INSTITUTION:___MSU College of Technology

INSTITUTION:	MSU College of Technology - Great Falls
COURSE TITLE:	Fundamentals of Health Insurance – Internet
COURSE NUMBER:	OO 111-80
NUMBER OF CREDITS:	4 Semester
INSTRUCTOR:	Deborah Newton
CONTACT INFORMATION:	Business e-mail: dnewton@msugf.edu Phone: 771-4391 – leave message with Business Department Assistant: Pam Buckheit

I. COURSE DESCRIPTION:

The goal of this course is to promote an understanding of the most common private and public health insurance programs in the United States. Students will study guidelines for Medicare, Medicaid, TRICARE, Worker’s Compensation, and Blue Cross/Blue Shield, among others. Students will use these guidelines to complete health insurance forms for the various programs. Basic legal and ethical issues in health insurance will also be discussed.

II. COURSE MATERIALS:

Text: Insurance Handbook for the Medical Office, 8^th edition. Marilyn Fordney Saunders Publishing. ISBN: 0-7216-05176

Note: This book will also be used in OO112 – Advanced Health Insurance so do not sell it back if you have to take OO 112.

Student Workbook: Insurance Handbook for the Medical Office, 8^th edition, ISBN 0-7216-05184. These should only be purchased new.

III. COURSE OBJECTIVES:

Upon completion of this course, the student will demonstrate an understanding of the following objectives:

1. Understand legal and ethical issues in the health insurance industry.

2. Become familiar with the guidelines for billing Medicare, Medicaid, TRICARE, Workers’ Compensation, and Blue Cross/Blue Shield;

3. Understand fee schedules and health insurance coding;

4. Complete health insurance forms completely and accurately;

5. Become familiar with managed care programs;

6. Use appropriate techniques to trace delinquent claims and file appeals for denied claims;

7. Apply medical language appropriately.

IV. COURSE OUTLINE:

1. Introduction/Syllabus

2. Role as an Insurance Billing Specialist – Chapter 1

3. Basics of Health Insurance – Chapter 2

3. Medical Documentation – Chapter 3

Quiz 1 – chapters 1-3

4. Diagnostic Coding – Chapter 4

5. Procedural Coding - Chapter 5

6. The Health Insurance Claim Form – Chapter 6

Quiz 2 – Chapters 4-6

7. Electronic Data Interchange – Chapter 7

8. Receiving Payments and Insurance Problem Solving – Chapter 8

9. Office and Insurance Collection Strategies - Chapter 9

Quiz 3 – Chapters 7-9

10. Private Insurance and Managed Care Systems - Chapter 10

11. Medicare - Chapter 11

12.Medicaid and Other State Programs - Chapter 12

Quiz 4 – Chapters 10-12

13. TRICARE AND CHAMPVA – Chapter 13

14. Workers’ Compensation - Chapter 14

15. Disability Income Insurance and Disability Benefits Programs – Chapter 15

Quiz 5 – chapters 13 - 15

V. COURSE EVALUATION

Assignments. You will have study questions/projects for each chapter. Once we begin working with the CMS-1500 forms, you will have case studies and forms to fill out and submit. A schedule of due dates will be posted in the Course Information area and reminders will be posted on the Course Calendar – points will be taken off for turning in late assignments (5% for each day it is late). It is important that you follow the schedule – if you have technology or other problems, please inform the instructor as soon as possible, either by e-mail or phone. All assignments should be saved in Rich Text Format (rtf) or Word (doc) format and then sent as attachments. Post these in the assignment area by midnight of the posted due date. Your corrected assignments will be returned to you in the assignment area. Your grade will be on top of each assignment and will also show up in MyGrades area on the homepage.

Discussions: There will be discussion topics for each unit. Responses must be posted by the due date to receive credit.

Quizzes. There will be short quizzes after each unit (see schedule above). The quizzes will be short answer primarily but may also include multiple choice, matching, etc. These are closed book.

VI. GRADING SCALE

The grading scale for this course is as follows:

92 – 100	A
82 – 91	B
72 – 81	C
62 - 71	D
61 and below	F

VII. SPECIAL ACCOMMODATIONS

Students with documented disabilities are entitled to reasonable accommodations in their classes. If you would like to use accommodations for this class, please contact Jill Davis, Disability Services Coordinator, in Academic Resources to make arrangements.

VIII. AHIMA Domains, Subdomains and Tasks for RHIT Certification Competencies:

I. Domain: Health Data Management

D. Subdomain: Reimbursement Methodologies

1. Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery.

2. Support accurate billing through coding, chargemaster, claims management and bill reconciliation processes.

IX. POLICIES AND PROCEDURES FOR ONLINE COURSES

E-mail. The instructor’s WebCT e-mail will be checked regularly every day. Students who have questions regarding course content, procedures or problems should send questions to me via the mailbox.

Class Liability. Please keep all messages sent to the whole class related to course content. When e-mailing the class, do not e-mail phone numbers or addresses unless it is being e-mailed directly to a specific individual or the instructor. This maintains student privacy. Please realize that the College and/or this instructor cannot and will not be held responsible for the content of any personal messages sent from one student directly to another student using this e-mail delivery system. It is expected that all students will adhere to accepted codes of ethical, personal and civil conduct when communicating online, using e-mail, or engaging in any real time online chat sessions. Failure to abide by such codes of conduct and etiquette will result in expulsion from the course with a failing grade.

Assignments. Due to the need for clear communication in the online environment, grammar and spelling become even more important. I recommend that online course members compose and proofread all assignments and postings in their word processing program. Then send the file as an attachment. Use the following procedure to send assignments and tests.

Technical problems, assignment delivery, etc. Each student is encouraged to make hard copies of assignments. Technical problems, computer crashes and disasters are bound to happen. Please notify the instructor as soon as possible if you are having technical problems so that arrangements can be made for you to keep up with the course. It is the responsibility of the student to access the course on another computer in the event of hardware or software problems. If you cannot get to a computer to contact the instructor about computer problems, please contact the Business Department Administrative Assistant, Pam Buckheit. and leave a message for the instructor.

In the event of ISP problems, notify the instructor if your problem is not resolved in time to send assignments or tests. Should the ISP problem become long term, you may send assignments or tests via fax to (505) 585-9090. This should be used as a last resort. You may also leave a phone message for the instructor to make other arrangements (see syllabus).

Miscellaneous information about online courses. Students often have the misperception that taking an online course is easier since you don’t have to "be in class." What is true is that online classes are more convenient, not easier. These courses require more personal involvement, and more work on the part of the student. Don’t put off assignments – it is important that you treat this as a regular class and set aside time to devote to it on a daily basis, just as you would if you were going to a classroom. If you find yourself getting behind, please contact the instructor as soon as possible so that we can work together to get you back on track. Do not wait until the end of the semester and then expect you will be able to make up 10 chapters - it just doesn't work.