Medical terminology is used to describe such things as parts of the body, locations in the body, bodily functions, diseases, surgical and clinical procedures, measurements, medical instruments, and many others. Each medical term describes in a single word - something that would otherwise require several words to express. For example, the term appendicitis is a short form of saying "inflammation of the appendix".
In this course, you will get familiar with medical terms, including prefixes, root words, and suffixes. Students will study the provider and medical abbreviations as well as diseases and treatment methodologies. This course will emphasize studying the following body systems: urinary, integumentary, musculoskeletal, respiratory, cardiovascular, digestive, reproductive, nervous, endocrine, eyes, ears, nose and throat. (lab 16 clock hrs/lec 16 hrs/ext 00 hrs)
The allocated time for this subject is 32 clock hours. However, for a good understanding of the subject matter you may need to spend considerably more time in reading, preparing assignments and taking exams.
This course is designed to introduce the beginning student to the basic principles of insurance terminology, health insurance and medical billing. In addition, the student will contemplate the impact of health insurance on today’s economy. We will also cover the different departments within an insurance company and operations. This phase will also give the student the opportunity to understand the importance of legal issues that affect the medical biller and health claims examiner. Students will be taught fundamentals of health information technology to provide them with the importance of written communication skills, accounts receivable management, supportive documentation, and customer service. As part of their day-to-day tasks, medical office administrators might answer phones, schedule appointments and organize medical records. ... Their duties include bookkeeping tasks, such as billing patients, preparing financial and tax reports and processing invoices.(Lec 20 clock hrs/ Lab 20 hrs)
Chapter 4 is the first of three coding chapters. According to a survey conducted by Medical Office Biller, in response to the question “What other tasks do billers work on besides billing?”, over 50 percent answered that medical billers are responsible for coding. The purpose of these chapters is to provide a basic introduction to ICD-10-CM (Chapter 4) and CPT/HCPCS coding and coding compliance (Chapter 5). Students who master the material gain sufficient understanding of coding for entry-level medical insurance specialists positions. It is critical for instructors to use current reference materials—ICD, CPT, and HCPCS—in the classroom and to emphasize to students the importance of always having current materials when employed. For outpatient coding, HIPAA requires the code set that is applicable as of the date of service. The material in Chapter 4 is divided into small sections so that it can be covered at a comfortable pace for the class. Reassure students that coding work is always done using the references and the documentation, not from memory. The coding cases at the end of the chapter are to be completed using the ICD-10-CM that is available for class use. (Lec 20 clock hrs/ Lab 20 hrs)
This course is designed to provide the student with the understanding and practical skills necessary to abstract relevant information from the medical records for completing the CMS-1500 claim form, as well as completely expediting the logins and processing of different types of medical forms. Students will study general guidelines for completing forms for different carriers to include: Medicare, Medicaid, and Workers’ Comp. This course will teach the student the knowledge necessary to optimize payment in a timely and cost efficient manner. The students will study the difference between clean, pending, rejected, incomplete and invalid claims and describe the reasons why claims were rejected. This course will also provide the student with the necessary skills to understand and complete the UB-92 claim form and to know when it may or may not minimize their chances of rejection by insurance carriers. (Lec 20 clock hrs/ Lab 20 hrs)
This course will introduce the student to the theory and practical skills necessary to process health insurance claims to include CMS-1500 and UB-92 as a health claims examiner. Additionally, the students will learn the difference between insurance companies and third party administrators. Students will be taught the basic concepts of medical billing practices of the areas that will be covered are: verification of eligibility, claims inventory, deductibles, provider billing, claims investigation, coordination of benefits, legislation and insurance riders. Emphasis will be placed on the premise that guidelines presented are generally accepted standards within the industry. (Lec 08 clock hrs/ Lab 32 hrs)
The current employment environment for administrative staff in physician practices reflects the pressures of decreasing provider compensation, rising costs for medical services and for employer and employee medical insurance, increased governmental regulation, increased public awareness of healthcare issues, and increased reimbursement complexity. These elements underpin the changes that occur almost daily in physician/patient relations and related billing/reimbursement issues, so students need to understand this background. They also need to develop the ability to analyze problems, identify the information that is required, research/abstract that information, determine the best course of action, and work in a team to communicate information and share results. Students begin their understanding of the work and the employment environment of medical insurance and billing. The chapter covers medical insurance and plans, reimbursement methods, and payers, concluding with the requirements for success as a medical insurance specialist. It provides the instructional material for accomplishing four goals: (Lec 08 clock hrs/ Lab 32 hrs)
This course will provide the student with the information and practical skills necessary to process dental claims. Topics to cover include the structures of the teeth, restorative procedures, oral surgery, and examining the claims billed for these procedures. This course will also introduce the student to an ADA claim form, coding and conversion to CPT-4. This course will provide the student with the knowledge and practical skills necessary in applying the correct guidelines in using CPT-4 In-patient, Out-patient, and confirmatory consultation codes, as well as modifiers commonly used in reporting consultations. (Lec 20 clock hrs/ Lab 20 hrs)
Student will study the coding of more complex diagnostic and procedural statements. This subject will cover clinical information regarding specific disease processes, more advanced diagnostic and procedural terminology, detailed instruction exploring the CPT book section by section builds upon previous basic knowledge of payer reimbursement guidelines for optimal reimbursement. Understanding how to use the medical record to provide necessary information essential to the assignment of accurate codes will be covered. Students will recognize when multiple coding is required, when it is recommended and when it should not be used. Class room work will involve coding signs and symptoms, V-codes, infectious disease, neoplasm, endocrine, nutritional and metabolic diseases of the blood and blood-forming organs, mental disorders, diseases of the nervous systems and sense organs, circulatory, respiratory, digestive, and genitourinary system as well as diseases of the musculoskeletal system and connective tissue injuries, complications of surgical and medical care, and external causes of injury will be covered. (Lec 16 clock hrs/ Lab 24 hrs)
In this subject students will learn managed care systems, and special plans, collection policies, tracing delinquent claims, insurance problem solving, and the appeal process of Medicare and Medicaid. Students will learn coding and billing compliance for medical practices. Review current practices with respect to ICD-9/10-CM diagnosis and CPT-4 procedure coding and modifier knowledge for the generation of medical visit APCs. Practical work will also include the coding and more complex diagnostic and procedural statements in complication of pregnancy, childbirth, congenital abnormalities, and certain condition arising on the prenatal period. (Lec 08 clock hrs/ Lab 32 clock hrs)