Medical Insurance Syllabus for 2025-2026
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Instructor Information

Course Information

AI Statement

Collusion is defined as “the unauthorized collaboration with another person or by any other means, including artificial intelligence (AI) and computer translators, in preparing work for fulfillment of course requirements.” Using AI like (ChatGPT or Google Gemini) to create a document is considered colluding. The use of Generative Artificial Intelligence on specific assignments is at the discretion of the instructor.

Title IX and Sexual Misconduct Reporting

Amarillo College prohibits discrimination and harassment based on sex, including sexual harassment, sexual assault, dating violence, domestic violence, and stalking, under Title IX and Texas Education Code §51.253–255. Faculty and staff are mandatory reporters and must share any related concerns with the Title IX Coordinator at titleix@actx.edu. Reports and additional information are available at https://www.actx.edu/hr/title-ixtitle-ix. Confidential counseling and advocacy services are available through the Counseling Center and Advocacy & Resource Center.

Recording Policy

Disability Statement

If you have a disability (learning, mental, physical) that affects your ability to participate effectively and have access to any program or service at Amarillo College please contact Disability Services at (806) 345-5639 . Our offices are located in the Enrollment Center, Suite 700. More information may be found at www.actx.edu/disability.
Disability Services facilitates access to all programs and services according to the ADA, Americans with Disabilities Act and Section 504 of the Rehabilitation Act, as well as other federal and state laws.

Amarillo College Web Accessibility Policy Statement

Amarillo College is committed to providing equal access to all programs and services, including all working, learning, and service environments that affect equal access for persons with disabilities. This commitment to provide equal access and opportunity for persons with disabilities is in compliance with federal and state law. Amarillo College also strives to provide Electronic and Information Resources (EIR) that are accessible to all authorized users.

If you find you are unable to access material in an accessible format please contact the Disability Services Office at (806) 345-5639 . This office will work in conjunction with other campus resources to address and accommodate your issue in a timely manner.

Statement for Mental Health and Advocacy & Resource Center:

As a student you may experience a range of issues that can cause barriers to learning, such as strained relationships, increased anxiety, alcohol/drug problems, feeling down, difficulty concentrating and/or lack of motivation. These mental health concerns or stressful events may lead to diminished academic performance or reduce a student's ability to participate in daily activities. Amarillo College offers services to assist you with addressing these and other concerns you may be experiencing. If you or someone you know are suffering from any of the aforementioned conditions, you can learn more about the broad range of confidential mental health services available on campus by calling the AC Counseling Center at 806-371-5900. The AC Counseling Center website is https://www.actx.edu/counseling/ . Also, if you are in need of social services (affordable housing, utilities, transportation, food, clothing, childcare, medical/dental/vision, legal), please call the AC Advocacy & Resource Center at 806-371-5439. The AC Advocacy & Resource Center website is https://www.actx.edu/arc

Amarillo College Tutoring for Success Policy:

Tutoring for Success applies to any student whose overall performance in the course falls below 75%. The instructor will create the task in the Student Engagement Portal (Watermark) to direct the student to the appropriate tutoring service, which may be faculty- or SI-led, discipline-specific, and/or general. The tutoring service assigned, the due date for when the tutoring must be completed, and the amount of tutoring required are at the discretion of the instructor. Additionally, the task will alert the student’s success team. Students who do not fulfill the assigned tutoring task may be subject to program- and course-specific penalties that could result in a grade reduction and/or in not being allowed to progress in the course until the tutoring requirement has been satisfied.

Administrative Drop Policy

Students who do not attend class on or prior to the census date will be administratively dropped. Effective Fall, 2016

Student Withdrawal Procedures

Students who wish to withdraw from a course must complete all steps indicated on the Academic Withdrawal Request form by the course withdrawal deadline.

NOTE: Students who are attending Texas institutions of higher education, for the first time fall 2007 and later, may not withdraw from more than six courses during their academic career. This withdrawal limitation does not include dual credit or developmental classes (Senate Bill 1231 Rule 4.10.) For more information on Drop and Withdrawal Policies, please visit the Registrar's Office Web site.

Privacy Statement

The Amarillo College Privacy Policy is found at https://www.actx.edu/-amarillo-college-privacy-notice , and applies to all Amarillo College students.  If you have questions about this privacy statement or you believe that your personal information has been released without your consent, send email to humanresources@actx.edu .

Course

MDCA-1343-002 Medical Insurance

Prerequisites

Prerequisite: BIOL 2401 minimum grade of "C" Corequisites: HITT 1205, minimum grade of "C" Previous or Concurrent

Course Description

Emphasizes medical office coding for payment and reimbursement by patient or third party payers for ambulatory care settings.

Student Resources Student Resources Website

Department Expectations

Occupational License Disclaimer

Notice to Students enrolled in an educational program for preparation of issuance of certain occupational licenses:

Students enrolled in an educational program in preparation for obtaining certain occupational licenses are potentially ineligible for such license if the student has been convicted of an offense. For further information, please contact:

Melodie Graves
Justice Involved Advocate
Student Service Center 117
mgraves24@actx.edu
806-371-5995
Make appointment at https://melodiegraves.youcanbook.me

You can also contact the Legal Clinic, or the faculty member in charge of the educational program that you seek to enroll in. The further information you will receive will include notification to you of your right to request a criminal history evaluation letter from the licensing authority in order to clarify your particular situation.

