Identify: Interpret information on an For VIII. P, use Interact professionally with 3rd types of 3rd party plans insurance card the EHR to party representatives information required to file a Verify eligibility for services support the Display tactful behavior when discussion (For 3rd party claim including documentation communicating with medical Obtain precertification or ex: Mary Corbet) providers regarding 3rd for filing a 3rd party claim preauthorization including requirements Outline managed care documentation Show sensitivity when requirements for patient referral Describe processes for: Complete an insurance claim communicating with patients 3. Use EHR to verification of eligibility form regarding 3rd party support precertification requirements discussion preauthorization Define a patient-centered medical home (PCMH) Differentiate between fraud and abuse Cognitive (Knowledge) Neehr Perfect Psychomotor (Skills) Neehr Perfect Affective (Behavior) Perfect IX. C Procedural & Diagnostic Chart or Activity IX. P Procedural & Diagnostic Chart or Activity IX. A Procedural & Diagnostic Chart or Activity Coding Coding Coding Describe how to use the most For IX. C, use the Perform procedural coding For IX. P, use any Utilize tactful communication current procedural coding EHR to support Perform diagnostic coding skills with medical providers to system the discussion. ensure accurate code selection Utilize medical necessity Describe how to use the most guidelines current diagnostic coding classification system Describe how to use the most current HCPCS level II coding system Discuss the effects of: upcoding downcoding Define medical necessity as it applies to procedural and diagnostic coding Cognitive (Knowledge) Neehr Perfect Psychomotor (Skills) Neehr Perfect Affective (Behaviors) Neehr Perfect X. C Implications Chart or Activity X. P Legal Implications Chart or Activity X. A Legal Implications Chart or Activity Differentiate between scope of Locate a state’s legal scope of Demonstrate sensitivity to For X. C, use the For X. A, use the practice and standards of care EHR to support practice for medical assistants patient rights EHR to support for medical assistants the discussion. Apply HIPAA rules in regard to: the discussion.
Identify: types of 3rd party plans information required to file a 3rd party claim for filing a 3rd party claim Outline managed care requirements for patient referral Describe processes for: verification of eligibility precertification preauthorization Define a patient-centered medical home (PCMH) Differentiate between fraud and abuse 3. Use EHR to support discussion Interpret information on an insurance card Verify eligibility for services including documentation Obtain precertification or preauthorization including documentation Complete an insurance claim form For VIII. P, use the EHR to support the discussion (For ex: Mary Corbet) Interact professionally with 3rd party representatives Display tactful behavior when communicating with medical providers regarding 3rd requirements Show sensitivity when communicating with patients regarding 3rd party requirements Cognitive (Knowledge) IX. C Procedural & Diagnostic Coding Neehr Perfect Chart or Activity Psychomotor (Skills) IX. P Procedural & Diagnostic Coding Neehr Perfect Chart or Activity Affective (Behavior) IX. A Procedural & Diagnostic Coding Perfect Chart or Activity Describe how to use the most current procedural coding system Describe how to use the most current diagnostic coding classification system Describe how to use the most current HCPCS level II coding system Discuss the effects of: upcoding downcoding Define medical necessity as it applies to procedural and diagnostic coding For IX. C, use the EHR to support the discussion. Perform procedural coding Perform diagnostic coding Utilize medical necessity guidelines For IX. P, use any Utilize tactful communication skills with medical providers to ensure accurate code selection Cognitive (Knowledge) X. C Implications Neehr Perfect Chart or Activity Psychomotor (Skills) X. P Legal Implications Neehr Perfect Chart or Activity Affective (Behaviors) X. A Legal Implications Neehr Perfect Chart or Activity Differentiate between scope of practice and standards of care for medical assistants For X. C, use the EHR to support the discussion. Locate a state’s legal scope of practice for medical assistants Apply HIPAA rules in regard to: Demonstrate sensitivity to patient rights For X. A, use the EHR to support the discussion.
Neehr-Perfect-Go-MA-Standards-Mapping-v3.docx