SST822 - Medical Health Billing
| Semester | |
| School | |
| Last revision date | 2024-02-20 09:38:53.612 |
| Last review date | 2024-02-20 09:38:53.612 |
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, Hospital Nursing 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.
Academic Integrity
Seneca upholds a learning community that values academic integrity, honesty, fairness, trust, respect, responsibility and courage. These values enhance Seneca's commitment to deliver high-quality education and teaching excellence, while supporting a positive learning environment. Ensure that you are aware of Seneca's Academic Integrity Policy which can be found at: http://www.senecapolytechnic.ca/about/policies/academic-integrity-policy.html Review section 2 of the policy for details regarding approaches to supporting integrity. Section 2.3 and Appendix B of the policy describe various sanctions that can be applied, if there is suspected academic misconduct (e.g., contract cheating, cheating, falsification, impersonation or plagiarism).
Please visit the Academic Integrity website http://open2.senecac.on.ca/sites/academic-integrity/for-students to understand and learn more about how to prepare and submit work so that it supports academic integrity, and to avoid academic misconduct.
Discrimination/Harassment
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 student.conduct@senecapolytechnic.ca.
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 Accessibility Services Office at ext. 22900 to initiate the process for documenting, assessing and implementing your individual accommodation needs.
Camera Use and Recordings - Synchronous (Live) Classes
Synchronous (live) classes may be delivered in person, in a Flexible Learning space, or online through a Seneca web conferencing platform such as MS Teams or Zoom. Flexible Learning spaces are equipped with cameras, microphones, monitors and speakers that capture and stream instructor and student interactions, providing an in-person experience for students choosing to study online.
Students joining a live class online may be required to have a working camera in order to participate, or for certain activities (e.g. group work, assessments), and high-speed broadband access (e.g. Cable, DSL) is highly recommended. In the event students encounter circumstances that impact their ability to join the platform with their camera on, they should reach out to the professor to discuss. Live classes may be recorded and made available to students to support access to course content and promote student learning and success.
By attending live classes, students are consenting to the collection and use of their personal information for the purposes of administering the class and associated coursework. To learn more about Seneca's privacy practices, visit Privacy Notice.
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
Week 2
Week 3
Preparation of Claims
Week 4
Billing for Family/General Practice
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
ASSIGNMENT NO. 2
Week 11
Reconciliation of MOHLTC Accounts
Week 12
FINAL EXAMINATION
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 Efficient Medical Billing
Karin Symonds,
Current edition.
Instructions: NO textbook substitutions.
Schedule of Benefits
Ministry of Health
Special Instructions - Free download. Information in course.
(Note: MACs are not compatible unless they run Windows OS. Students who use MACs must contact the instructor for alternative assignments, but they will not have the opportunity to practice billing software)
Reference Material
None
Required Supplies
Computer Software - A Windows Operating System is required. MACs are not compatible unless they run a Windows OS. The MAC user will be given an alternate theory assignment in lieu of the computerized billing portion of the course, however, the MAC user does not have opportunity to practice on the billing software.
Student Progression and Promotion Policy
http://www.senecapolytechnic.ca/about/policies/student-progression-and-promotion-policy.html
Grading Policyhttp://www.senecapolytechnic.ca/about/policies/grading-policy.html
| 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) |
| OR | |
| EXC | Excellent |
| SAT | Satisfactory |
| UNSAT | Unsatisfactory |
For further information, see a copy of the Academic Policy, available online (http://www.senecapolytechnic.ca/about/policies/academics-and-student-services.html) or at Seneca's Registrar's Offices. (https://www.senecapolytechnic.ca/registrar.html).
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.)
Grading is based on the following marking scheme:
| Assignments | 60% |
| Exam | 40% |