Medical Coding and Billing Specialist Certificate Program

Transcription

1 Medical Coding and Billing Specialist Certificate Program Delivery Method: Program Hours: Program Modules: Online asynchronous learning with video lectures. 576 hours (2 Modules) Module I (288 hours) Section I: Medical Terminology/Anatomy and Physiology (225 hours) Section II: Introduction to Medical Coding (63 hours) Module II (288 hours) Section I: Advanced Concepts in Medical Coding (112 hours) Section II: Health Insurance Billing (176 hours) NOTE: Each Section is divided into a series of lessons we call Study Units (SU). Software Requirements: Microsoft Windows XP, Vista or Windows 7 Microsoft Office 2010 Textbooks: (Optional) Schroeder, Carol L. Introduction to Medical Terminology, Second Edition Cengage Learning ISBN: Linker, Robin, and Sandra L. Johnson. Understanding Medical Coding: A Comprehensive Guide. Clifton Park, NY: Delmar, ISBN: Moisio, Marie A. A Guide to Health Insurance Billing. Clifton Park, NY: Delmar, ISBN:

2 Prior Knowledge requirements There are no pre-requisites for this course. Students containing no prior knowledge with Medical Coding and Billing are welcome to enroll. All that the professor expects from a new student is a solid work ethic and eagerness to learn! Educational Outcome: Students will receive a Certificate of Completion from eperceptum for their successful completion of the Medical Coding and Billing Certificate Program. Students will be able to proudly flaunt a verified eperceptum certificate that is both respected and recognized by leading corporations. Summary Course Objective: Upon completion of this course, students will be able to identify, spell, and define all the primary medical terms related to the diagnosis, pathology, and treatment of the major body systems. Students will also be able to correctly code a claim, link the correct Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for reimbursement, and understand adjustments. In addition, students will find out how and when to bill patients and what to do if there is a denial or rejection. Lastly, students will understand the health insurance industry, identify the foundational skills in medical coding (including ICD-10-CM), demonstrate commonly used insurance claims procedures, and analyze insurance claims from several major health insurance programs. Course Concepts: Location of Concept: 1. Medical Terminology Study Units Health and Disease Study Unit 2 3. Skeletal System Study Unit 3 4. Muscular System Study Unit 4 5. Cardiovascular System Study Units 5, Lymphatic System Study Unit 6 7. Respiratory System Study Unit 7 8. Digestive System Study Unit 8 9. Urinary System Study Unit Nervous System Study Unit Eyes and Ears Study Unit Integumentary System Study Units 12, Endocrine System Study Unit Reproductive Systems Study Unit Diagnostic Procedures Study Unit Medical Coding Study Unit ICD-9-CM Study Unit HCPCS Level II Study Unit Current Procedural Terminology Study Unit Pharmacology Study Unit 15 2

3 21. Immune System Study Unit General Surgery Study Unit Anesthesia Study Unit Cardiology Study Unit OB/GYN Study Unit Radiology Study Unit Medicine Study Unit Laboratory Study Unit Insurance Billing Study Unit Health Insurance Study Units ICD-10-CM Study Unit Insurance Claim Study Unit CMS Study Unit UB-04 (CMS-1450) Study Unit Electronic Data Interchange Study Unit Blue Cross/Blue Shield Study Unit Medicare Study Unit Medicaid Study Unit Tricare Study Unit Workers' Compensation Study Unit Evaluation Study Unit Management Study Unit Champva Study Unit Pathology Study Unit 25 At the conclusion of each study unit, a quiz will be administered and the student must receive a 70% or higher to meet successful completion requirements. Support and mentoring will be available to review material in areas where 70% is not obtained. Students will have 3 attempts to obtain at least a 70%. To receive a Medical Coding and Billing Certificate from eperceptum, the student must satisfactorily complete the entire training program. This course will prepare you for your Certified Professional Coder (CPC) medical coding certification. The CPC validates proficiency in the correct application of Current Procedural Terminology, Healthcare Common Procedure Coding System (HCPCS) Level II procedure and supply codes, and ICD-9-CM diagnosis codes used for coding and billing for medical claims in a physician's office. Module I (288 hours) Section I: Medical Terminology and Introduction to Anatomy/Physiology (225 hours) 3