Hours

(3 sem hrs; 2 lec, 2 lab)

Class Type

Online Course

Syllabus Information

Textbooks

Understanding Health Insurance; A Guide to Billing and Reimbursement, Michelle A. Greene, MPS, RHIA, FAHIMA, CPC, Cengage, 2023 Edition.

Access to Mindtap with Cengage all access.
 

Supplies

Laptop, Textbook, Pencils, Pens, Paper

Student Performance

 End-of-Course Outcomes:  Compare and contrast insurance plans; define various health care delivery systems; bill patients and insurance carriers for medical services; and produce insurance claim form.

Upon completion of the following the student will be able to perform the following with at least a 70% accuracy as evaluated by the program's faculty.

•           Distinguish between the two major health insurance contract classes.
•           List and define the general terms involved with federal, state and private health insurance plans, and common insurance terminology.
•          Demonstrate the ability to abstract insurance data from the patient record onto the health insurance claim form.
•          Explain the purpose of coding for medical professional services.
•           Demonstrate procedural and diagnostic coding correctly.
•           Describe the history of the health insurance claim form and be able to understand the different categories involved in the claim form.
•           Develop a procedure abstracting insurance data from patient record & followup notations for patient ledger card.
•           Cite the essential items of Blue Cross-Blue Shield insurance plans & how it started.
•           Develop an understanding of Medicaid benefits and what information is necessary when filing for these benefits.
•         Verbalize the essential items of Medicare insurance coverage and how it started.  Develop an understanding of the Medicare abbreviations.                 
•          Describe the essential items of CHAMPUS, CHAMPVA and VA Outpatient Clinic insurance.
           Relate the history of how these insurance coverages started.
•          Cite the essential items of coverage for unemployment compensation & for doctor's certificate for verification of disability
•         Know and understand the coverage for federal and state workers' compensation laws
•         Describe the difference between compulsory and elective laws & how funding is achieved for workers' compensation.
•           Define terminology as it relates to workers' compensation.
•          Explain the advantages of filing a lien.
•          Identify the types of prepaid health plans -- Health Maintenance Organization & Peer Review.
•          Explain all the facets of dental insurance, including coverage under prepaid dental plans. 
           Dental insurance cases will be worked on in the classroom.
•          State the different ways in which a medical/dental office can utilize a computer system.
•          Describe the application of credit and collection procedures after insurance claims have been filed & payment has been received.  Advantages listed for having a superbill, telephone debt collections, understanding bankruptcy &     small claims court procedures.
•          Abstract from the patient records the necessary insurance information for the cases involved in the textbook and added cases in the classroom.
•          Recognize the special insurance groups and file claims for these in the classroom.
 

COURSE OBJECTIVE:
To provide the student with the basic knowledge in order to distinguish between the various  types of medical insurance available to patients and to be able to provide maximum reimbursement to the physician, medical facilities and the patient.  

COURSE GOALS:
Upon completion of this course the student will be able to:
•        Abstract insurance data from the medical record to the health insurance claim form to provide maximum reimbursement to the physician and the patient.
•        Increase the efficiency and streamline administrative procedures  for insurance billing.   
 

Students Rights and Responsibilities

Log in using the AC Connect Portal

In order to receive your AC Connect Email, you must log in through AC Connect at https://acconnect.actx.edu .

If you are an active staff or faculty member according to Human Resources, use "Exchange". All other students, use "AC Connect (Google) Email".

Expected Student Behavior

WITHDRAWING FROM A COURSE:
It is the responsibility of the student to officially drop or withdraw  from a course.  Failure to officially withdraw may result in the student receiving a grade of “F” in the course. 
Students are not automatically dropped from their class roles as a result on non-attendance.

STUDENT GRIEVANCE PROCEDURE:
A student who has a problem with the course or the course instructor should make every attempt to resolve the problem with the course instructor, Judy Massie.  If that is not successful, the student may appeal the decision of the instructor to the Program Director, Jessica Hill, Associate Dean of Health Sciences, Kim Boyd, Dean of the Health Sciences Division, Kim Crowley,  Associate Vice President of Academic Affairs, Becky Burton, Vice President of Academic Affairs, Dr. Tamra Clunis, and the President -- IN THAT ORDER.   Please refer to the current Online Amarillo College catalog for complete explanation of the grievance procedures.

CELLULAR TELEPHONES:
Telephones are disruptive during class time.  Telephones must be turned off during class time with the exception of emergency personnel, pagers must either be turned off or set on vibrate during class time.   Please notify me in writing if you fall in this category, otherwise failure to comply will result in you being asked to leave class for that day.  You will still be responsible for the material covered in class.  If you feel that you will have an emergency during class time, leave the number of the student services office and they will contact you immediately.  The number is 371-5300. 

