Midland College Syllabus HITT 2340 Spring 2008 Advanced Medical Billing and Coding

Transcription

1 Midland College Syllabus HITT 2340 Spring 2008 Advanced Medical Billing and Coding HITT 2340 Course Syllabus - Page 1 Course Description Text, References and Supplies Development of coding techniques of CPT and ICD-9-CM with emphasis on case studies, health records, and federal regulations regarding perspective payment systems and methods of reimbursement. Prerequisite: HITT Corequisite: HITT Textbooks required: 1)Understanding Health Insurance: A Guide to Billing and Reimbursement, Cengage Publications, author Green & Rowell, 2008 with ACCESS CODE. 2) Case Studies for Health Information Management, 1st Edition. Charlotte McCuen; Nanette B. Sayles; Patricia Schnering. Cengage Delmar Learning References: Faye Brown s ICD-9-CM Coding Handbook, 2007 Edition. American Hospital Association (AHA) Press. Coding & Reimbursement for Hospital Outpatient Services, Lolita M. Jones, RHIA, CCS, AHIMA Coding and Reimbursement of Hospital Inpatient Services, Karen S. Scott, MEd, RHIA, CCS, AHIMA Current Procedural Terminology, CPT, 2008, American Medical Association. ICD-9-CM Code Book, Volumes 1, 2, & 3, Elsevier Publishing Supplies (optional): Either microphone with headset or separate microphone with speakers through PC for talking with instructor on SKYPE. Course Goals/ Objectives 1. Locate information in the Federal Register. 2. Analyze and select proper codes for patient chart exercises. 3. Evaluate accuracy of coded charts. 4. Clarify conflicting, ambiguous, or non-specific information appearing in a medical record. 5. Abstract information from the medical record. 6. Select correct principle diagnosis and principle procedure. 7. Apply payor reimbursement guidelines (i.e. PPS, APCs, and RBRVS). 8. Assess quality and adequacy of documentation. 9. Determine and validate appropriate DRG. 10. Identify all secondary diagnoses and patient procedures. 11. Accurately complete billing forms. 12. Analyze MEDPAR data. 13. Accurately use physician queries. 14. Perform data quality reviews to validate code assignment Use encoder to research coding and DRG changes Research national health information initiatives. 17. Summarize federal legislation and regulations affecting health care. 18. Interpret a chargemaster. 19. Apply special rules for the Medicare physician fee schedule payment system. 20. Research local coverage determinations (LCD) and national coverage determinations (NCD). 21. Complete workers compensation claims properly.

2 HITT 2340 Course Syllabus - Page 2 Domains, Subdomains and Tasks I. Healthcare Data Management I.D. Subdomain: Reimbursement Methodologies I.D.1. Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery. I.D.2.Support accurate billing through coding, chargemaster, claims management and bill reconciliation processes. I.D.3. Use established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative I.D.4. Compile patient data and perform data quality reviews to validate code Assignment and compliance with reporting requirements such as outpatient prospective payment systems. III. Domain: Health Services Organization and Delivery III.A.Subdomain: Healthcare Delivery Systems III.A.1. Apply information system policies and procedures required by national health information initiatives on the healthcare delivery system. III.A.2. Apply current laws, accreditation, licensure and certification standards related to health information initiatives from the national, state, local and facility levels. IV. Domain: Information Technology & Systems A. Subdomain: Information and Communication Technologies IV.A.2. Use common software applications such as spreadsheets, databases, word processing, graphics, presentation, and so on in the execution of work processes. IV.A.3. Use specialized software in the completion of HIM processes such as record tracking, release of information, coding, grouping, registries, billing, quality improvement, and imaging. Student Contributions and Class Policies 1. Read and study assignments. 2. Each exercise assigned will be expected to be completed and ready for discussion. 3. Participate and contribute to the discussions using Discussion Board threads. 4. Complete each lesson and examination as scheduled. 5. Use encoder to complete projects, charts, and homework as instructed. 6. Complete the FINAL EXAM by the due date with an approved proctor. Late assignments and exams: All work must be submitted on or before the due dates. Work not submitted on time will be given a grade of zero unless mitigating circumstances exist. Students can work ahead of schedule when conflicts arise with the course schedule. Contacting the instructor ahead of time to submit work early is permitted, but late work is not accepted. A zero will be placed in the gradebook for assignments not completed by the due date. Testing philosophy: All tests are reviewed in class as a learning experience. Students who have completed all pertinent exercises and previous exams may politely challenge the instructor on questions they felt were poorly worded. If the instructor concedes the argument, scores will be adjusted for the entire class. Virtual Lab: Each student will be required to attend online lab in order to learn the QuadraMed encoder. Case Studies will be assigned as a grade and must be attended in order to receive a grade other than zero. The instructor will be available during office hours to work through example. DISCUSSION BOARD: The posts will be answered daily except for weekends. This form of

