Course Code: REL-ACU-0-OHIRD
Hours: 1
Type: Online Course
Content Expiration Date: 4/30/2025
Learning Objectives:
Identify all elements necessary to complete and process a claim.
Recognize opportunities to avoid denials.
Recall the process of insurance verification.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Demographics and Insurance Information
Incorrect or Incomplete Demographic Information
Outdated Insurance Information
Financial Impact
Summary
Section 3: Codes and Credentials
Missing or Invalid ICD/CPT Codes
ICD-10-CM
Using Appropriate ICD-10-CM Codes
ICD-10-PCS
Impact of Billing and Coding Errors
Primary, Secondary, and Other Diagnoses
Credentialing and Independent Contractors
Summary
Section 4: Prior Authorization, Medical Necessity, and Denials
The Prior Authorization Process
Complications During Prior Authorization
Medical Necessity
Clinical, Nonclinical, and Inpatient Denials
Revenue Cycle Management
Summary
Section 5: Clinical Vignette
Meet Ms. King
Section 6: Conclusion
Course Summary
Course Contributors
References
Instructor: Kathy A. Jabor, BSN, RN, CCDS, LCN, IQCI
Kathy Jabour is a Clinical Appeals Manager at Lifespan Corporate Services. She is an accomplished RN and CDIS with a solid record of achievement in program development. Areas of expertise include Clinical Documentation Improvement, auditing and DRG Validation, legal writing and Denials & Appeals Management.
Writer: Kimberly Workman, MA
Ms. Workman is an Instructional Designer at Relias. She has a Master of Arts in Technology and Communication, as well as graduate certificates in Public Health, Epidemiology, and Digital Communications. Ms. Workman has a background in writing and designing online continuing medical education for physicians and other health professionals on multiple educational platforms, including web-based, game-based, and immersive learning environments. She has also used simulation training extensively to connect learning to real-world environments.
Target Audience:
The target audience for this course is: Medical Assistants; in the following settings: Hospitals: Acute.
Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Relias Learning has a grievance policy in place to facilitate reports of dissatisfaction. Relias Learning will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias Learning at support@reliaslearning.com.
All courses offered by Relias Learning, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.