ACADEMIC DISHONESTY:
Academic dishonesty shall constitute a violation of the college rules & regulations & is punishable as prescribed by Amarillo College Board policies.  Academic dishonesty shall include, but is not limited to, cheating on a test, plagiarism, and collusion.
 “Cheating on a test” shall include:
•    Copying from another student’s test paper.
•    Using test materials not authorized by the person administering the test.
•    Collaborating with or seeking aid from another student during a test without permission from the test administrator/instructor.
•    Knowingly using, buying, selling, stealing, or soliciting, in whole or in part, the contents of an administered/unadministered test.
•    Substituting for another student, or permitting another student to substitute for one’s self, to take a test.
•    Bribing another person to obtain an administered/unadministered test or information about an administered/unadministered test. 

“Plagiarism” shall be defined as the appropriating, buying, receiving as a gift, or obtaining by any means another’s work and the unacknowledged submission or incorporation of it in one’s own written work. 

“Collusion” shall be defined as the unauthorized collaboration with another person in preparing written work for fulfillment of course requirements.
 

Grading Criteria

EVALUATION METHOD:
QUIZZES: 
Quizzes will be given at the discretion of the instructor.  Quizzes may or may not be announced by the instructor.  Material covered by these quizzes will consist of review material or new material assigned in class.  Quizzes may be given orally, fill in the blank, matching, crossword puzzles, take-home or in a group.  There will be a minimum 8 to 10 quizzes. 

Each Online Quiz will open @ 6:00pm on the assigned date.
Each Online Quiz will CLOSE @ 11:59pm on the DUE date.

IF A QUIZ IS MISSED, THERE WILL BE NO MAKEUP QUIZZES. 
If a student arrives late to class, while a quiz is in progress, he/she will NOT be given extra time to complete the quiz.  If a student arrives late to class after a quiz has been given, he/she will not be allowed to take the quiz.  

Assignments:
There will be Cengage assignments for homework made in class and these assignments will also be posted to the AC Online course calendar.
Quizzes/Homework will be worth 40% of your FINAL GRADE.  
NO quiz or homework grades will be dropped.

 

MAJOR EXAMS:
These exams will be announced during class at least a week in advance of the exam date.
Major Exams will be given online.  

There will be NO makeup exams for the exams taken online.
Each Online Exam will open @ 6:00pm on the assigned date.
Each Online Exam will CLOSE @ 11:59pm on the DUE date.

Students with questions regarding examination results may review examinations, under the supervision of the MDS faculty, by appointment only.  Students who feel that a question was scored improperly must submit the following to the appropriate instructor, in writing by email.

•    The exam question and the reason for requesting an instructor review of the score.
•    The page and paragraph number, in the student's textbook or lecture notes, that verifies that the student's answer is correct.  Other sources of information, such as textbooks that have not been assigned, will not be considered.

The request must be submitted within one (1) calendar week after the instructor notifies the student of the grade.  The student will be notified within one (1)calendar week if the points have or have not been awarded.  Exam questions from an exam given more than one (1) week previously will not be considered.

MAJOR EXAMS WILL ARE WORTH 20% OF YOUR FINAL GRADE.
NO MAJOR EXAM GRADES WILL BE DROPPED.

Mandatory Tutoring :  In an effort to increase retention in MDS and MA courses, any student who scores below a 70 on any exam (excluding the Final Exam week) must complete a mandatory tutoring assignment before taking the next exam. Before receiving a skills assignment, students must first schedule a time with the instructor. The assignment will be given at that time.       

FINAL EXAM: 
There will be a comprehensive final exam administered in this course. 
The final exam will be administered online.

If a student misses the designated time for the final exam, a grade of zero (0) will be given for the final exam, unless an incomplete has been granted.
Arrangements to receive an incomplete "I" grade for the course must be made prior to the date of the final exam.  Students will need to provide the instructor with appropriate documentation.
Incompletes are granted only for emergency situations such as hospitalization of the student, serious injury to the student on the day of the final exam, etc.
Incompletes are NOT granted for situations involving vacation plans, transportation difficulties, doctor's appointments, honeymoons, etc.

The final exam is worth 20% of the final grade.

GRADING SUMMARY:        
A  =    90.0 - 100.0%             
B  =    80.0 - 89.9%                
C  =    70.0 - 79.9%                
F  =    69.9% or less   

A "D" is not possible in this course.

GRADE SCALE:

Quizzes= 20% of the final grade.
Assignments  =    40% of the final grade.
Major Exams         =    20% of the final grade.
Final Exam            =    20% of the final grade

Final grades will not be rounded in this course.

Attendance

ATTENDANCE POLICY: 
"Regular attendance is necessary for satisfactory achievement.  Therefore, it is the responsibility of the student to attend class.." 

Asynchronous Attendance & Participation Rule

Weekly Check-In – You must log into the course at least 3 times per week to stay on track.

Assignments & Deadlines – Attendance is measured by turning in assignments, quizzes, and exams on time. Missing deadlines counts as an absence.

Consistency Matters – Skipping weeks or falling behind may result in being marked absent and could affect your final grade.

Communication – If something prevents you from keeping up, contact me right away. Extensions may be considered for documented situations.

Calendar

Additional Information