I. General Information

1. Course Title:
Medical Office Procedures

2. Course Prefix & Number:
HINS 1163

3. Course Credits and Contact Hours:

Credits: 3

Lecture Hours: 3

4. Course Description:

This course covers administrative duties in the medical practice as well as how to bill payers and patients. The course introduces students to the revenue cycle of a medical office by focusing on scheduling, registration, and billing. Students will be introduced to and use a practice management program to complete medical office tasks. Students will be exposed to a clinic scenario to include patient interaction, third-party payer interaction, and provider interaction.

5. Placement Tests Required:

6. Prerequisite Courses:

There are no prerequisites for this course.

9. Co-requisite Courses:

There are no corequisites for this course.

II. Transfer and Articulation

1. Course Equivalency - similar course from other regional institutions:

Ridgewater College, ADS 1320 Medical Office Management, 3 credits
Southeast Technical College, MEDS 1212 Medical Office Procedures, 4 credits

2. Transfer - regional institutions with which this course has a written articulation agreement:

III. Course Purpose

1. Program-Applicable Courses – This course fulfills a requirement for the following program(s):

Healthcare Administrative Specialist, AAS Degree
Healthcare Accounting, AAS Degree
Healthcare Administrative Specialist, Diploma
Healthcare Administrative Specialist, Certificate 

IV. Learning Outcomes

1. College-Wide Outcomes

College-Wide Outcomes/Competencies	Students will be able to:
Analyze and follow a sequence of operations	Identify the steps needed to complete the revenue cycle using practice management principles.
Utilize appropriate technology	Demonstrate completion of primary/secondary claims, processing payments from payers, and handling patient's accounts using a practice management program.
Apply ethical principles in decision-making	Using HIPAA and ARRA/HITECH laws determine release of information requirements in response to specific cases studies.

2. Course Specific Outcomes - Students will be able to achieve the following measurable goals upon completion of the course:

• Identify three ways the healthcare administrative specialist helps to ensure the financial success of the physician practice;
• Explain the ten steps in the medical billing cycle;
• Identify the eight types of charges that may be collected from the patient at the time of service;
• Compare the calculation of payments for participating and nonparticipating providers, and describe how balance billing regulations affect the charges that are due from patients;
• Describe the major features of group health plans regarding eligibility, portability, and required coverage;
• Explain the differences in health reimbursement accounts, health savings accounts, and flexible saving (spending) accounts;
• Identify the differences among Medicare Part A, Part B, Part C, and Part D;
• Describe the the types of plans that states offer Medicaid recipients;
• Explain how TRICARE Standard, TRICARE Prime, TRICARE Extra, and CHAMPVA programs differ;
• Explain the claim adjudication process;
• Describe the purpose and general steps of the appeal process; and
• Describe the purpose and content of patients' statements and the procedures for working with them.  

V. Topical Outline

Listed below are major areas of content typically covered in this course.

1. Lecture Sessions

1. The Administrative Medical Assistant career
• Administrative Medical Assistant - personal attributes
• Employment opportunities
• Work ethic and professionalism
• Professional growth
• Certifications
• Industry organizations
• Interpersonal relationships
2. Medical ethics, law, and compliance
• Ethics
• Law
• HIPAA/HITECH and ARRA
• Compliance plans
• Safeguards against litigation
3. Office communications
• Communication cycle
• Nonverbal communication
• Written communication
• Telephone skills
• Scheduling
• Pre-registration
4. Managing health information
• Computer usage
• Introduction to the medical record
• Documentation formats
• Ownership, quality assurance, and records retention
• Filing systems
• Introduction to electronic health records
• Use of technology in physician practice
• Functions of electronic health record programs
• Advantages of electronic health records
• The HITECH Act’s impact on privacy and security
5. Insurance and coding
• Insurance terminology
• Insurance plans
• Government
• Third-party payers
• Workers' compensation, auto and liability 
• Participation and payment method
• Introduction to procedural and diagnostic coding and compliance
6. Billing, reimbursement, and collections
• Charge entry/recording transactions
• Insurance claims
• Payments from patients
• Payments from payers
• Delinquent accounts
• Medical billing cycle
• Preregister patients
• Establishing financial responsibility
• Check-in process
• Check-out process
• Review coding compliance
• Review billing compliance
• Prepare and transmit claims
• Monitor payor adjudication
• Generate patient statements
• Follow up on patient payments/collections
7. Practice finance
• Essential financial records
• Identifying theft and red flag requirements
• Reports Day sheets and patient lists
• Billing/payment status report
• Practice analysis
• Unapplied payment/adjustment report
8. Practice Management System
• Introduction to Medisoft
• Entering patient information
• Working with cases
• Enter charges transactions and payments
• Creating claims
• Creating patient statements

2. Laboratory/Studio Sessions