Dixie State College Medical Insurance Billing and Coding Program
Welcome to the Medical Insurance Billing and Coding program offered through Dixie State College! You are about to embark on a new world, the world of medical insurance billing, claims examination, patient accounting, legal aspects of insurance and an introduction to coding. Consider this course of study an opportunity to gain a better understanding of healthcare by learning a new language. This will enable you to get a job assisting in the growing field of medicine. It is a very exciting opportunity! This program is divided into separate modules to enable you to be ready for a job in the medical insurance billing & coding field. As you begin your study you will be going through a number of learning curves. Rest assured that if you apply yourself and consistently work each week to complete each task, you will emerge ready for employment and for the challenges associated with this growing profession. INTRODUCTION TO MEDICAL INSURANCE BILLING AND CODING: Medical Insurance Billing and Coding is the perfect program for people who want to contribute to quality patient care from behind-the-scenes. Individuals who specialize in this area enjoy working with healthcare professionals and computer technology. If the following qualities describe you, Medical Insurance Billing and Coding might be a good program choice: Interested in the medical profession Looking for a flexible schedule Highly organized Detail oriented Team player Like problem solving Enjoy continuous learning OCCUPATIONAL TITLES: Billing Specialist, Coding Specialist, Medical Collector, Patient Account Representative, Claims Analyst, Claims Processor, Electronic Claims Processor, Reimbursement Specialist, Claims Reviewer, Billing Coordinator, Claims Assistant Professional, Billing Coordinator. NATURE OF WORK: A successful biller/examiner will know medical terminology, anatomy, proper form completion, and required coding. This person will also need to know basic computer information and have a typing speed of at least 35 words-per-minute. A successful biller/examiner works with patients, other offices staff, medical personnel and other office personnel. Customer Service is very important, as the people they contact are either colleagues or they are patients who could be at stressful points in their lives. DSC Med. Insurance Billing & Coding Program Page, 2
WORKING CONDITIONS: Medical billers usually work in an office setting. Sometimes billers don t work near where the patients are being seen. There are billing offices and services in large corporate buildings, in small suburban offices, and in the doctor s office itself. A lot of billers and coders have been able to work from home. They can either work for themselves getting independent physicians as clients or they can work for larger firms that provide them with their workload via electronic means. JOB OUTLOOK AND EMPLOYMENT: Medical Billing and its related occupations continue to be the fastest growing opportunities in health care. Medical billing and coding specialists play a critical role in healthcare organizations by maintaining accurate records and protecting patient health information. Insurance companies and the government are spending more time and money researching and controlling claims fraud, abusive practices, and medical necessity issues. Healthcare organizations are being held to higher standards. Because of this, opportunities for medical billing and coding specialists are needed at insurance companies, doctors, hospitals, pharmacies, and other providers are hiring more. In fact, employment of medical billing and coding specialists is expected to grow much faster than the average for all occupations through 2012. Most companies and practices are looking for experience and or schooling, again because of the legal ramifications of incorrect billing practices. There are also companies that are requiring false claims insurance to be reviewed by their coders/billers. Medical billers are also able to work independently out of their homes. They can set up electronic billing through their home computers. Also available is the ability to be an insurance specialist or consultant. This would be a position of self-employment to help patients understand their insurance bills and what they should be paying. This could require additional licensure. Positions are available in doctors offices, hospitals, pharmacies, nursing homes, and rehabilitation centers, insurance companies, ac-counting offices, legal offices, and consulting firms. TRAINING AND OTHER QUALIFICATIONS AND ADVANCEMENT: At present, there is no set standard for educational requirements in these fields. However, more employers are looking for some formal training at an accredited vocational or career training school. Certification in these fields is not always required, but is highly recommended. There are several organizations sponsoring certification examinations. There are several types of certifications available for different specializations. Some certifications are fairly new, so it is advised to research your field to find the best one suited to your needs. It s also important to know that the advancement opportunities are unlimited including office managers, supervisors, managers, and directors of billing or examining departments, directors of coding, reimbursement, revenue cycles, etc. DSC Med. Insurance Billing & Coding Program Page, 3
