations
-Determine which members of the workforce are required to participate in HIPAA training
-Determine which type of legal organizations are exempt from HIPAA regulations
-Identify the procedures and timeline for documenting HIPAA compliance
-Identify the compliance date for HIPAA Privacy Rules for various the types of organizations
-Determine how the Office of Civil Rights is notified of HIPAA violations
-Determine the resources available for implementing compliance
-Determine which training approaches meet HIPAA compliance
-Identify health care organizations as defined by HIPAA
-Determine when incidental disclosures of protected health information are permissible
-Identify a hybrid organization
-Determine which position must be created in the HIPAA privacy regulations

Regulatory Environment
-Identify how often the Department of Health and Human Services is permitted to change or update the regulations once the effective date of HIPAA privacy regulations have passed
-Determine which privacy rules prevail based on which state provides more patient protection and what state prevails when multiple states are involved
-Identify which federal organization the Office of Civil Rights falls under
-Determine what qualifies a provider as a covered entity
-Identify egregious violations of the HIPAA statue that have criminal penalties

Workplace Privacy
-Define the Final Privacy Rule
-Determine organizations that are exempt from developing notice of privacy practices or having to track disclosures of patient information
-Define non-routine disclosure of personal health information
-Identify the primary purpose of the disclosure accounting provisions
-Determine the procedures for developing a notice of privacy practices to include emergency treatment situations
-Determine the minimum necessary HIPAA privacy regulations for medical professionals to access patient records
-Determine if utilizing fund raising databases for previous fundraising history falls under the HIPAA rules
-Define incidental release
-Determine which situations are covered under release of information for public health purposes
-Identify how to make sign-in sheets HIPPA complaint
Required Brainbench Certifications (or equivalent industry certification):
- Health Insurance

Recommended Additional Competency Testing:
- Health Care Industry Knowledge
Recognized Primary Course Textbooks and Instructional Resources:

McGraw-Hill - From Patient to Payment: Insurance Procedures for the Medical Office, 5th edition, ISBN: 0-07325479-7

Elsevier - Virtual Medical Office: Insurance Handbook for the Medical Office, 9th edition, ISBN: 978-1-4160-4739-1

Delmar Thomson - Understanding Health Insurance, 8th edition, ISBN: 1-4018-9595-6
Career Majors That Sequence This Course
Career Cluster Pathway Career Major
Business Management & Administration Administrative & Information Support Administrative Medical Assistant
Business Management & Administration Administrative & Information Support Electronic Health Record Specialist (EHR Specialist)
Business Management & Administration Administrative & Information Support Medical Insurance Coder
Business Management & Administration Administrative & Information Support Medical Office Assistant
Business Management & Administration Administrative & Information Support Medical Transcriptionist