4 Objective: After completing this section, students will be able to identify, spell, and define all the primary medical terms related to the diagnosis, pathology, and treatment of the major body systems. Study Unit 1: Introduction to Medical Terminology Topic A: Introduction Topic B: Word Parts/Roots Topic C: Suffixes/Prefixes Topic D: Pronunciation Topic E: Spelling/Abbreviations Topic F: Basic Medical Terms Topic G: Career Opportunities Study Unit 1 Quiz Study Unit 2: The Human Body in Health and Disease Topic B: Anatomic Reference Systems Topic C: Structures Of Body Topic D: Cells/Genetics Topic E: Tissues/Glands Topic F: Body Systems And Related Organs Topic G: Pathology Topic H: Aging Study Unit 2 Quiz Study Unit 3: The Skeletal System Topic B: Structures And Functions Of Skeletal System Topic C: Structure Of Bones Topic D: Joints Topic E: The Skeleton Topic F: Pathology Of The Skeletal System Topic G: Diagnostic And Treatment Procedures Topic H: Abbreviations Topic I: Career Opportunities Study Unit 3 Quiz Study Unit 4: The Muscular System Topic B: Functions And Structures Topic C: Types Of Muscle Tissues Topic D: Muscle Contraction And Relaxation Topic E: Contrasting Muscle Motion Topic F: How Muscles Are Named Topic G: Pathology Of The Muscular System 4

5 Topic H: Diagnostic And Treatment Procedures Topic I: Abbreviations Topic J: Career Opportunities Study Unit 4 Quiz Study Unit 5: The Cardiovascular System Topic B: Functions And Structures Topic C: Blood Vessels/Blood Topic D: Pathology Of The Cardiovascular System Topic E: Diagnostic And Treatment Procedures Topic G: Career Opportunities Study Unit 5 Quiz Study Unit 6: The Lymphatic and Immune Systems Topic B: Functions And Structures Of Lymphatic System Topic C: Functions And Structures Of Immune System Study Unit 6: The Lymphatic and Immune Systems continued Topic D: Pathogenic Organisms Topic E: Oncology Topic G: Career Opportunities Study Unit 6 Quiz Study Unit 7: The Respiratory System Topic B: Functions And Structures Topic C: Respiration Topic D: Pathology Of The Respiration System Topic E: Diagnostic And Treatment Procedures Topic G: Career Opportunities Study Unit 7 Quiz Study Unit 8: The Digestive System Topic B: Structures Topic C: Digestion Topic D: Pathology Of The Digestive System Topic E: Diagnostic And Treatment Procedures Topic G: Career Opportunities Study Unit 8 Quiz Study Unit 9: The Urinary System 5

6 Topic B: Functions And Structures Topic C: The Excretion Of Urine Topic D: Pathology Of The Urinary System Topic E: Diagnostic And Treatment Procedures Topic G: Career Opportunities Study Unit 9 Quiz Study Unit 10: The Nervous System Topic B: Functions And Structures Topic C: The Central Nervous System Topic D: The Peripheral Nervous System Study Unit 10: The Nervous System continued Topic E: The Autonomic Nervous System Topic F: Pathology Of The Nervous System Topic G: Diagnostic And Treatment Procedures Topic H: Mental Health Topic I: Abbreviations Topic J: Career Opportunities Study Unit 10 Quiz Study Unit 11: Special Senses: Eyes and Ears Topic B: Functions And Structures of Eyes Topic C: Pathology Of The Eyes And Vision Topic D: Diagnostic And Treatment Procedures Of The Eyes Topic E: Functions And Structures Of Ears Topic F: Pathology Of The Ears And Hearing Topic G: Diagnostic And Treatment Procedures Of The Ears Topic H: Diagnostic And Treatment Procedures Of The Ears Topic I: Abbreviations Topic J: Career Opportunities Study Unit 11 Quiz Study Unit 12: Skin: The Integumentary System Topic B: Functions Of The Integumentary System Topic C: Structures Of The Skin Topic D: Pathology Of The Integumentary System Topic E: Diagnostic And Treatment Procedures Topic G: Career Opportunities Study Unit 12 Quiz 6