EARNINGS: These fields have a wage range between $8-$10 an hour to start and up to $30-$40 an hour for years of experience and responsibility. Dixie Regional Medical Center in St. George starts at $9.50 and can go up to $16.00 an hour for experience and years on the job. ADDITIONAL INFORMATOIN: The organizations for Medical Billing Specialists, Claims Assistance Professionals, Coders, and the like are listed below. It is recommended that you join at least one, but research them beforehand, to find the appropriate one for your career goals. Keep in mind that these organizations may have a local chapter as well, so check your local Telephone Directory for local groups. Alliance of Claims Assistance Professionals (ACAP) - 873 Brentwood Drive, West Chicago, IL 60185-3743. (http://www.claims.org/, askacap@charter.net). American Academy of Professional Coders (AAPC) - 2480 South 3850 West, Suite B, Salt Lake City, Utah 84120; 800/626-CODE. (http://www.aapc.com/, info@aapc.com) Certification and extensive information for Coders, Office Managers, Claims Examiners, Hospital Outpatient Coders, Experienced Reimbursement Specialists and Coding Educators. The web site job ad section lets you post your résumé and receive job alerts by e-mail. American Medical Billing Association (AMBA) - 4297 Forrest Drive, Sulphur, OK 73086; 580/622-2624. Their web site presents information about online courses, networking opportunities, and information on preparing for the examination to become a Certified Medical Reimbursement Specialist. Visit (http://www.ambanet.net/amba.htm). Healthcare Information and Management Systems Society (HIMSS) - 230 East Ohio, Suite 500, Chicago, IL 60611-3269; 312/664-4467. (http://www.himss.org, himss@himss.org). Includes a membership directory, résumé posting, job alerts, and you can research potential employers and Career Development Resources with résumé and interviewing advice and more. Members only. Medical Coding and Billing - Information about coding and billing careers on http://www.medicalcodingandbilling.com includes certification, education, and also medical office management career information. Lists of professional associations. Medical Group Management Association (MGMA) - 104 Inverness Terrace East, Englewood, CO 80012, 303/799-1111or 877/275-6462. (www.mgma.com) This organization is designed for the supervisors of medical group practices. The Web site has job ads, networking, internship information and a Core Learning Series for education. Jobs ads are in monthly publication MGMA Connections. Medical Records Institute - 425 Boylston Street, 4th Floor, Boston, Massachusetts 02116; 617/964-3923. This organization s web site (http://www.medrecinst.com, cust_service@medrecinst.com) promotes electronic health records, mobile health, and related applications. National Healthcareer Association (NHA) - 134 Evergreen Place, 9 th Floor, East Orange, NJ 07018; 800/499-9092 or 973/678-9100. The National Healthcareer Association (NHA) offers DSC Med. Insurance Billing & Coding Program Page, 4
education, training and certification for many health care jobs, including Certified Medical Transcriptionist (CMT) and Certified Billing and Coding Specialist (CBCS). (http://www.nha2000.com/) Professional Association of Health Care Office Managers (PAHCOM) - 461 East Ten Mile Road, Pensacola, Florida 32534-9714; 800/451-9311. (http://www.pahcom.com/) Web site has information on education, local chapters, and on the Certified Medical Manager exam. The Benefits page of the web site posts job openings. PROFESSIONAL CERTIFICATION EXAMINATIONS: Professional associations sponsor certification examinations that allow graduates of relevant programs to earn credentials communicating that the person has met certain standards of excellence. Once a person successfully passes a certification examination, the professional association issues the credential that can be listed after the person s name (e.g., Michelle A. Green, RHIA). The following professional associations sponsor certification examinations of interest to graduates of an insurance and coding program: American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) Certified Professional Coder Hospital (CPC-H) Certified Professional Coder Apprentice (CPC-A) and Certified Professional Coder Hospital Apprentice (CPC-HA) American Health Information Management Association (AHIMA) Certified Coding Assistant (CCA) Certified Coding Specialist (CCS) Certified Coding Specialist Physician-Based (CCS-P) American Medical Billing Association (AMBA) Certified Medical Reimbursement Specialist (CMRS) National Electronic Billers Alliance (NEBA) Certified Healthcare Reimbursement Specialist (CHRS) OTHER OPTIONS: Throughout this program you will become familiar with medical coding. You may find this field interesting as a possible career choice. Further information for those who decide that medical coding is the direction to pursue: The Bureau of Labor Statistics (BLS) Occupational Outlook Handbook classifies coders as medical records and health information technicians whose career is considered one of the fastest growing occupations... and most... [coders] will be employed in hospitals, but job growth will be faster in offices and clinics of physicians, nursing homes, and home health agencies. The BLS expects this field to... grow much faster than the average for all occupations through 2012, due to rapid growth in the number of medical tests, treatments, and procedures which will be increasingly scrutinized by third-party payers, regulators, courts, and consumers. The American Academy of Professional Coders (AAPC) conducted a salary survey among its members in 2004, which revealed a $37,598 average annual salary for certified coders (compared with $29,645 for noncertified coders). The American Health Information Management Association (AHIMA) 2003 membership profile reveals that 70% of coding professionals earn $30,000 or more annually. The BLS reports median annual earnings of medical records and health information technicians as $28,327 in 2002. DSC Med. Insurance Billing & Coding Program Page, 5
