MA 214 - Physician Office Coding and Reimbursement

Credit Hours: 2

In this course students learn to identify attributes of the revenue cycle, recognize third-party reimbursement procedures for patient referrals, precertification, prior authorization, insurance claims and remittance advices and perform current procedural and diagnostic coding (ICD-10-CM, CPT, HCPCS II) using medical necessity guidelines and the MEDENT Electronic Health Records (EHR) Practice Management System. Students also learn the importance of upcoding, downcoding, insurance verification and claim tracking.

Course Outcomes
Upon completion of this course, the student will be able to:

Recognize types of third-party plans and the steps for filing a third-party claim
Identify managed care requirements for patient referrals
Identify processes for eligibility for services
Obtain precertification or preauthorization with documentation
Verify insurance eligibility and generate an insurance claim form
Identify the purpose and components of Explanation of Benefits (EOB) and Remittance Advice (RA) Statements
Perform diagnostic and procedural coding
Identify fraud and abuse as they relate to third-party reimbursement
Recognize medical necessity guidelines

F/S (N)

This course is required for the Medical Assisting AAS Degree and 100% of the Psychomotor and Affective competencies need to be passed.
Reminder: To be eligible for an Associate in Applied Science degree in Medical Assisting, students must attain a C average or better in all MA courses