Open Educational Resource
CRS 110 - Medical Insurance & Reimbursement Systems Public Deposited
This course prepares students to understand the evolution and function of health insurance, to include Medicare, Medicaid, commercial and managed care. The students will learn to understand, prepare and process claims. Course Outcomes: 1. Identify types of insurance plans and models of managed care currently deployed in the health related insurance field. 2. Apply third-party insurance guidelines to complete and process insurance claim forms after performing basic mathematical calculations, obtaining exact answers to claims processing functions, and determining whether those answers are reasonable. 3. Communicate results of claims processing using mathematical processes and concepts that demonstrate the following: copay, coinsurance, write-off/discount, primary insurance payment, secondary insurance payment, patient responsibility. 4. Demonstrate competency in applying and utilizing RVU's (relative value units), RBRVS (resource based relative value system) and DRG's (Diagnostic Related Groups).