The Dixie State College Medical Insurance Billing & Coding PROGRAM OUTLINE: A mastery of English and spelling and a minimum typing speed of 35 words per minute are necessary by the completion of this program. Completion of this course is approximately 250 hours. PROFICIENCY SUMMARY: Any proficiency material presented in this program is essential to the profession and based on national accreditation standards. To complete this unit, you will be expected to complete all items listed on the check-off list and any procedure skills listed for each module in the textbook. You will have a proficiency exam at the end of each chapter. You will be assessed through oral, written and skill demonstration to the level of 100% completion of assigned tasks and 85% score on any exam. The last module consists of a program proficiency exam. UNIT PRESENTATION: The program consists of 14 modules. Module 1, 2, 4 14 will be using the following text books: Understanding Health Insurance, A Guide to Billing and Reimbursement, Eighth Edition, 2006 Author: Jo Ann C. Rowell; Michelle A. Green ISBN #: 1-4018-9595-6 Publisher: Thomson Delmar Learning Workbook to Accompany Understanding Health Insurance, a Guide to Billing and Reimbursement, Eighth Edition, 2006. Author: Susan A. Brisky; Ruth M. Burke ISBN#: 1-4018-9609-X Publisher: Thomson Delmar Learning Medical Billing & Coding Demystified, 2007 Author: Marilyn Burgos; Donya Johnson; James Keogh ISBN#: 0-07-147220-7 Publisher: McGraw Hill Module 3 will be using the following text book: The Language of Medicine, Seventh edition, 2003 Author: by Davi-Ellen Chabner ISBN#: 1-4160-3674-1 Publisher: W.B. Saunders Co. Optional books: A comprehensive medical dictionary, such as DSC Med. Insurance Billing & Coding Program Page, 6
Dorland s Illustrated Medical Dictionary, latest edition. Published by Elsevier, Philadelphia, PA. Stedman s Medical Dictionary, latest edition. Published by Lippincott Williams & Wilkins, Baltimore, MD. Tabor s Cyclopedic Medical Dictionary, latest edition. Published by F. A. Davis, Brookings, OR. UNIT EXPECTATIONS: Each chapter in Understanding Health Insurance begins with a list of Key Terms. You are expected to spell and define these words at the beginning of each chapter before you begin the reading assignment. This will help you as you begin your reading. You will be required to show your instructor this list of defined words. Each chapter has Objectives. Review each outcome before you begin reading. These objectives will help direct your reading and improve chapter understanding. Each chapter will have a quiz or review. You will need to take the quiz or review and then check yourself with the answer book. This should let you know if you understand the concepts and what material you may need to go back over. Your module proficiency exam will be very similar. You must receive an 85% or better on the module proficiency exam before you can continue to the next module. You may retake the test again at the Instructor s discretion. The instructor may also have you complete extra assignments to help you grasp any concepts you do not understand. The exam is not to penalize you but allows both you and the instructor to know what concepts you did not understand. Keep track of the time you spend on each chapter including any or all studying, reading, defining, rereading, note taking, etc. You will be reporting this time at the end of the chapter check-off list. This includes time spent in class, in lab, and at home. If you have received the text book from the DSC office, you MAY NOT write in it. It is owned by DSC and is on loan. You will need to purchase a notebook to write out all the exercises. However, you may also feel you need to purchase a book on your own so you may write in it. For some, this may be a good idea. Terminology is learned through repetition and writing and re-writing the words again and again. IN CONCLUSION: Please be familiar with the program. Each module will have its own check-off list that will describe in detail your program of study, assignments, readings, tests, sequencing, and any other pertinent information. The best way to learn these skills is for you to be consistent in your study. Remember, there will be a learning curve as you acquaint yourself with this new language and world of medical insurance. You MUST spend the time in practicing what you are learning! This program is set up to work with your time schedule. However, you are expected to be in class at the designated time. Roll will be taken. Note that the more time you put into learning and the course work, the sooner you will be DSC Med. Insurance Billing & Coding Program Page, 7
completed with this course and the better adapted to be successful in this career. There is no short cut! Time and commitment is the best teacher! Allow yourself the time to learn. If you have received the text book from the DSC office, you MAY NOT write in it. It is owned by DSC and is on loan. You will need to purchase a notebook to write out all the exercises. However, you may also feel you need to purchase a book on your own so you may write in it. For some course textbooks, such as Medical Terminology, WE HIGHLY SUGGEST THIS OPTION. You will want to reference what you have learned again and again At the completion of this program, which is offered through Dixie State College, you will receive a certificate of completion. This tells your employer that you have completed an extensive course of study for the position of medical insurance billing and coding and have received the necessary training for entry level work. An internship may be available. Please sign on the line below that you have read and understand the course expectations. Your instructor will also sign this form that s/he has reviewed the information and answered any questions you have. Student Date Instructor Date DSC Med. Insurance Billing & Coding Program Page, 8
Module 1 Introduction to Selected Careers in Health Care Check-off list for Module 1 (Please check off each activity when completed) Date Started Do Text Instruction Completed Read MBCD Introduction, pages xi xviii. Read MBCD Chapter 1 Introduction to Medical Billing and Coding, pages 1 17. Review MBCD Chapter 1 Quiz, page 18 19. Read UHI Introduction, pages xiii xxiv. Know UHI Chapter 2 Objectives, page 13. Define UHI Spell and define all Key Term listed on page 13. Read UHI Chapter 2 Introduction to Health Insurance, pages 13 25. Do UHIWK Workbook, Assignments 2.1 to 2.3. Review UHI Chapter 2 Review pages 26 27. Know UHI Chapter 3 Objectives, page 29 Define UHI Spell and define all Key Term listed on pages 29 30. Read UHI Chapter 3 Managed Health Care, pages 29 44. Do UHIWK Workbook, Assignments 3.1 to 3.3. Review UHI Chapter 3 Review pages 44 45. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 9
