Medical Insurance Syllabus for 2021-2022
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Instructor Information

Office Location

West Campus Allied Health 166

Office Hours

Appointments must be scheduled.

Instructor will be checking course 3 times a day.

Course Information

COVID-19 Protocols

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 Student Service Center office 112. More information may be found at
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 . 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

Amarillo College Tutoring for Success Policy:

The Tutoring for Success policy applies to any student whose grade or performance in the course falls below a departmentally determined minimum threshold. In either of those cases, the instructor will direct the student to the appropriate tutoring service, which may be faculty-led, discipline-specific, and/or general. Under this policy, the instructor will follow specific departmental guidelines governing the use, duration, and grade component of the tutoring need.

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 , 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 .


POFM-1327-001 Medical Insurance


Course Description

Survey of medical insurance including the life cycle of various claim forms, terminology, litigation, patient relations and ethical issues.

Student ResourcesStudent 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
Make appointment at

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.


(3 sem hrs; 3 lec)

Class Type

On Campus Course

Syllabus Information


Fordney's Medical Insurance, Linda M. Smith, CPC, CPC-I, CEMC, CMBS, Elsevier, 15th Edition

Workbook -  Fordney's Medical Insurance, Linda M. Smith, CPC, CPC-I, CEMC, CMBS, Elsevier, 15th Edition


Textbook, Workbook, paper, pens, pencils.
Quality Internet provider and computer.

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.

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.  

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

Student 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 .

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

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.

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.  If that is not successful, the student may appeal the decision of the instructor to the Program Director, Associate Dean of Health Sciences, Dean of the Health Sciences Division, Associate Vice President of Academic Affairs, or Vice President of Academic Affairs, and the President -- IN THAT ORDER.   Please refer to the current Online Amarillo College catalog for complete explanation of the grievance procedures.

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 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

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 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.

You must be in class to receive the quiz & you must be in class to grade the quiz in order for the grade to count.
The student must attend the entire class in order to have the quiz grade count. 
In other words the student cannot drop by class, pick up the quiz and leave. 
If you receive a take-home quiz on Monday, this quiz should be brought to class on Wednesday ready to be graded. 
If you are not in class to grade your quiz, you will receive a grade of zero (0). 
You may not turn take-home quizzes in early or late.     

There will be assignments for homework made in class and these assignments will also be posted to the AC Online course calendar.
Quizzes/Homework will be worth 20% of your FINAL GRADE.  
NO quiz or homework grades will be dropped.

If a homework assignment is not turned in on the assigned date, the student must have the late assignment turned into the instructor within 48 hours.
DO NOT email the late assignment to the instructor. 

The student will receive a 30% deduction for the assignment being turned in late.  This means if a student has completed the late assignment and scores 100% the grade for the late assignment will be 70%.

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 approximately  5-7 exams.

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.


Mandatory Tutoring :  In an effort to increase retention in MDS 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.       

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 25% of the final grade.

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.

Attendance           =   20% of the final grade.
Quiz/Homework    =   20% of the final grade.
Major Exams         =   35% of the final grade.
Final Exam            =   25% of the final grade

Final grades will not be rounded in this course.


"Regular attendance is necessary for satisfactory achievement.  Therefore, it is the responsibility of the student to attend class.."  Any student who is chronically late to class or leaves early or is absent more than 3 times during the course may earn a failing final course grade.

Attendance will be taken at the beginning of all class meetings and at the conclusion of the class meetingIf a student loses connection at any time during the class session and does not reconnect to the course the student  will be considered absent.
100 points will be given to all students who arrive on time to class and who stay for the entire class period. 

Students who arrive late or leave early, regardless of the reason, will be awarded only 50 points. 
In order to receive any credit for attendance the student must not be more than 15 minutes late or leave class more than 15 minutes early.  

Covid Policy:  Any student who cannot attend class on campus must contact the instructor before the class meeting.  The student will be required to attend class through Bb Collaborate link in the course.  You must have a computer with a camera and the camera must remain on during the entire class session. 

Cell Phones are NOT relaible please do not try to connect to the class with your cell phone. 

You may be asked to provide documentation as to why you cannot attend class in person, such as a positive covid test or a physician note.

Attendance will be worth 20% of your final grade. 



Week 1  

Chapter 1    Role of an Insurance Billing Specialist
Chapter. 2    Privacy, Security, & HIPAA

Week 2
Chapter. 2    Privacy, Security, & HIPAA
Quiz 1          Chapters 1 & 2
Chapter 3     Compliance, Fraud, and Abuse

Week 3
Chapter 3    Compliance, Fraud, and Abuse
Chapter 4    Basics of Health Insurance
Exam 1       Chapters 1 & 2

Week 4
Quiz 2       Chapter 3

Chapter. 4  Basics of Health Insurance
Chapter 5  The Blue Plans, Private Insurance, & Managed Care Plans

Week 5
Quiz 3       Chapter 4

Chapter 6  Medicare

Week 6
Quiz 4       Chapter 5

Chapter 6  Medicare

Week 7
Exam 2  Chapters 3 & 4

Chapter 7  Medicaid & Other State Programs

Week 8
Quiz 5       Chapters 6 & 7

Chapter 11  Medical Documentation & the Electronic Health Record

Week 9
Exam 3  Chapters 5, 6 & 7
Chapter 11  Medical Documentation & the Electronic Health Record

Week 10
Chapter 11  Medical Documentation & the Electronic Health Record
Quiz 6         Chapter 11

Week 11
Chapter 14   Paper Claim

Week 12
Chapter 15 The Electronic Claim

Week 13
Exam 4       Chapters 11, 14, 15

Chapter 16  Receiving Payments & Insurance Problem Solving

Week 14
Chapter. 17  Collection Strategies

Week 15
Exam 5        Chapters 16, 17, & ABBREVIATIONS

Chapter 12  Diagnostic Coding  (Introduction)
Chapter 13  Procedural Coding  (Introduction)

Week 16
Final Exam  online in Bb.

Additional Information

Dates of Importance:
Jan. 18, 2022       First day of class
Mar. 14th-20th     Spring Break – NO class meetings
Mar. 21, 2022       Last day to withdraw or drop a class
May 9th-12th       Final Exams Week


HELP:  General Questions
You may email or you may call (806) 371-5000. 

HOURS:     AskAC

Monday through Thursday  8:00 am to 7:00 pm
  8:00 am to 5:00 pm  Summer closes 5:00 pm
Closed Saturday, Sunday,  and Holidays

Student Help Center - "The Underground"
Basement of the Ware Student Commons   371-5992

The Student Help Center provides Amarillo College Students with technical assistance. 

If a student needs to update their computer or check for viruses, the center will provide these services FREE OF CHARGE to AC Students.
Your instructor highly recommends that students take advantage of these services!

Location:  Washington Street Campus - Ware Students Common - Basement "The Underground"

The Underground has computers available for the students to use on a first come, first serve basis.  If you are having internet or computer problems the Underground is available to help.

Monday - Thursday  7:00am to 9:00pm

Friday                        7:00 am to 4:00 pm
Sunday                      2:00 pm to 6:00 pm


Syllabus Created on:

01/18/22 11:01 AM

Last Edited on:

01/18/22 11:07 AM