Health Insurance Insights: Plans, Processes, and Prior Authorization (6 Admin CEUs)

The health insurance system in the U.S. is complex, with multiple governmental and private payers and agencies involved in health care delivery. Medical assistants who complete this course will have a more holistic understanding of the health care system and be able to educate and counsel patients on how to navigate past the shoals and make the system work for them. Further, the course will help you help your practice stay compliant with regulations and speed the patient billing and insurer reimbursement processes.

The course comprises six sections:

• Section 1: Insurance Basics
  Provides an overview of common terms in health insurance, including premiums, deductibles, co-payments, and out-of-pocket costs.
• Section 2: Government Insurance: Medicare, Medicaid, TRICARE, and VA
  Comprises government plans, which cover specific populations of patients, including the elderly (Medicare), people with limited income (Medicaid), and members of the U.S. armed forces (TRICARE and the Veterans Health Administration). Includes discussion of the various flavors of Medicare, including Medigap and Medicare Advantage, and the available benefits (and restrictions) of Medicaid, along with a review of the different types of health care services available to the military and veterans.
• Section 3: Automobile Insurance and Workers’ Compensation
  Car insurance is not just intended to provide coverage for automobiles—it includes coverage for injuries sustained by drivers and passengers. Meanwhile, workers’ compensation ensures that on-the-job injuries are covered.
• Section 4: Private Insurance
  More than two thirds of Americans have health insurance coverage through their employer, provided through private insurance firms. This section covers the alphabet soup of different types of plan options (EPO, HMO, PPO, POS) and reinforces the importance of verifying patients’ insurance coverage (and seeking insurer authorization, if needed).
• Section 5: Accounts Receivable/Payable, No Surprises Act, and Estimates
  Timely and accurate billing of (and reimbursement by) insurance firms is critical to the health of any medical practice. In their administrative capacity, medical assistants should be aware of the financial aspects of medicine and insurance, and they should work to ensure a smooth flow of funds, for the benefit of both the patient and the practice’s bottom line.
• Section 6: Authorizations
  Ensuring that a given medical procedure will be covered by insurance is key to ensuring patient satisfaction and practice sustainability. Key terms defined and explained include referrals, denials, and formulary medications, as well as Currently Procedural Terminology (CPT) and International Classification of Diseases, Tenth Revision (ICD-10) coding.

Improving Patient Satisfaction through Quality Measures (2 Admin/Gen CEUs)

This course will help medical assisting professionals:

• Understand team engagement and why it is important to the patient experience
• Build an environment of trust, accountability, and service, which ultimately improves the patient experience
• Recruit and retain team members who contribute to a positive and healthy environment
• Understand the importance of positive patient experience and how it is measured
• Implement metrics and survey tools to measure the patient experience
• Help guide practice staff on strategies to increase patient satisfaction

The course also covers the transition from the traditional fee-for-service model of care to value-based care (VBC), which moves the focus away from volume and cost toward patients and preventive care. VBC holds the promise for higher quality, lower costs, fewer tests and nonbeneficial procedures, and healthier patients. Through an iterative process of providing patient care, analyzing patient data, and improving future care, the practice can work towards true VBC, which at essence is practicing good care

Insurance Insights & Quality Measures is a project of the Career Professional Development Committee of the AAMA that aims to enhance medical assistants’ and other allied health professionals’ skills and assist medical assistants in advancing their career outlook and growing into new and emerging roles in the health care delivery system.

Learners who pass the posttests for both courses will also earn the Insurance Insights & Quality Measures digital badge.
 
Price for AAMA members—$95
Price for nonmembers—$160

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