7 Study Unit 13: The Endocrine System Topic B: Functions And Structures Topic C: Pathology Of The Endocrine System Topic D: The Pituitary Gland Topic E: The Pineal Gland Topic F: The Thyroid Gland Topic G: The Parathyroid Gland Topic H: The Thymus Topic I: The Pancreatic Islets Topic J: The Adrenal Glands Topic K: The Gonads Topic L: Abbreviations Study Unit 13: The Endocrine System continued Topic M: Career Opportunities Study Unit 13 Quiz Study Unit 14: The Reproductive Systems Topic B: Functions And Structures Of Male Reproductive System Topic C: Pathology Of Male Reproductive System Topic D: Diagnostic And Treatment Procedures Of Male Reproductive System Topic E: Sexually Transmitted Diseases Topic F: Functions And Structures Of Female Reproductive System Topic G: Pathology Of Female Reproductive System Topic H: Diagnostic And Treatment Procedures Of Female Reproductive System Topic I: Pregnancy And Childbirth Topic J: Pathology Of Pregnancy And Childbirth Topic K: Assisted Reproduction Topic L: Abbreviations Topic M: Career Opportunities Study Unit 14 Quiz Study Unit 15: Diagnostic Procedures and Pharmacology Topic B: Basic Examination Procedures and Positions Topic C: Laboratory Tests Topic D: Endoscopy Topic E: Centesis Topic F: Imagining Techniques Topic G: Pharmacology Topic H: Medical Technologist Topic I: Abbreviations Topic J: Career Opportunities 7

8 Study Unit 15 Quiz Section II: Introduction to Medical Coding (63 hours) Objective: After completing this section, the student will be able to identify, categorize, and interpret ICD-9-CM, as well as recognize the foundational skills to medical coding. Study Unit 16: Introduction to Coding Topic A: Career As A Medical Coder Topic B: Skills Required Topic C: Fraud And Abuse Topic D: Confidentiality Study Unit 16: Introduction to Coding continued Topic E: Health Information Technology For Economic And Clinical Health (HITECH) Topic F: Physician Quality Reporting System (PQRS) Topic G: Electronic Prescribing Incentive Program Topic H: Quality Improvement Organization (QIO) Topic I: Types Of Coding Topic J: ICD-9-CM Codes Topic K: ICD-10-CM Codes Study Unit 16 Quiz Study Unit 17: ICD-9-CM Topic A: History And Usage Of ICD-9-CM Topic B: How To Look Up A Term Topic C: V Codes And E Codes Topic D: Categories, Subcategories, And Subclassifications Topic E: Coding Conventions Topic F: Volume 3: Procedural Coding With ICD-9-CM Topic G: Infections Topic H: Circulatory System Coding Topic I: Diabetes Mellitus Topic J: Using V Codes Topic K: Obstetrical Coding Topic L: Neoplasms Topic M: Poisoning Versus Adverse Effects Topic N: Complications And Late Effects Topic O: Official Coding Guidelines Study Unit 17 Quiz Study Unit 18: HCPCS Level II 8

9 Topic A: History Of HCPCS Topic B: Format Topic C: HCPCSII Hierarchy Topic D: Code Revisions Topic E: HCPCSII Chapter Details Topic F: Accuracy Tips Topic G: HCPCSII Medication Study Unit 18 Quiz Study Unit 19: Current Procedural Terminology (CPT) Basics Topic A: AMA/CPT Code Book Topic B: Symbols Topic C: Unlisted Codes Topic D: Anesthesia Study Unit 19: Current Procedural Terminology (CPT) Basics continued Topic E: CPT Surgical Guidelines Topic F: Medicine Section Topic G: Category I And II Codes Topic H: Online Medical Evaluation Topic I: Tips For Selecting A CPT Code Study Unit 19 Quiz Module II (288 hours) Section I: Advanced Concepts in Medical Coding (112 hours) Objective: After completing this section, students will also be able to correctly code a claim, link the correct CPT and ICD-9-CM codes for reimbursement, and understand adjustments at an advanced level. Study Unit 20: Evaluation and Management (E/M) Topic A: AMA/CPT Evaluation And Management Guidelines Topic B: CPT Criteria For Documentation And E/M Code Selection Topic C: Counseling And Coordination Of Care Topic D: E/M Categories Topic E: Emergency Department Care Topic F: 1997 Evaluation And Management Documentation Guidelines Study Unit 20 Quiz Study Unit 21: Anesthesia and General Surgery Topic A: Types Of Anesthesia Topic B: Anesthesia Coding And Modifiers 9