Module 2 Medical Law & Ethics Check-off list for Module 2 (Please check off each activity when completed) Date Started Do Text Instruction Completed Read MBCD Chapter 2 Ethical and Legal Aspects of Medical Billing, pages 21 37. Review MBCD Chapter 2 Quiz, page 38 39. Know UHI Chapter 5 Objectives, page 87. Define UHI Spell and define all Key Term listed on page 87. Read UHI Chapter 5 Legal and Regulatory Issues, pages 87 119. Do UHIWK Workbook, Assignments 5.1 to 5.4. Review UHI Chapter 5 Review page 119. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 10
Module 3 Medical Terminology Check-off list for Module 3 (Please check off each activity when completed) Date Started Do Text Instruction Completed Read MBCD Chapter 3 Medical Terminology and Procedures, pages 41 55. Review MBCD Chapter 3 Quiz, page 56 57. The rest of this module is a separate packet. Get this packet from your instructor. You must complete the entire packet before going on to Module 4! When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 11
Module 4 Front Desk/Reception Check-off list for Module 4 (Please check off each activity when completed) Date Started Do Text Instruction Completed Read MBCD Chapter 4 Medical Office Procedures, pages 59 75. Review MBCD Chapter 4 Quiz, page 76 77. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 12
Module 5 Diagnostic Coding Check-off list for Module 5 (Please check off each activity when completed) Date Started Do Text Instruction Completed Read MBCD Chapter 5 Introduction to Diagnostic Procedure, pages 79 88. Review MBCD Chapter 5 Quiz, page 88 90. Know UHI Chapter 6 Objectives, page 123. Define UHI Spell and define all Key Term listed on page 123-124. Read UHI Chapter 6 ICD-9-CM Coding, pages 123 177. Do UHIWK Workbook, Assignments 6.1 to 6.12. Review UHI Chapter 6 Review page 177-184. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 13
Module 6 Procedural Coding Check-off list for Module 6 (Please check off each activity when completed) Date Started Do Text Instruction Completed Read MBCD Chapter 6 Introduction to Procedural Coding, pages 91 98. Review MBCD Chapter 6 Quiz, page 99 100. Know UHI Chapter 7 Objectives, page 185. Define UHI Spell and define all Key Term listed on page 185-186. Read UHI Chapter 7 CPT Coding, pages 185 243. Do UHIWK Workbook, Assignments 7.1 to 7.10. Review UHI Chapter 7 Review pages 244 246. Know UHI Chapter 8 Objectives, page 247 Define UHI Spell and define all Key Term listed on page 247. Read UHI Chapter 8 HCPCS Coding, pages 247 257. Do UHIWK Workbook, Assignments 8.1 to 8.6. Review UHI Chapter 8 Review page 258. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 14
Module 7 Insurance Billing I Check-off list for Module 7 (Please check off each activity when completed) Date Started Do Text Instruction Completed Read MBCD Chapter 7 Introduction to Insurance Plans, pages 101 114. Review MBCD Chapter 7 Quiz, page 115 116. Read MBCD Chapter 8 The Insurance Cycle, pages 117 140. Review MBCD Chapter 8 Quiz, page 141 142. Know UHI Chapter 4 Objectives, page 47. Define UHI Spell and define all Key Term listed on page 47-48. Read UHI Chapter 4 Life Cycle of an Insurance Claim, pages 47 82. Do UHIWK Workbook, Assignments 4.1 to 4.4. Review UHI Chapter 4 Review pages 82 85. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 15
Module 8 Insurance Billing II Check-off list for Module 8 (Please check off each activity when completed) Date Started Do Text Instruction Completed Know UHI Chapter 9 Objectives, page 259 Define UHI Spell and define all Key Term listed on page 259. Read UHI Chapter 9 CMS Reimbursement Methodologies, pages 259 280. Do UHIWK Workbook, Assignments 9.1 to 9.3. Review UHI Chapter 9 Review page 281. Know UHI Chapter 10 Objectives, page 283 Define UHI Spell and define all Key Term listed on page 283. Read UHI Chapter 10 Coding for Medical Necessity, pages 283 308. Do UHIWK Workbook, Assignments 10.1 to 10.6. Review UHI Chapter 10 Review pages 309-313. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 16
Module 9 Insurance Billing III Check-off list for Module 9 (Please check off each activity when completed) Date Started Do Text Instruction Completed Know UHI Chapter 11 Objectives, page 315. Define UHI Spell and define all Key Term listed on page 315. Read UHI Chapter 11 Essential CMS-1500 Claim Instructions, pages 315 335. Do UHIWK Workbook, Assignments 11.1 to 11.3. Review UHI Chapter 11 Review pages 335 336. Know UHI Chapter 12 Objectives, page 337 Define UHI Spell and define all Key Term listed on page 337. Read UHI Chapter 12 Commercial Insurance, pages 337 353. Do UHIWK Workbook, Assignments 12.1 to 12.3. Review UHI Chapter 12 Review pages 353-354. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 17
Module 10 Insurance Billing IV Check-off list for Module 10 (Please check off each activity when completed) Date Started Do Text Instruction Completed Know UHI Chapter 13 Objectives, page 355. Define UHI Spell and define all Key Term listed on page 355-356. Read UHI Chapter 13 Blue Cross and Blue Shield Plans, pages 315 335. Do UHIWK Workbook, Assignments 13.1 to 13.3. Review UHI Chapter 13 Review pages 381 382. Know UHI Chapter 14 Objectives, page 383 Define UHI Spell and define all Key Term listed on page 383-384. Read UHI Chapter 14 Medicare, pages 383 426. Do UHIWK Workbook, Assignments 14.1 to 14.5. Review UHI Chapter 14 Review pages 353-354. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 18
