SST822 - Medical Health Billing

Outline info
Last revision date 2018-09-24 01:02:05.112
Last review date 2018-11-07 15:11:10.688

Subject Title
Medical Health Billing

Subject Description
This  course is designed to provide the student with the basic principles of efficient Health Claim Billing in Ontario. The student will learn how to use the Schedule of Benefits and Preambles of the Ministry of Health, as well as be introduced to computerized billing.

Credit Status
This is a credit subject applicable towards the Medical Unit Clerk and Medical Administrative Assistant Certificate Programs offered through the Faculty of Continuing Education and Training.

Learning Outcomes
Upon successful completion of this subject the student will be able to:

1. Accurately record the services provided by each physician for each patient;

2. Submit claims within the time frame set out by the Ministry of Health and Long-Term Care;

3. Reconcile accounts with the Remittance Advice;

4. Apply for any claims which were not paid and for which the physician deserves reimbursement;

5. Correctly interpret and handle the reprocessing of returned claims;

6. Produce the year end Accounts Receivable Report;

7. Demonstrate familiarity with the Schedule of Benefits;

8. Use the Schedule of Benefits to determine the correct fee for a particular service;

9. Correctly select diagnosis codes;

10. Use a medical billing software package to perform the above tasks.

Cheating and Plagiarism
Each student should be aware of the College's policy regarding Cheating and Plagiarism. Seneca's Academic Policy will be strictly enforced.

To support academic honesty at Seneca College, all work submitted by students may be reviewed for authenticity and originality, utilizing software tools and third party services. Please visit the Academic Honesty site on for further information regarding cheating and plagiarism policies and procedures.

All students and employees have the right to study and work in an environment that is free from discrimination and/or harassment. Language or activities that defeat this objective violate the College Policy on Discrimination/Harassment and shall not be tolerated. Information and assistance are available from the Student Conduct Office at

Accommodation for Students with Disabilities
The College will provide reasonable accommodation to students with disabilities in order to promote academic success. If you require accommodation, contact the Counselling and Disabilities Services Office at ext. 22900 to initiate the process for documenting, assessing and implementing your individual accommodation needs.

Grammar is Important SST 051, Keyboard Information Processing KIP103 and Medical Terminology SST831.

It is your responsibility to ensure that program requirements and subject prerequisites as outlined are met. Prerequisites are included for your academic protection. Subject content and your professor's teaching assumes that students are academically prepared and instruction will proceed accordingly. Students lacking prerequisites not only jeopardize their own ability to succeed but present unnecessary interruption. If you lack appropriate prerequisites (or advance standing for the prerequisite subject) you may be asked to withdraw or transfer to a more appropriate subject with the risk of academic/financial penalty. It is your responsibility to save documents, articles and notes that the instructor has provided on BlackBoard or in class. Students will not be able to access BlackBoard as of the last day of the student's class.

Topic Outline
The order of the topics is at the discretion of the professor. The content of one module does not have to be completed before another module is started, nor do the modules have to be taught in the order listed. Rather by the end of the subject all the topics will have been covered.

Week 1 

An introduction to the Ministry of Health and Long-Term Care  (MOHLTC) Insurance Plan and billing software

Week 2 
The MOHLTC Schedule of Benefits and the Diagnostic Codes 

Week 3
          Preparation of Claims

Week 4
          Billing for Family/General Practice
Week 5 
Billing for Family/General Practice - Review 

Week 6 

Week 7 
Billing for Medical Specialists 

Week 8 
Billing for General Surgery 

Week 9
Billing for Medical Specialists and General Surgeons - Review

Week 10
          ASSIGNMENT NO. 2 

Week 11
          Reconciliation of MOHLTC Accounts

Week 12

Mode of Instruction
Online mode of delivery 
During this course students are likely to experience self-directed learning at their own individual pace, and contact with the instructor. In addition, the opportunity to submit questions and comments both privately and in a public discussion area will be available and encouraged.

Prescribed Texts
Easy Steps to Effective Medical Billing (includes CD).  Karin Symonds, 2018 edition.
Instructions: NO textbook substitutions.
Note: No other textbook version will be allowed.

Schedule of Benefits.  Ministry of Health.  Free Download; information provided in the course.

(Note: MAC's are not compatible unless they run Windows OS. Students who use MAC's must contact the instructor for alternative assignments, but they will not have the opportunity to practice billing software)

Reference Material

Required Supplies

Promotion Policy

Grading Policy
A+ 90%  to  100%
A 80%  to  89%
B+ 75%  to  79%
B 70%  to  74%
C+ 65%  to  69%
C 60%  to  64%
D+ 55%  to  59%
D 50%  to  54%
F 0%    to  49% (Not a Pass)
EXC Excellent
SAT Satisfactory
UNSAT Unsatisfactory

For further information, see a copy of the Academic Policy, available online ( or at Seneca's Registrar's Offices.

Modes of Evaluation
Since this is a professional credit subject, marking standards reinforce professional practice by demanding legible, tidy work. Written materials should be well organized, correctly formatted and grammatically correct, with proper spelling and punctuation.

Please Note

  • Assignments, tests and the final examination are evaluated on subject knowledge as well as correct language usage, organization, and mastery of the subject. 
  • In recognition of the significance of proper language skills in the workplace, marks are deducted, in accordance with departmental policy, for language errors on all tests, assignments and exams. (i.e. spelling, grammar, word usage, sentence, and paragraph structure, etc.) 

  • The student must retain a copy of all assignments.
  • If assignments are handed in late without sufficient medical or other reason, which must be documented and approved, two marks per day will be deducted for each day the assignment is late up to a maximum of 10 marks in total. 
  • Assignments will not be accepted after the return of graded assignments to the class and/or the provision to the class of the answers to the assignment.
  • Written assignments must be word processed. At the professor’s discretion, assignments that are not word processed, may be subject to mark deduction or not accepted. 
  • For particulars, please obtain standards, dates, etc. from your instructor.

Absenteeism and Tests
  • Students should be aware that absenteeism will impact on their ability to achieve satisfactory grades.
  • If you miss a test, you must provide the reason in writing to the instructor within one week. If your reason is accepted, the weighting of that test will be added to that of the final exam. Otherwise, you will be given a zero for the test. You must submit an original doctor’s certificate identifying the date, length of time of expected absence and the specific reason for your absence, or other appropriate documentation.
  • Progress tests and quizzes may not be announced in advance and details of the assignment requirements may be explained in class.

Final Exam/ Final Assignment
  • Students must attain a grade of at least 50% to pass the course.

Field Placement Requirements

Students who do not successfully complete all professional subjects may not be eligible for placement. 

Academic Honesty

Students at Seneca College are expected to be honest and forthright in their academic endeavours. When students cheat on an examination, steal the words or ideas of another, or falsify their research results, it corrupts the learning process. A Seneca College degree, diploma or certificate signifies to society mastery of a set of defined learning outcomes in a designated field of study. If academic credit is obtained dishonestly, the value of every graduate's diploma in the field of study is diminished, as is the reputation of the college as a whole.

Penalties for Academic Dishonesty

The penalty for a first offence is a grade of '0' on the assignment or examination. The penalty for the second offence is expulsion for a time period determined by the Academic Honesty Committee, normally for a minimum of three semesters. For further information refer to the policies section of the Seneca College student handbook, or to the following website:

Grading is based on the following marking scheme:

Assignments 60%
Exam 40%

Materials permitted into tests and exams are at the discretion of the instructor.

Approved by: Sandra Noble