Medical Coding and Billing

MEDICAL CODING AND BILLING

Course Outline

Students will learn how to apply the basic principles of Health Claim billing as outlined in the MOH (Ontario) “Schedule of Benefits" to complete health claims and the reconciliation of accounts. The student will learn to input Health Number billing on a computerized system.

Learning Objective

• The meaning of the MOH codes, prefixes, and suffixes
• How the Ministry of Health (MOH) operates
• How to prepare claims for procedures and services using evening and night rates
• How health claims are processed from patient encounter to receipt of payment
• The relevant materials and reference information available when preparing and reconciling claims
• How to locate diagnosis codes on the diagnosis code list
• How to prepare billing sheets for patient claims, which are typical of a Family Practice
• How to complete billing sheets typical of a General Surgeon
• The difference between calls/visits, test/procedures and surgical procedures and how to locate each in the Schedule of Benefits
• The process of billing a third party
• The methods of making the process of HCP billing and reconciliation as efficient as possible
• How to design an efficient billing and reconciliation system for their particular office environment
• The basic information that is required to complete a patient claim to the MOH

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