Module 11 Insurance Billing V Check-off list for Module 11 (Please check off each activity when completed) Date Started Do Text Instruction Completed Know UHI Chapter 15 Objectives, page 429. Define UHI Spell and define all Key Term listed on page 429. Read UHI Chapter 15 Medicaid, pages 429 453. Do UHIWK Workbook, Assignments 15.1 to 15.3. Review UHI Chapter 15 Review pages 453 454. Know UHI Chapter 16 Objectives, page 455 Define UHI Spell and define all Key Term listed on page 455-456. Read UHI Chapter 16 TRICARE, pages 455 482. Do UHIWK Workbook, Assignments 16.1 to 16.2. Review UHI Chapter 16 Review pages 482-483. Know UHI Chapter 17 Objectives, page 485 Define UHI Spell and define all Key Term listed on page 485-486. Read UHI Chapter 17 Worker s Compensation, pages 485 506. Do UHIWK Workbook, Assignments 17.1 to 17.2. Review UHI Chapter 17 Review pages 506-508. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 19
Module 12 Patient Billing & Collections Check-off list for Module 12 (Please check off each activity when completed) Date Started Do Text Instruction Completed Read MBCD Chapter 9 Billing and Coding Errors How to Avoid Them, pages 143 148. Review MBCD Chapter 9 Quiz, page 149 150. Read MBCD Chapter 10 Strategies for Handling Claim Disputes, pages 151 160. Review MBCD Chapter 10 Quiz, page 161 162. Read MBCD Chapter 11 Medical BillingSsoftware Programs and Systems, pages 163 171. Review MBCD Chapter 11 Quiz, page 171 173. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take Module proficiency exam. You must complete 100% of all assignments and exercises and an 85% or better on the exam in order to advance to the next module. When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 20
Module 13 UB-92 & Dental Claims Processing Check-off list for Module 13 (Please check off each activity when completed) Date Started Do Text Instruction Completed Review UHI Appendix V UB-92 pages 599 616. Review UHI Appendix VI Dental Claims Processing pages 617-625. Correct Correct all quizzes and workbook assignments Turn In Turn in all spelling words, corrected quizzes, exercises, and assignments. Take There is no exam for this module! When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 21
Module 14 Program Proficiency Exam Check-off list for Module 14 (Please check off each activity when completed) Date Started Do Text Instruction Completed You will be taking a final proficiency exam to complete this program. Check with your instructor for the exam. When you have finish this exam, with an 85% or better, you are finished with the Medical Insurance Billing and Coding Program and will be receiving a certificate of completion from DSC. Great job!!!! When you have successfully completed all the above items and with your instructor s approval, you may go on to the next module. Instructor s Signature of Completion Test score Completion Date Total # of Hours MBCD: Medical Billing & Coding Demystified UHI: Understanding Health Insurance UHIWK: Understanding Health Insurance Student Workbook DSC Med. Insurance Billing & Coding Program Page, 22
The Understanding Health Insurance (UHI) Student Practice CD-ROM by Elizabeth Shea and David Burow Introduction The Understanding Health Insurance (UHI) Student Practice CD-ROM, included inside the back cover of the textbook, is designed to help you practice completing the CMS-1500 claims. The software is designed to help you when completing the Case Studies 1-1 through 1-20 located in Appendix I and 2-1 through 2-21 located in Appendix II of the textbook. As you enter data from these cases, the software program checks your entries against expected answers. Select the Study Mode to receive immediate feedback upon entry of Case Study data. If you do not select the interactive function, you will receive feedback at the conclusion of entering of all the data contained in a case study. When you start the program, enter your name and, optionally, the course name. Your name and course will appear on the reports and printouts from the program, so double check that everything is entered correctly before clicking OK. Using This Tutorial This tutorial introduces and provides reference information for the UHI Student Practice CD-ROM, and it contains four sections. The first section serves as a reference guide to explain general features and lists procedures for accessing these features. The second section details use of the CD-ROM to complete a CMS-1500 claim. The third section is a tutorial using the Blank Form mode that guides you through completion of a claim for a sample case study like those located in Appendix I of the text. Section four is a tutorial to be completed prior to working with the case studies in Appendix I and Appendix II of the text (for which you will code all diagnoses and procedures/services). NOTE: If you are familiar with earlier versions of the Student Practice Disk, you will find many changes. You will want to pay special attention to those sections that introduce new features of the practice disk. Be sure to review Section I: General Program Instructions, Section II: Completing Claims, Section III: Tutorial for Blank Form Mode, and Section IV: Tutorial for Study or Self Test Modes. Copyright 2006 Thomson Delmar Learning Main Menu The first thing you will see on the screen once you start the UHI program is the Main Menu. From this window you can use any of the exercises available in the UHI Program. From the Main Menu you can select from among the Blank Form, Study, or Self Test modes for completing case studies found in Appendix I and Appendix II of your textbook. Note: you can return to the Main Menu at any point in the program. Click any of the options to begin an exercise. DSC Med. Insurance Billing & Coding Program Page, 23