10 Topic C: The Respiratory System Topic D: The Cardiovascular System Topic E: The Hemic And Lymphatic Systems Topic F: The Digestive System Topic G: The Urinary System Topic H: The Male Genital System Topic I: Central Nervous System Topic J: The Eye And Ocular Adnexa Topic K: The Auditory System Study Unit 21 Quiz Study Unit 22: Integumentary System Topic A: ICD-9-CM Code Selection Topic B: Evaluation and Management Services Study Unit 22: Integumentary System continued Topic C: Surgical Guidelines Topic D: Incision And Drainage Topic E: Debridement Topic F: Paring Or Cutting Topic G: Removal Of Skin Tags Topic H: Lesion Removal Or Destruction Topic I: Intralesional Injections And Tissue Expanders Topic J: Nails Topic K: Adjacent Tissue Transfer of Rearrangement Topic L: Flaps (Skin And Deep Tissues) Topic M: Pressure Ulcers (Decubitus Uclers) Topic N: Moh's Micrographic Surgery Topic O: Breast Procedures Topic P: Repair And Reconstruction Study Unit 22 Quiz Study Unit 23: Cardiology and the Cardiovascular System Topic A: Cardiac And Vascular Anatomy And Physiology Topic B: ICD-9-CM Code Selection Topic C: CPT Series Of CPT Topic D: Intra-cardiac Electrophysiological Procedure/Studies Topic E: Noninvasive Vascular Diagnostic Studies Topic F: Series Of CPT Radiology Topic G: Using Modifiers Effectively Topic H: Considering An Unlisted Code Topic I: Category II And Category II Codes Study Unit 23 Quiz Study Unit 24: Obstetrics and Gynecology (OB/GYN) Topic A: Unique Aspects Of Coding OB/GYN 10

11 Topic B: Subspecialties Of OB/GYN Topic C: Anatomy And Physiology Of The Female Reproductive System Topic D: Obstetrics And Gynecology (OB/GYN) Topic E: Obstetrics (OB) Study Unit 24 Quiz Study Unit 25: Radiology, Pathology, and Laboratory Topic A: Radiology Topic B: CPT Radiology Topic C: Radiology Modifiers Topic D: Diagnostic Radiology Topic E: Diagnostic Ultrasound Topic F: Radiation Oncology Topic G: Nuclear Medicine Study Unit 25: Radiology, Pathology, and Laboratory continued Topic H: CPT Pathology And Laboratory Topic I: Organ Or Disease Oriented Panels Topic J: Evocative/Suppression Testing Topic K: Chemistry Topic L: Hematology And Coagulation Topic M: Immunology Topic N: Transfusion Medicine Topic O: Anatomic Pathology And Cytopathology Topic P: Microbiology Study Unit 25 Quiz Study Unit 26: Medicine Topic A: Medicine Guidelines Topic B: Immune Globulins Topic C: Immunization Administration Topic D: Vaccines And Toxoids Topic E: Therapeutic Infusions Topic F: Injections Topic G: Psychiatry Topic H: Psychiatric Therapeutic Care Topic I: Biofeedback And Dialysis Topic J: Gastroenterology Topic K: Otorhinolaryngology Services Topic L: Allergy And Clinical Immunology Topic M: Neurology And Neuromuscular Procedures Topic N: Central Nervous System Assessments/Tests Topic O: Health And Behavior Assessment Topic P: Chemotherapy Administration Topic Q: Photodynamic Therapy And Dermatological Procedures 11

