EASTERN ARIZONA COLLEGE Professional Practice in Coding and Billing

Transcription

1 EASTERN ARIZONA COLLEGE Professional Practice in Coding and Billing Course Design Course Information Division Allied Health Course Number HCE 216 Title Professional Practice in Coding and Billing Credits 3 Developed by Dr. Stephen Cullen/Patricia A. Burke Lecture/Lab Ratio 0 Lecture/6 Lab Transfer Status ASU NAU UA Pending Evaluation Pending Evaluation Pending Evaluation Activity Course CIP Code Assessment Mode Portfolio Semester Taught Upon Request GE Category ne Separate Lab Awareness Course Intensive Writing Course Prerequisites Prior or concurrent enrollment in HCE 214 required Educational Value This course is designed for students aspiring to enter the field of medical coding and billing. Description Designed to provide for student attainment of the entry-level competencies for medical coding and billing. Placement in a clinic, physician office, hospital, managed care organization, private billing, or insurance company setting is required for a minimum of 90 hours. In an actual work situation, students will perform both medical coding and billing competencies. Supplies tebook Pen/Pencil Access to a computer and the Internet EASTERN ARIZONA COLLEGE Professional Practice in Coding and Billing

2 Competencies and 1. Recognize the role and responsibilities of an Insurance Specialist. a. Compare and contrast between medical etiquette and medical ethics. b. Outline Health Insurance Portability and Accountability. c. Describe the Privacy Rule Confidentiality and Protected Health Information. d. List the seven basic components of a compliance plan. o learner compares and contrasts between medical etiquette and medical ethics o learner outlines Health Insurance Portability and Accountability o learner describes the Privacy Rule Confidentiality and Protected Health Information o learner lists the seven basic components of a compliance plan 2. Identify basics of health insurance. a. Describe the different type of health insurance coverage. b. Outline the documentation process. c. List the principals of general principles of health record documentation. d. Reason for the development use of diagnostic codes. e. List the rules for coding. f. Define electronic data interchange. g. Outlining the steps when receiving a payment or resolving insurance problems. h. Recite the stages of insurance collection. o learner describes the different types of health insurance coverage o learner outlines the documentation process o learner lists the principles of general principles of health record documentation o learner identifies the reason for the development use of diagnostic codes o learner lists the rules for coding EASTERN ARIZONA COLLEGE Professional Practice in Coding and Billing

3 o o o learner defines electronic data interchange learner outlines the steps when receiving a payment or resolving insurance problems learner recites the stages of insurance collection 3. Recognize health care payers. a. Describe the difference between Blue Plan, Private Insurance, and Managed Care Plans. b. Identify the difference between Medicare and Medicaid. c. Explain the structure of network-based managed care health insurance programs. d. Identify the TRICARE Program. e. Explain the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA). f. Identifies the laws and insurance coverage for Worker s Compensation. g. Explain how to process Disability Income Insurance and Disability Benefit Programs. o learner describes the difference between Blue Plan, Private Insurance, and Managed Care Plans. o learner identifies the difference between Medicare and Medicaid. o learner explains the structure of network-based managed care health insurance programs. o learner identifies the TRICARE Program. o learner explains the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA). o learner identifies the laws and insurance coverage for Worker s Compensation. o learner explains how to process Disability Income Insurance and Disability Benefit Programs. 4. Identifies the difference between Inpatient and Outpatient Billing. a. Define Inpatient Billing. b. Define Outpatient Billing. c. Outline admissions procedures and major insurance programs. d. Define Inpatient ICD-9-CM Volume 3 Procedures. e. Define Inpatient ICD-10-CM Volume 3 Tabular List. f. Define Outpatient Level I CPT coding System. EASTERN ARIZONA COLLEGE Professional Practice in Coding and Billing

4 g. Define HCPCS Level II Medicare National Coding. o through participation in class activities and discussions o learner defines inpatient billing o learner defines outpatient billing o learner outlines admissions procedures and major insurance programs o learner defines inpatient ICD-9-CM Volume 3 Procedures o learner defines Inpatient ICD-10-CM Volume 3 Tabular List o learner defines Outpatient Level I CPT Coding System o learner defines HCPCS Level II Medicare National Coding 5. Develop job seeking strategies and professional advancement. a. Outline ways to conduct on-line employment searches. b. Discuss elements of resumes. c. Discuss elements of letters of recommendations. d. Discuss elements of letter of introduction. e. Discuss elements of giving an effective interview. f. Discuss self-employment opportunities. o through participation in class activities and discussions o learner outlines ways to conduct online employment searches o learner discusses elements of resumes o learner discusses elements of letters of recommendations o learner discusses elements of letter of introduction o learner discusses elements of giving an effective interview o learner discusses self-employment opportunities Types of Instruction Actual work experience EASTERN ARIZONA COLLEGE Professional Practice in Coding and Billing

5 Grading Information Grading Rationale Skill performance of each competency will be assessed. Students must pass all critical criteria. Grading Scale This course is Pass/Fail. Students must pass competencies at the work site. EASTERN ARIZONA COLLEGE Professional Practice in Coding and Billing