Three Modes: Blank Form, Study, and Self Test Case studies can be completed in the Blank Form, Study and/or Test mode. The Blank Form mode, located at the bottom of the computer screen, is used to complete workbook case studies, and tests and other cases assigned by your instructor. The Study and Test Modes guide you through Case Studies 1-1 through 1-20 and 2-1 through 2-21, where you are expected to read the progress notes, determine the diagnosis(es) from the documentation and assign the proper ICD code(s) for each case. The procedures/ services to be coded are located on the case study form. Your selection of Study or Test Mode will determine the amount of feedback you receive from the computer as you work through the Case Studies 1-1 through 1-20 and 2-1 though 2-21. Study mode provides maximum feedback, responding immediately to each block of data entered and compiling a summary report at the end of each case. Thus, you will want to work in Study mode as you begin to learn to work with skill builders and claims for these case studies. The Test Mode does not provide immediate feedback as you enter blocks of data, but it does check your work once you have completed a skill builder or a claim. Thus, Test mode is particularly useful for practicing what you have learned. You can save or print your work while working in any of the three modes. Selecting Study or Test mode from the Main Menu If you select Study mode or Test mode, select a case in the scroll box located within the section of the window corresponding to the appropriate mode. Within the block that corresponds to the mode you selected, select the CMS-1500 to load the desired exercise program. The exercise you selected will now appear on the screen. Saving Your Progress The UHI program makes it easy for you to track your progress as you work through the case studies. Your work on claims must be manually stored on either a floppy disk or the hard drive. Follow the steps below to save your work. Saving in Blank Form Mode If you are using the program to complete a case that is not contained in this text, you will be prompted to save the claim upon exiting. Follow the steps below to save the work you do in Blank Form mode. DSC Med. Insurance Billing & Coding Program Page, 24
At any point while completing a claim in Blank Form mode: 1. Select Save from the File menu. 2. In the File Name text box, type a name for the claim storage file. This may be either a case study number for Case Studies 1-1 through 1-20 or a name specifically assigned by your instructor for tests or special assignments (be sure that the file name is no longer than eight characters, with no spaces). 3. Check to be sure the Drives dialog box indicates where you want to store your work. Drive C is used for storage on the hard drive. Drive A is the usual placement for a floppy disk, but if you are using a floppy disk in a networked computer system the drive designation may be different. If the Drive designation needs to be changed, click on the dialog box and select the proper drive. 4. Click OK to save and return to the claim. Saving the Claim in Study or Test Mode All case study claims must be manually saved after you have completed work on a claim. Click File, Save, move the mouse up to the File Name box, click in the space to right of *.UHI, and enter the assigned case study number you are working on, followed by.uhi. Example: 1-1.UHI or 1-1.uhi If the case study requires 2 claims, enter a P after the case study number for a primary claim or an S for a secondary claim. Example: 1-4P.UHI or 1-4P,uhi Example: 1-4S.UHI or 1-4S.uhi If the case study requires more than 2 claims, enter an A, B, or C after the case study number for a primary, secondary, or tertiary claim, respectively. Example: 1-5A,UHI or 1-5A.uhi Example: 1-5B.UHI or 1-5B.uhi Example: 1-5C.UHI or 1-5C.uhi Printer Setup To print claims you may need to designate where your files will print. To verify or change your printer setup: 1. Select Printer Setup from the File menu (available in a skill builder or claim window). 2. Select the printer options you want and click OK. See your printer documentation or the Windows User's Guide for more information about your printer setup. Printing a Blank Claim DSC Med. Insurance Billing & Coding Program Page, 25
Before you start working on a claim exercise, you may want to print a blank claim for notes. Follow these steps to print a blank form: 1. Click File, Printer Setup to check that the correct printer is identified, and verify that orientation is set to portrait and paper size is 8½ x 11. 2. Click Blank CMS-1500 3. Click on the CMS-1500 Form link. 4. Turn the printer on. 5. Click Print. Help and Other On-Line Resources Help At any point in the program, you can access help by selecting Help from the Resources file menu located on the menu bar at the top of the UHI window. Once the help window appears, click the item that you would like more information about. When you are ready to return to the program, click Close. Glossary A glossary of health insurance terminology is available for you as you work on the claims. To access the glossary, select Glossary from the Content menu in the Help menu. Once the glossary window appears, click an item to see the definition. When you are ready to return to the program, click Close in the glossary window. Case Studies 1-1 through 1-20 The case study information for Case Studies 1-1 through 1-20 located in Appendix I of the textbook are available for you to review on the computer. To access the case study information, select either Study Mode or Test Mode from the Main Menu, select the case study, and click Case Study. Case Studies 2-1 through 2-21 The case study information as well as the patient records for Case Studies 2-1 through 2-21 located in Appendix II of the textbook are available for you to review on the computer. To access these forms, select either Study Mode or Test Mode from the Main Menu, select the case study, and click Case Study or Patient Record. Copyright 2006 Thomson Delmar Learning Use any of the three modes to practice entering data on the CMS-1500 claim. Beginning a Claim Session Before beginning a claim session, you may want to study the case and make notes on a blank form. DSC Med. Insurance Billing & Coding Program Page, 26
