COURSE SYLLABUS AND SCHEDULE OUTLINE FOR
MEDICAL
INSURANCE AND RECORDS (34-HCMT-272-901)
WINTER QUARTER 2003
Th 6:30P 9:10P
PETERS-JONES BULIDING ROOM 103
Fax: 732-5304
Division Office: 732-5255
Website: http://www.ucclermont.edu/~bauerj
Office Hours: T 9:00A 9:30A, 3:10P 4:00P, Th
12:30P 2:30P (2nd and 4th Thursdays of the month), and
Required Text(s)
Working with Insurance and Managed Care Plans, Jan Davison and Maxine Lewis, PMIC, 2nd
edition, 1999. ISBN: 1-57066-131-6.
E.Z. Coder, Tanaka,
Unicore Medical, 2000 and 2001 edition.
ISBN: 1-56781-206-6.
A discussion of medical records management and insurance principles as they relate to the medical practice.
1) Analyze the special needs, requirements, and legal ramifications of record keeping and management of medical practice records.
2) Understand the use of current procedural terminology (CPT) for documentation and reimbursement for medical office procedures.
3) Understand the use of ICD codes for the classification of patient health status.
4) Review the legal aspects of documenting patient care.
5) Discuss risk management as it relates to the medical practice.
6) Understand the billing and collection procedures for the medical office.
7) Review various insurance mechanisms and insurance/provider network structures.
8) Understand the changes that are effecting the practice of medicine today and for the future.
Exams: There will be three (3) exams during the quarter. Exam formats will be fill-in-the-blank and multiple choice. Exams will be given as indicted on the Course Schedule.
Individual Application Assignments: There will be five (5) application assignments during the term. Application assignments are designed to provide the student the opportunity to demonstrate competence with the material though application of the concepts presented in class. Assignments will come from the textbook and outside sources and will be assigned throughout the term.
Claims Adjudication Projects (CAP): Each student will be given insurance claims to process (adjudicate) during the quarter. Various real-world scenarios will be explored. Additional details will be provided during the quarter.
Group Insurance Contract Project: Each student will be assigned to a group and each group will be responsible for developing an insurance contract. Additional details and an outline for this project will be supplied during the term.
Grading:
The final grade will be determined as follows:
Exam One (Chapters 1, 2, 3, & 5) .. 100 points
Exam Two (Chapters 4, 6, 7, & 11) ... 100 points
Final Exam (Comprehensive) . . 100 points
Application Assignments (5 @ 10 Points)
. 50
points
Claims Adjudication Projects (3 @ 25 Points) 75 points
Insurance Contract Project 75 points
Total Points 500 points
The numerical average will be calculated by dividing total points by 5.
Prerequisite: 34-HCMT-171 Introduction to Medical Office Management
Attendance
is a requirement of the course. If for
some reason you cannot attend a class, please let me know by using one of the
phone numbers (or other means) listed above.
Make-up work will not be accepted without prior approval from the instructor.
Make-up
exams will be given at the discretion of the instructor. The student must notify the instructor of the absence before the exam begins. Notification after the exam begins will
result in the student receiving a score of zero for the exam. If proper notification is given, a make-up
exam will be administered which may be significantly more challenging than the
examination given on the scheduled date.
The
policy as stated in the
The
current withdrawal policy of
Students with Disabilities: The policy of the University of Cincinnati
Clermont College requires students to self-identify and provide proper
documentation to the Director of the
The following plus/minus
grading system will apply:
92 - 100% =
A 91 - 89% = A-
88 - 87% = B+ 86 -
82% = B 81 - 79% = B-
78 77% =
C+ 76 72% = C 71
69% = C- 68 67% = D+ 66 62% = D
61 59% = D
- 58% and Under = F
Jan 09 Introduction to Course and Syllabus Review
Chapter 1 Introduction to the Claims Process
Jan 16 Chapter 1 Introduction to the Claims Process (Continued)
Chapter 3 Common Operations and Terminology
Assignment of Groups
Jan 23 Chapter 5 Procedure Coding
Review
of Insurance Contract Project
Jan 30 Chapter 5 Procedure Coding (Continued)
Chapter 2 The Physician Payment Process
Feb 06 Exam #1 Chapters 1, 2, 3, and 5
Chapter 4 Diagnosis Coding with ICD-9
Feb 13 Chapter 4 Diagnosis Coding with ICD-9 (Continued)
Chapter 6 Completing the Universal Claim Form
Introduction to the Claims Adjudication Project (CAP)
Feb 20 Chapter 7 Backing up the Codes with Documentation
CAP Assignment 1 Due
Feb 27 Chapter 11 Managed Care Plans
CAP Assignment 2 Due
Mar 06 Exam #2 Chapters 4, 6, 7, and 11
Chapter 10 Private Plans and Self-Insured
CAP Assignment 3 Due
Mar 13 Chapter 12 Quality Improvement Controls
Insurance Contract Results Due
Mar 20 Final Exam Comprehensive -
Thursday, March 20th at 6:30p