MAP 173 - Medical Office Management II-B

• Handling patient accounts and understanding the flow of funds through the practice.
• Understand banking procedures for the business.
• Learn strategies for creating a positive work environment and a motivated team atmosphere.
• Develop tools and skills for finding and retaining employment.

Course Objectives:

Unit 1: Medical Billing and Reimbursement Essentials

• Describe the medical billing process, identify types of information contained in the patient’s billing record, and interpret information on an insurance card.
• Discuss managed care policies and procedures, including precertification/preauthorization and referrals, and show sensitivity when communicating with patients regarding third party requirements.
• Identify: a. types of third party plans; b. steps for filing a third party claim
• Explain how to submit health insurance claims, including electronic claims, to various third-party payers.
• Complete an insurance claim form.
• Identify fraud and abuse as they relate to third party reimbursement.
• Discuss methods of preventing the rejection of claims.
• Display tactful behavior when communicating with medical providers regarding third party requirements.
• Describe ways of checking a claim’s status.
• Identify the purpose and components of the Explanation of Benefits (EOB) and Remittance Advice (RA) statements.
• Discuss reasons for denied claims.
• Define medical necessity.
• Utilize medical necessity guidelines.
• Apply managed care policies and procedures and describe the process for precertification.
• Obtain precertification or preauthorization including documentation.
• Identify patient financial obligations for services rendered.
• Inform a patient of financial obligations for services rendered.
• Demonstrate professionalism when discussing patient’s billing record.
• Assist a patient in understanding an Explanation of Benefits (EOB).

Unit 2: Patient Accounts and Practice Management

• Define the following bookkeeping terms: a. charges; b. payments; c. accounts receivable; d. accounts payable; e. adjustments; f. end of day reconciliation
• Perform accounts receivable procedures to patient accounts including posting: a. charges; b. payments; c. adjustments  
• Also, discuss payment at the time of service and display sensitivity when requesting payment for services rendered.
• Describe the impact of the Truth in Lending Act on collections policies for patient accounts.
• Describe successful collection techniques for patient accounts.
• Describe types of adjustments made to patient accounts including: a. non-sufficient funds (NSF) check; b. collection agency transaction; c. credit balance; d. third party
• Explain the purpose of the Federal Reserve Bank and the types of banks it manages.
• Identify common types of bank accounts.
• Discuss the importance of signature cards.
• Explain how online banking has made standard banking process more efficient.
• Compare different types of negotiable instruments.
• Identify precautions for accepting the following types of payments: a. cash; b. check; c. credit card; d. debit card
• Review the procedure followed when the healthcare facility receives a nonsufficient funds (NSF) check.
• Describe banking procedures as related to the ambulatory care setting.
• Explain the importance of depositing checks daily.
• Prepare a bank deposit.
• Compare types of check endorsements.
• Understand the purpose of bank account reconciliation for auditing purposes, and how to pay bills in order to maximize cash flow.

Unit 3: Advanced Roles in Administration

• Define the qualities and responsibilities of a successful office manager in a healthcare facility.
• Explain how to conduct a staff meeting with an agenda.
• Identify several ways in which employees are motivated.
• Discuss strategies to create a team environment in the healthcare facility.
• Identify communication barriers.
• Identify the need to find the right employee for an opening in the medical office.
• Review a general job description for medical assistants.
• Explain how to search through résumés and applications for potential candidates.
• Identify legal and illegal applicant interview questions.
• Explain how to select the most qualified candidates.
• Identify follow-up activities the office manager should perform after an interview.
• Review new employee orientation, including paperwork, training and development.
• Discuss strategies for determining fair salaries and raises, addressing a problem employee and terminating an employee.
• Identify information that should be included in a personnel policy manual.
• Describe how office policies are different from personnel policies.

Unit 4: Skills and Strategies

• Describe personality traits important to employers.
• Discuss personality traits, technical skills and transferable job skills.
• Discuss career objectives and describe how personal needs affect the job search.
• Create a résumé and cover letter.
• Practice interview skills for a mock interview.
• Identify legal and illegal applicant interview questions.
• Explain common human resource hiring requirements when starting a new job.