1. To begin a claim session, you will need to start from the Main Menu. 2. If you are working in the Blank Form mode, select Blank Form on the main menu window. Then proceed to number 3 below. If you are working in the Study or Self-Test mode, select a case from the Select Case scroll box in the window section corresponding to the interactive mode you will be using. Details about the case studies are contained in Appendices of your textbook. 3. Click CMS-1500 Form to open a new claim. 4. Next, identify the number of forms required for the case you selected. In the Required Forms dialog box, enter the number of forms that are needed for the case selected. 5. Click OK (in the Blank Form mode, a blank claim will be displayed). In the Study or Self Test modes, if you enter an incorrect number of forms, an error message appears and you are given another chance to enter the number of required forms. If the case you selected requires two or more forms, you will need to identify whether you will begin with the primary or secondary form. Click the appropriate box. In the Destination dialog box, enter the name of the organization to which the form should be sent. When you have finished entering this information, press enter. 4. The claim window now appears. Tip: Remember, everything you type must be in capital letters and follow optical scanning guidelines. Press the Caps Lock key on your keyboard before entering data onto the form. You are now ready to enter data onto the CMS-1500 claim. When working with Case Studies 1-1 through 1-20 located in Appendix I of your textbook and the workbook case studies, all information needed to complete the claim can be found on the encounter form. Case Studies 2-1 through 2-21, located in Appendix II of the textbook, were designed to simulate the source documents needed to create a CMS-1500 claim for each case. Use these materials and the program Comparison Charts you generated when entering data into each CMS-1500 claim. Navigating the Claim and Entering Data The following sections describe how to enter claim information on the CMS-1500 form. Specific rules apply for the data entry in each block. Finding and Moving the Cursor At the start of a claim session, the blinking line appears in Block 1, indicating where the cursor is. Whatever you type on the keyboard will appear on the screen where the cursor is. Move the cursor to the next block by pressing the Tab key. Or, move the cursor to any other block by pointing and clicking the mouse. DSC Med. Insurance Billing & Coding Program Page, 27
A blinking cursor will appear in the requested block signaling that the block has been activated for data entry. WARNING! Be careful when you move the cursor as you work in Study mode. Once you begin typing in a particular block, that block is activated. Moving the cursor to another block, using either the mouse or the Tab key, is the equivalent of pressing Enter. Whatever you have entered in that block will be evaluated. As you are entering data into a block, you may want to refer to other blocks on the claim. To keep the cursor in the current block while reviewing other areas of the form, use the up arrow and down arrow keys to move vertically on the form. Entering an X in CMS-1500 Claim Blocks To enter an X in a required block on the CMS-1500: Use the mouse or the Tab key to move the cursor to the box within the CMS-1500 Block (pressing the Shift key while pressing the Tab key will move the cursor to the left). With the cursor in the appropriate box, enter a capital X. If you change your mind, clear the block by using the backspace key. You may have to use the arrow key to move the cursor to the right side of the X before using the backspace key. After you have entered an X in the appropriate box, move the cursor to another block or press Enter if you are working in Study mode and would like to see if your entry is correct. Entering Data on the CMS-1500 To complete a block that requires you to enter data: Set the Caps Lock key to ensure that all data is entered in capital letters (optical scanning guideline). Start with the cursor in a position located farthest to the left in the block. Key Combinations and the Navigation Function UP/DOWN ARROW Scroll up and down without moving cursor LEFT/RIGHT ARROW Move cursor within active block CONTROL + LEFT/RIGHT ARROW Scroll left and right without moving cursor PAGE UP/DOWN View form areas without moving cursor CONTROL + PAGE UP/DOWN View form top or bottom without moving cursor HOME Return screen to active block CONTROL + HOME View left part of form without moving cursor END Move cursor to last character in active block CONTROL + END View right part of form without moving cursor TAB Move cursor to the next form block SHIFT + TAB Move cursor to proceeding form block ENTER Blank Form mode: Moves cursor to next block DSC Med. Insurance Billing & Coding Program Page, 28
Study mode: Signals completion of a block of data and submits block for evaluation Self Test mode: Moves cursor to next block CONTROL + G Go To Block Number window is activated CONTROL + N Moves cursor to next block CONTROL + P Moves cursor to previous block To edit your entry, use the left and right arrow keys and the backspace key. After you have entered the data, move the cursor to another block or press Enter if you are working in Study mode and would like to see if your entry is correct. Entering Dates in Blocks 3, 9B, 11A, 12, and 14-16 1. Start with the cursor in the left most position of the block (note that the vertical lines separating the month, day, and year temporarily disappear). 2. Enter the two digits that correspond to the month. 3. Enter one space. 4. Enter the two digits that correspond to the day of the month. 5. Enter one space. 