Insurance Procedures for the Medical Office: NON-MEDICARE
I. Course Prefix/Number: HIT 116
Course Name: Insurance Procedures for the Medical Office: NON-MEDICARE
Credits: 1 (1 lecture; 0 lab)
III. Course (Catalog) Description
Introductory course gives instruction in health records and insurance processing procedures in the medical office. Focus is on correlating health information with billing procedures.
IV. Learning Objectives
Upon successful completion of this course, the student will be able to:
- Describe the health insurance claims process, and the importance of working efficiently and accurately in a medical office.
- Complete the CMS-1500 claim form for the different third party payers.
- Differentiate between the major types of health insurance and be familiar with their requirements.
- Identify specific claim procedures for major payers.
- Interpret the explanation of benefits statements received from third party payers.
- Explain the proper steps in follow-up of denied or delayed payments.
- Define and explain terms relating to managed care and reimbursement.
- Explain how medical practice reimbursement is determined by managed care organizations and federal regulatory agencies, and the importance of health record documentation in this process.
- Discuss current and future technologies (i.e. electronic claim submission and Internet) and the impact that they may have on the flow of information in the medical office.
- Demonstrate knowledge of confidentiality and security policies that should exist for health information originating in the medical office.
V. Academic Integrity and Student Conduct
• plagiarism (turning in work not written by you, or lacking proper citation),
• falsification and fabrication (lying or distorting the truth),
• helping others to cheat,
• unauthorized changes on official documents,
• pretending to be someone else or having someone else pretend to be you,
• making or accepting bribes, special favors, or threats, and
• any other behavior that violates academic integrity.
There are serious consequences to violations of the academic integrity policy. Oakton's policies and procedures provide students a fair hearing if a complaint is made against you. If you are found to have violated the policy, the minimum penalty is failure on the assignment and, a disciplinary record will be established and kept on file in the office of the Vice President for Student Affairs for a period of 3 years.
Please review the Code of Academic Conduct and the Code of Student Conduct, both located online at
VI. Sequence of Topics
- Introduction to medical insurance
- The CMS-1500 claim form
- Reimbursement: managed care and indemnity plans
- Blue Cross and Blue Shield
- Medicaid (Public Aid)
- Champus/Champva (Tricare)
- Workers’ Compensation
- Legal considerations
- Reimbursement follow-up
- Electronic media claims
- Computerized medical office systems
VII. Methods of Instruction
This course will be presented in lecture-discussion format with in-class exercises utilized to practice and build skills. Students will participate in activities and exercised to simulate medical office procedures. Activities using a computer will also be included.
Course may be taught as face-to-face, hybrid or online course.
VIII. Course Practices Required
Students will be expected to prepare for each class by completing assigned readings and homework assignments. Participation in class discussions will help both student and professor to assess understanding of course material. All assignments must be submitted on due dates provided by the instructor, and should be neat and legible.
Course may be taught as face-to-face, hybrid or online course.
IX. Instructional Materials
X. Methods of Evaluating Student Progress
Students will be evaluated on homework assignments, and exams. Grades will be determined on a cumulative point basis, which will be averaged. Grade distribution is as follows:
Grade distribution is as follows:
A = 94%
B = 88%
C = 82%
D = 76%
F = Below 76%
XI. Other Course Information
Attendance: Class attendance is expected. Absences should be reported to the instructor before the start of class, or as soon as possible in the case of an emergency. It is the student's responsibility to arrange to make up the work and to find out what assignments were given.
Students who inform the instructor in advance (at the beginning of the semester) of an intended absence for a MAJOR religious observance will not be penalized. However, instructors are not responsible for teaching material again and missed work, tests and quizzes must be made up either in advance or immediately following the intended absence.
Code of Student Conduct: Refer to college catalog.
Health Status Change: Any change in health status of currently enrolled students, resulting in the inability to meet the course/program objectives and standards as outlined in the Essential Skills requirement policy will require documentation and medical approval for the student to return to clinical, theory, and lab – which require lifting without restrictions.
Make-up of Exams - Make-up of exams will be allowed when students contact the instructor prior to the exam being given. Students will have one week from the date of the exam. Exams will be made up in the testing center unless other arrangements are made with the instructor.
Incomplete grades - It is the student's responsibility to initiate requests for an “incomplete” and to follow through with the procedure to remove the incomplete grade.
Late assignments - Late assignments will be accepted if the student has made arrangements with the instructor prior to the due date.
Cell phones: Cell phones may not be used in the classroom. They must be turned off while class is in session.
If you have a documented learning, psychological, or physical disability you may be entitled to reasonable academic accommodations or services. To request accommodations or services, contact the Access and Disability Resource Center at the Des Plaines or Skokie campus. All students are expected to fulfill essential course requirements. The College will not waive any essential skill or requirement of a course or degree program.
Oakton Community College is committed to maintaining a campus environment emphasizing the dignity and worth of all members of the community, and complies with all federal and state Title IX requirements.
Resources and support for
- pregnancy-related and parenting accommodations; and
- victims of sexual misconduct
Resources and support for LGBTQ+ students can be found at www.oakton.edu/lgbtq.
Electronic video and/or audio recording is not permitted during class unless the student obtains written permission from the instructor. In cases where recordings are allowed, such content is restricted to personal use only. Any distribution of such recordings is strictly prohibited. Personal use is defined as use by an individual student for the purpose of studying or completing course assignments.
For students who have been approved for audio and/or video recording of lectures and other classroom activities as a reasonable accommodation by Oakton’s Access Disabilities Resource Center (ADRC), applicable federal law requires instructors to permit those recordings. Such recordings are also limited to personal use. Any distribution of such recordings is strictly prohibited.
Violation of this policy will result in disciplinary action through the Code of Student Conduct.