Course
Prefix/Number:
Course
Title: Medical
Insurance and Coding
Division: Outreach and Workforce Development
Program: Medical
Assistant
Credit
Hours: 3.0
Initiation/Revised
Date: Fall 2005
CLASSIFICATION
OF INSTRUCTION
This
course is designed to prepare students to process health insurance claims and
understand health insurance plan options.
It will introduce information about major insurance programs and federal
health care legislation, provide a basic knowledge of national diagnosis and
procedure coding systems, and simplify the process of completing claims.
Required:
Buck, Carol J., (2006). Medical Coding Online (Class Edition) to
Accompany Step-by-Step Coding 2006 (Textbook Package), 2006 edition.
Fordney, Marilyn T.,
(2004). Insurance Handbook for the
Medical Office with HIPAA, 9th edition.
Covell,
CPT-4, HCPCS, ICD-9-CM,
Current Year
3.
Perform
procedural coding.
4.
Perform
diagnostic coding.
5.
Complete insurance
claim forms.
I.
Current Procedural Terminology (CPT) - Buck
A. Introduction to the CPT Manual
B. Evaluation and Management (E/M) Section
C. Anesthesia Section and Modifiers
D. Introduction to the Surgery Section and Integumentary System
E. Musculoskeletal System 6. Respiratory System
F. Cardiovascular System 8. Female Genital System
and Maternity Care and
Delivery
G.
General Surgery I
H. General Surgery II
I. Radiology Section
J. Pathology/Laboratory
K. Medicine Section and the Level II National
Codes
II.
International Classification of Diseases, 9th Revision,
Clinical Modification (ICD-9-CM)
A. An Overview of the ICD-9-CM
B. Using the ICD-9-CM
III. An Overview of Reimbursement
A. Third-Party
Reimbursement Issues Appendix
B.
Official ICD-9-CM
Guidelines for Coding and Reporting
C.
HIPAA for the
Physician’s Office
IV.
Career Role and Responsibilities
A. Role of an Insurance Billing Specialist
B.
Compliance and
the E-Health Initiative
V.
The Claims Process
A.
Basics of Health
Insurance
B.
Medical
Documentation
C.
Diagnostic Coding
D.
Procedural Coding
E.
The Paper Claim:
CMS-1500
F.
Electronic Data
Interchange: Transactions and Security
G.
Receiving
Payments and Insurance Problem Solving
H.
Office and
Insurance Collection Strategies
V.
Health Care Payers
A. The Blues Plans, Private Insurance, and Managed
Care Plans
B. Medicare
C. Medicaid and
Other State Programs
D. TRICARE and
CHAMPVA
E. Workers’
Compensation
F. Disability
Income Insurance and Disability Benefit Programs
VI. Inpatient and Outpatient
Billing
a.
Hospital Billing
Lecture, Internet, CD Rom
Activities, Workbook and Group Assignments, Discussion, Guest Speakers,
Collaborative Projects, Demonstrations.
Students
will be required to complete reading assignments, chapter reviews, case studies
as assigned, participate in discussions with other classmates on topics
determined by instructor, complete assignments and examinations of knowledge, and
demonstrate skill competency.
The
student must participate in all activities, as well as accurately complete
assignments and examinations in order to receive a passing grade in this course
The
comprehensive final examination for this course will take place during the scheduled
finals week of the enrolled semester. Further
details and information will be provided closer to time of exam.
GRADING
SCALE
90-100% = A
80-89% = B
70-79% = C
60-69% = D
59% or less = F
Attendance Policy
Absences that occur due to students participating in official
college activities are excused except in those cases where outside bodies, such
as the State Board of Nursing, have requirements for minimum class minutes for
each student. Students who are excused will be given reasonable opportunity to
make up any missed work or receive substitute assignments from the instructor
and should not be penalized for the absence.
Proper procedure should be followed in notifying faculty in advance of
the student’s planned participation in the event. Ultimately it is the student’s responsibility
to notify the instructor in advance of the planned absence.
Unless students are participating in a school activity or are excused by the instructor,
they are expected to attend class. If a
student’s absences exceed one-hundred (100) minutes per credit hour for the
course or, in the case of on-line or other non-traditional courses, the student
is inactive for one-eighth of the total course duration, the instructor has the
right, but is not required, to withdraw a student from the course. Once the student has been dropped for
excessive absences, the registrar’s office will send a letter to the student,
stating that he or she has been dropped.
A student may petition the chief academic officer for reinstatement by
submitting a letter stating valid reasons for the absences within one week of
the registrar’s notification. If the
student is reinstated into the class, the instructor and the registrar will be
notified.
Academic Integrity
NCCC expects every
student to demonstrate ethical behavior with regard to academic pursuits. Academic integrity in coursework is a
specific requirement. Definitions,
examples, and possible consequences for violations of Academic Integrity, as
well as the appeals process, can be found in the College Catalog, Student
Handbook, and/or Code of Student Conduct and Discipline.
Cell Phone Policy
Student cell phones and
pagers must be turned off during class times. Faculty may approve an exception
for special circumstances.
ASSESSMENT
OF STUDENT GAIN
Assessment
of student gain will be measured by comparing the student’s knowledge of the
subject when the class begins and then by using the same measurement at the
close of the class. This measurement
will be done via pre and post tests over the stated course competencies,
through skills competency assessment tracking sheets, and competency evaluation
exams.
NOTE:
Information and statements in
this document are subject to change at the discretion of NCCC. Changes will be published in writing and made
available to students.
NOTE:
If
you are a student with a disability who may need accommodation(s) under the
Americans with Disabilities Act (ADA), please notify the Director of Advising and Counseling, Chanute Campus, Student
Union, 620-431-2820 ext 280 or the Dean,
Ottawa Campus, 785-242-2607 ext 312, as soon as possible. You will need to bring your documentation for
review in order to determine reasonable accommodations, and then we can assist
you in arranging any necessary accommodations.
.