6. Enter the four digits that correspond to the year. Note: Use the Tab key or the mouse to move the cursor to the next portion of the block or to the next block. The vertical lines separating the month, day, and year reappear. Entering Dates in Blocks 24 and 31. Dates are entered in these blocks as an 8-digit number, without any spaces. Example: MMDDYYYY Example: 01122005 Entering Diagnosis Codes in Block 21 Diagnosis codes contain three-digit numeric or alphanumeric characters and a decimal point followed by one or two more digits. The decimal point is preprinted on the CMS-1500 claim; therefore, do not enter the decimal point. Instead, enter a space to separate the digits on the left of the decimal point from the digits on the right of the decimal point. There must be at least one space for the code to be evaluated as correct. Do not separate any of the other digits by spaces. Example of numeric code (786.3): [space]786[space]3 or 786[space][space]3 Example of alphanumeric codes (V01.3, E882.0): [space]v01[space]3 E882[space]0 After entering a code, press Tab to move to the next code in the block. Note that the code is automatically aligned with the decimal point. DSC Med. Insurance Billing & Coding Program Page, 29
Entering Procedure/Service Codes and Modifiers in Block 24 Procedure/service codes and modifiers (column D) in Block 24 should be entered as one string of characters. To differentiate the code from the modifier, enter one space. To differentiate the modifier from any additional modifiers enter one space before each additional modifier. Example: 99223[space]57 Entering Dollar Amounts Do not enter dollar signs or decimal points when entering dollar amounts on the CMS-1500 claim. Enter a space between the dollars and cents. Be sure to enter two digits for the cents, even if the two digits are zeros. Example: 45[space]00 Feedback Feedback is not available in Blank Form mode. When working in Study mode, the computer verifies the accuracy of your data as you enter it, providing feedback as you work. In addition, after you complete an entire claim, the computer will score the entire form, providing you with a score report. When working in Self Test mode, the computer does not provide feedback as you work but does score completed forms and provides a score report. Feedback in Study Mode Each time you complete a block of data in the Study mode, the computer will verify the accuracy of the data entered. If an error is detected, a message is displayed providing you with the option to try again, study, or have the computer display the expected answer. If an error is detected on the second try, another message is displayed. After the second try however, the try again and study options are not available. There are two ways to signal that you have completed a block of data: by pressing Enter or using the mouse to move the cursor to another block on the claim. When you press Enter, if the data is entered correctly a message appears announcing that your answer is correct. When you move the cursor to another block and your data is entered correctly, no message appears. Thus, if you do not want to see a message unless your data is incorrect, simply move the cursor to the next block when you have completed a block. Note: If you are entering a multi-line address (Blocks 5, 7, and 32), use the mouse or Tab to move from one line to another. Do not use Enter at the end of the line. The tally box, located in the lower right portion of the screen, tracks the number of blocks entered correctly on the first try, the number of blocks entered correctly on a second or third try, the number DSC Med. Insurance Billing & Coding Program Page, 30
of times the study option was used after entering incorrect data, and the number of incorrect responses. In general, there is no particular order that you need to follow as you complete the CMS-1500 claim. That is, you could complete Block 4 before completing Block 2 without any penalty to your score. However, since the information in Blocks 21 and 24 are interdependent, you will need to complete Block 21 before Block 24 to have them properly verified. If you enter the data in these blocks out of order, a message will appear requesting that you complete the blocks in order. Scoring in Study and Self Test Modes When you have completed a claim in the Study or Self Test mode, follow these steps below to obtain an overall score: 1. Review the form to be sure you completed all the necessary blocks. Note: If a case requires separate claims, follow these steps after completing each form. 2. If you are working in Study mode, take note of your scores located at the bottom right portion of the screen 3. If working in the Self Test mode, print a copy of your work, review it, and make any desired changes before going to the next step. After making any changes to the data, reprint the form. 4. Click Done on the Toolbar. 5. A warning notice appears to remind you that any blocks left blank will be graded as blank. If your form is ready to be graded, click Yes. The next screen asks "Do you want to add justifications?" If you check Yes, the computer will take you to the Justification screen where you can defend the data you entered in any item you think might be graded as an error. This justification section was added to allow for any variation in CMS- 1500 claims completion instructions that an instructor may provide. The justifications appear on the Summary Report for each claim. Although it does not affect the computer scoring, it will allow the instructor to discount the computer-scored error if your justification is rational. 6. Print the claim and Summary Report. Printing The Claim and a Summary Report The CMS-1500 claim is printed with the correct answers in each block. Shaded blocks on the printed form indicate that you did not answer correctly on the first try. The summary report provides study information for the blocks that you did not answer correctly on the first try. The data that you entered is included with an explanation of the correct answer. Any justification notes that you entered while completing the case study are also included with the explanation of the correct answer. DSC Med. Insurance Billing & Coding Program Page, 31
Copyright 2006 Thomson Delmar Learning DSC Med. Insurance Billing & Coding Program Page, 32