12 Topic R: Physical Medicine And Rehabilitation Topic S: Chiropractic Manipulative Treatment Topic T: Home Health Procedures Study Unit 26 Quiz Study Unit 27: Modifiers: A Practical Understanding Topic A: CPT Modifiers Topic B: Modifiers Approved For ASC Hospital Outpatient Use Topic C: HCPCS Level II Modifiers Topic D: NCCI Modifiers Topic E: Category II Modifiers Study Unit 27 Quiz Section II: Health Insurance Billing (176 hours) Objective: After completing this section, students will find out how and when to bill patients and what to do if there is a denial or rejection. Students will also understand the health insurance industry, demonstrate commonly used insurance claims procedures, and analyze insurance claims from several major health insurance programs. Study Unit 28: The Insurance Billing Specialist Topic B: Insurance Billing Specialist Topic C: Employment Opportunities Topic D: Educational, Certification, And Career Opportunities Topic E: Abbreviations Study Unit 28 Quiz Study Unit 29: Legal Aspects of Insurance Billing Topic B: Origin Of Legal Issues Topic C: General Legal Terms Topic D: Confidential Information Topic E: Insurance Fraud And Abuse Laws Study Unit 29 Quiz Study Unit 30: Introduction to Health Insurance Topic B: Defining Health Insurance Topic C: Managed Care Topic D: Managed Care Organizations Topic E: Health Insurance Terminology Topic F: Paying The Bill With Health Insurance 12

13 Topic G: Abbreviations Study Unit 30 Quiz Study Unit 31: ICD-10-CM Topic B: ICD-10-CM Topic C: ICD-10-CM Tabular List Conventions Topic D: Assigning ICD-10-CM Diagnosis Codes Topic E: ICD-10-PCS Study Unit 31 Quiz Study Unit 32: Developing an Insurance Claim Topic A: Key Terms and Overview Topic B: Patient Registration Study Unit 32: Developing an Insurance Claim continued Topic C: Clinical Assessment And Treatment Topic D: Patient Departure Procedures: New And Established Patients Topic E: Insurance Claim Form: Generation And Submission Study Unit 32 Quiz Study Unit 33: Common CMS Completion Guidelines Topic B: Optical Scanning Guidelines Topic C: CMS-1500 Guidelines Topic D: CMS-1500 Patient Information Topic E: CMS-1500 Treatment And Provider Information Topic F: Common Errors Made When Completing The CMS-1500 Topic G: Abbreviations Study Unit 33 Quiz Study Unit 34: Common UB-04 (CMS-1450) Completion Guidelines Topic B: Hospital Reimbursement Topic C: Developing The Insurance Claim Topic D: UB-04 Completion Guidelines Topic E: Submitting The Insurance Claim Study Unit 34 Quiz Study Unit 35: Electronic Data Interchange Topic B: Electronic Claims Submission Options Topic C: Completing The Health Insurance Claim Topic D: Confidentiality And Electronic Claims Processing Topic E: Electronic Record Management 13

14 Study Unit 35 Quiz Study Unit 36: Blue Cross/Blue Shield Topic B: Blue Cross/Blue Shield Health Insurance Plans Topic C: Participating And Nonparticipating Providers Topic D: Provider Reimbursement Topic E: CMS-1500 Completion: Blue Cross/Blue Shield Study Unit 36 Quiz Study Unit 37: Medicare Topic A: Key Terms and Overview Topic B: Medicare Covered Services Study Unit 37: Medicare continued Topic C: Medicare Deductibles And Co-Payments Topic D: Medicare Providers Topic E: Prescription Drug Benefit Topic F: Medicare Fee Schedule Topic G: National Correct Coding Initiative Topic H: Medicare Claims Submission Topic I: Processing Medicare Payments Topic J: Abbreviations Study Unit 37 Quiz Study Unit 38: Medicaid Topic B: Medicaid Coverage Topic C: Medicaid Billing Topic D: Abbreviations Study Unit 38 Quiz Study Unit 39: Tricare and Champva Topic B: TRICARE Health Benefits Programs Topic C: Participating And Nonparticipating Providers Topic D: Covered And Noncovered Services Topic E: Durable Medical Equipment (DME) Topic F: TRICARE Billing Topic G: CHAMPVA Topic H: CHAMPVA Billing Topic I: CMS-1500 Guidelines For CHAMPVA Topic J: Abbreviations Study Unit 39 Quiz Study Unit 40: Workers' Compensation 14

15 Topic B: Federal Workers' Compensation Programs Topic C: State-Sponsored Workers' Compensation Programs Topic D: Workers' Compensation Basics Topic E: Abbreviations Study Unit 40 Quiz 15