OMS Billing

The OMS Billing course is the capstone to the Coding Certificate Program. It focuses on documentation guidelines, predetermination tips, claims filing, appeal tips and fraud and abuse. Accurate coding and billing services must be a priority for every OMS and his or her staff due to increased fraud and abuse investigations stemming from strict billing guidelines and inaccurate coding.

Learning Objectives:

  1. Review healthcare fraud and abuse issues addressed by federal and state laws and their impact on offering discounts.
  2. Demonstrate adherence to standards for appropriate coding and implement compliance plans that include conducting compliance audits.
  3. Explain various methods for setting office fees, including annual percentage increases, cost-based fees, national percentiles and percentage increases over Medicare.
  4. Describe types of managed care organizations – including HMO, PPO and POS plans – and basic elements of MCO contracts.
  5. Discuss basic elements of commercial and government-sponsored health insurance plans, including different reimbursement methodologies.
  6. Apply and/or understand Medicare-related policies, such as the National Provider Identifier, provider enrollment, accepting assignment, participation vs. nonparticipation vs. opting out, mandatory claims submission, timeframes for claims filing, Medicare notices (ABN) and more.
  7. Use pre-, intra- and post-claims processing submission procedures, such as predetermination, preauthorization, coordination of benefits, clean claim filing, electronic submission, contractual adjustments, write-offs, overpayments and more.
  8. Define the appeals process, starting with reading and understanding the EOB, writing appeal letters, internal and external commercial insurance reviews, and the Medicare process.
  9. Examine future healthcare reimbursement topics, including pay for performance, healthcare transparency and computer-assisted coding.

For optimal viewing, Chrome or Firefox are recommended browsers.   As a reminder, your course access will expire in 60 days of registration or upon completion of the course.


Dawn Jackson, DrPH, RHIA, CCS-P, FAHIMA

Dr. Dawn Jackson is full professor and program director of the Health Services Administration program at Eastern Kentucky University. She obtained her bachelor’s degree in Health Information Management from East Carolina University, Greenville, N.C., her master’s degree in Allied Health Education from Eastern Kentucky University, Richmond, Ky., and a doctorate degree in Health Services Management from the University of Kentucky, Lexington, Ky. She also is a fellow with the American Health Information Management Association. 
Dr. Jackson’s areas of expertise include healthcare reimbursement systems, coding and billing processes, medical law and healthcare management. A certified coding specialist, she has trained physicians and their staff for more than 26 years and has presented coding courses for the American Association of Oral and Maxillofacial Surgeons for almost 23 years.

Continuing Education Provider Approval
The American Association of Oral and Maxillofacial Surgeons is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education.

ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

The American Association of Oral and Maxillofacial Surgeons designates this activity for 9.0 continuing education credit(s).

AGD - Accepted Program Provider
FAGD/MAGD Credit
5/1/18 – 12/31/22
Provider ID# 214680

The American Association of Oral and Maxillofacial Surgeons (AAOMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Association of Oral and Maxillofacial Surgeons designates this internet-based enduring material for a maximum of 9.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

For AAPC credit, please contact the AAOMS Coding and Reimbursement Staff at (800) 822-6637. 

Key:

Complete
Failed
Available
Locked
Faculty and Planner Disclosure
Pre-Quiz
15 Questions  |  1 attempt  |  0/15 points to pass
15 Questions  |  1 attempt  |  0/15 points to pass
Unit 1A: Patient Protection and Affordable Care Act
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Open to view video.
Unit 1B: Healthcare Fraud and Abuse
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Unit 2: Patient Discounts
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Open to view video.
Unit 3: Clinical Coding & Compliance
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Open to view video.
Unit 4: Establishing Fee Schedules
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Open to view video.
Unit 5: Managed Care Organizations
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Open to view video.
Unit 6: Healthcare Reimbursement Systems
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Open to view video.
Unit 7: Reimbursement Methodologies
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Open to view video.
Unit 8: Medicare-Related Issues (part one)
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Open to view video.
Unit 8: Medicare-Related Issues (part two)
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Open to view video.
Unit 8: Medicare-Related Issues (part three)
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Open to view video.
Unit 9: Claims Processing & Payment (part one)
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Open to view video.
Unit 9: Claims Processing & Payment (part two)
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Open to view video.
Unit 9: Claims Processing & Payment (part three)
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Open to view video.
Unit 10: Appeals Process
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Open to view video.
Unit 11: Miscellaneous Reimbursement Issues
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Open to view video. Learn More About Medicare’s new Quality Payment Program: https://qpp.cms.gov
Conclusion
Open to download resource.
Open to download resource.
Course Quiz
15 Questions  |  Unlimited attempts  |  11/15 points to pass
15 Questions  |  Unlimited attempts  |  11/15 points to pass
Course Evaluation
11 Questions
Certificate
9.00 CDE/CME credits  |  Certificate available
9.00 CDE/CME credits  |  Certificate available