3 HITT 2340 Course Syllabus - Page 3 communication is important in online courses. This tool will help you stay connected to other classmates and it will help students to ask those questions just as if you were in an actual classroom setting. Discussion board will also be used as a participation tool, and part of the semester grade is based on participation. When posting a response to the discussion board about a topic, post your original response before reviewing other classmate s postings. Then, read the other postings and respond to at least two other students for full credit for participation. Scoring: First original response: up to 6 points, 2 nd and 3 rd responses, up to 2 points each. Only when the content of the question is personal in nature should the instructor be ed. Also be sure to sign your name at the end of the . Remember some addresses give instructors absolutely no clue as to who sent it. ATTENDANCE: Because this is strictly an internet course, attendance will be substituted by participating on the discussion board. You will be required to respond to 2 posts in the discussion board 4 out of 7 days of the week. Answers to the discussion questions, and weekly summaries are counted as a posting. Participation is part of your semester grade. Original posts should show evidence that the material was read and understood. ADA POLICY: Students needing additional time to test due to a documented learning disability, contact Dale Williams, Counselor, at or dwilliams@midland.edu at the beginning of the course to make accommodations. See the current Midland College catalog for more information. Computer Requirements: Students should have access to Microsoft Word and Excel for assignment submission. Students taking online courses are responsible to have access to a computer for submission of assignments and postings. For specific computer requirements, see Blackboard System Requirements for Midland College courses at AOL, MSN, and Prodigy browsers will not work with Blackboard. These browsers will lock up or lock you out of assignments and tests. Instead, download Mozilla at or Netscape 7.0. Computer Downtime: This is an online course. Each student is required to have a functioning computer for the entirety of the semester. Having computer problems does not exempt students from completing work by the due date. If the Blackboard system goes down or is unavailable, an announcement will be posted as the due date will be extended. If your system goes down, find another computer to submit your homework/posts before the due date. It is strongly suggested that assignments are to be submitted early to avoid any technical difficulties. SUBMITTING ASSIGNMENTS IN BLACKBOARD: 1. Use a word document format. 2. Save assignment in a rich text file (.rtf) or (.doc). You will find this on your computer under File, Save As, Save Type As (under the name of your document). If you have questions about rtf files, see Course Documents for more information. 3. Each assignment should be submitted through Blackboard under View/Complete assignment as attachment. If there is more than one task due with the assignment such as CH1A (Workbook 1-1, 1-3, and 1-4), all these tasks should be submitted in one word document. DO NOT send three different files. 4. Each assignment should have a header that includes your name, date, course number, and assignment name. Failure to include this content will result in points deducted from your grade. Examples: To save: Ch1mct.rtf Chapter 1 by Melody Cheryl Thompson (rtf file) Ch2jwj.rtf Chapter 2 by James W. Johnson (rtf file)

4 HITT 2340 Course Syllabus - Page 4 Evaluation of Students Instructors Information Each student s grade will be determined by the following ratings: Discussion Board 16% Chapter Assignments 18% Quiz (listed as Exam category) 30% Section Exams 18% Final Examination 18% A semester grade of less than "C" will NOT be acceptable as passing in this course. In order to progress from one course to another as defined in the program curriculum, the student is required to complete all courses listed in the curriculum in the college catalog with a minimum of a "C". Name: Shawnda Meshirer, RHIT, CCS Office phone: Office Hours: 9:00 11:00 and 1:30 4:30 Tuesdays and Thursdays Virtual Office online with SKYPE: 8:00 9:00 p.m. Monday evenings. smeshirer@midland.edu Office Location: A15 AMS (Aaron Medical Science Building) HITT Department Office Telephone: Division Dean and Division Secretary Names: Dr. Becky Hammack and Kay Floyd Division Office Location and Telephone: 209HS, Students are encouraged to contact the instructor at any time; however, making an appointment will guarantee the instructor s availability at a specific time. SKYPE Instructions Download software at This is free software. Students will need a headset with a microphone OR a computer with speakers and a microphone that is connected to the computer. SKYPE is free to call anyone through the internet to another on the internet. Course Withdrawal Academic Honesty The last day to withdraw from the course with a grade of W is April 10, It is the student s responsibility to complete the Withdrawal Form online to receive a grade of W. Midland College expects that students will honor the policies set forth by Midland College. Any student cheating in the course will be removed from the course an F submitted for the grade. A letter will also be sent to the Registar to be added to the student s admission file. Please refer to policies on cheating, plagiarism, and collusion in the Student Responsibilities section of Midland College Catalog & Handbook at

5 HITT 2340 Course Syllabus - Page 5 Course Schedule HITT 2340 Advanced Billing and Coding Spring 2008 Due Date Understanding Health Insurance Text Case Studies in HIM by case number 1/20 Introduce yourself Take Pre-Test None 1/26 Ch 1. Health Insurance Specialist Career 2-1 Official Coding Resources Ch 2. Introduction to Health Insurance 2/02 Ch 3. Managed Health Care 2-5 Coding Quality 2-8 Classification Systems 2/09 Ch 4. Development of an Insurance Claim 2-6 Chargemaster Audit 2/12 Test #1 2/16 Ch 5. Legal and Regulatory Issues 2-10 Encoder Functional Req. 2/23 Ch 8. HCPCS Level II Coding 2-11 Encoder Selection 3/01 Ch 9. CMS Reimbursement Methodologies 2-16 Using Workflow Tech in Physician Query Mgmt. 3/08 Ch 10. Coding for Medical Necessity 2-17 Physician Orders for Outpatient Testing 3/11 Test #2 3/15 Ch 11. Essential CMS-1500 Claim Instructions 2-42 Calculating Commercial Insurance Reimbursement 3/29 Ch 12. Commercial Insurance 2-33 MEDPAR Data Analysis 2-27 Complication/Comorbidity (CC) analysis 4/05 Ch 13. Blue Cross Blue Shield 2-34 Explanation of Benefits 4/08 Test #3 4/12 Ch 14. Medicare 2-37 Medicare Coverage 4/19 Ch 15. Medicaid 2-38 Local Care Determination (LCD) 4/26 Ch 16. TRICARE Take Post-Test 2-41 Medical Necessity 2-44 Discharged Not Final Billed (DNFB) 5/03 Ch 17. Workers Compensation 2-26 Diagnosis-Related Group Changes 5/5 or 5/6 Proctored Comprehensive Final Exam Discussion Board Topic Introduce yourself