Description
COURSE DESCRIPTION
Module 3 of the Traditional Medicine Clinical Practice Certification (TMCPC) Program will further develop the competencies in ETHICS AND PRACTICE MANAGEMENT. It concentrates on insurance billing standards in traditional medicine. It covers key topics, including billing forms such as the Superbill and Insurance Claim Form 1500. This class covers front- and back-office billing procedures, various types of insurance, payment processes, and common issues, including claim denials and audits. It outlines critical billing and documentation requirements for Individual Payers, Self-Insured Plans, Specialty Care Services, the Veterans Administration (VA), Workers’ Compensation, Personal Injury, Medicaid, Medicare, COBRA, and pending and FSA/HAS accounts. The course introduces Insurance Verification, the Advance Beneficiary Notice (ABN), the GA modifier, the Good Faith Estimate, and other essential forms. It clarifies the differences between being an in-network and out-of-network provider. Additionally, the class navigates Explanation of Benefits, the process of payment collection, and write-off rules. The module also covers audit triggers and strategies for handling them. Students will learn ethical billing practices and demonstrate the use of electronic health records systems for billing purposes. Students will be able to describe and apply billing and collection procedures. CASE MANAGEMENT competencies in the creation of professional correspondence relevant to the claim denial (e.g., writing of the Appeal Letter) will be mastered. Templates of the associated forms and office policies will be reviewed.
COURSE LEARNING OUTCOMES, GOALS & OBJECTIVES
- Demonstrate Knowledge of Billing Basics
- Understand Insurance Company Types and Billing Specifics
- Demonstrate Knowledge of Insurance Payment and Recoupment
- Navigate Insurance Claim Appeal
- Demonstrate Knowledge of Audit
REQUIRED TEXTBOOKS & EDUCATIONAL MATERIALS:
- The Traditional Medicine Clinical Practice Manual Textbook (is printed on demand, and ships directly from the publisher. Please allow at least 2 weeks for delivery.)
- The Traditional Medicine Clinical Practice CLINIC and OFFICE Policies & Procedures Downloadable Manual
