Professional Fees, Billing and Coding

COURSE INFORMATION:

Admission Requirements
  • Grade 12 or OSSD Equivalent
  • Mature Student
  • Textbook: Administrative and Clinical Procedures for the Canadian Health Professional Plus Choice Learning — Access Card Package, 4/E Valerie Thompson ©2018 • Pearson Education Canada, Primary textbook – and Ancillaries – Instructor Handouts, Kinn’s The Medical Assistant – Book, Study Guide, Checklist, and SimChart for the Medical Office Package with ICD-10 Supplement, 12th Edition © 2014 Elservier Inc. By Deborah B. Proctor, EdD, RN, CMA and Alexandra Patricia Adams, BBA, RMA, CMA (AAMA), MA

Course Fees: $485.00
Other Compulsory Fees: Inclusive
Course Hours: 100 Hours
Course Intake: Every Monday
Department: PT – Continuing Education
Registration: Nativetc.com


COURSE OVERVIEW

In this subject students will be introduced to provincial/territorial health care plans and the commonly insured and uninsured health services are discussed. Students will also be introduced into the way provincial and territorial ministries process health claims; the key importance of health card validation in the claims submission process; the structure of Ontario service, therapeutic, premium, and diagnostic codes. Students will view a detailed breakdown of physician billing numbers, group numbers, and specialty codes and their importance in the billing process. Students will also become familiar with the billing process and four methods of claim submission and the stages of the billing cycle along with the types of claims including, health care plan, reciprocal medical billing, and workers’ compensation; file rejects and claims-error reports; rationalization of third party and uninsured service billing.

TRAINING LOCATIONS

North Bay Campus or Online – www.nativetc.com

Part 1: Insured and Uninsured Services

Part 2: Other Health Benefits

Part 3: Determining the Value of an Insured Service

Part 4: Eligibility for Health-Care Plans

Part 5: Health Cards

Part 6: Registering for Provincial or Territorial Health Insurance Coverage

Part 7: Billing for Out-of Province or Territory Clients

Part 8: Private Insurance

Part 9: The Claims Review Process

Part 10: Claims Monitoring and Control

Part 11: Health Card Validation

Part 12: Physician Registration/Billing Number

Part 13: Billing Codes

Part 14: Common Forms Used in Claims Submission

Part 15: Claims Submission: The Process

Part 16: Methods of Claims Submission

Part 17: Client Registration

Part 18: Software Billing Options

Part 19: Information Components of a Claim

Part 20: RCMP Billing

Part 21: Manual Review Field

Part 22: Types of Claims

Part 23: Feedback from the Ministry

Part 24: Billing for Services Not Publicly Insured

Skill Competencies: Demonstrate processing and managing healthcare claims through the appropriate insurance plans including OHIP, WSIP and other third party providers using the appropriate diagnostic and procedural coding

Knowledge Competencies: Describe how to process and manage healthcare claims through the appropriate insurance plans including OHIP, WSIP and other third party providers using the appropriate diagnostic and procedural coding