ALTH 2230 Billing & Coding III and Capstone

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I.COURSE TITLE: Medical Billing & Coding III and Capstone

COURSE NUMBER: 2230CATALOG PREFIX: ALTH

Instructor: / Phone:
Email: / Term:
Office Hours: / Days/Time:
Office Campus/Room: / Course Campus/Room:
Course Webpage/Login:

II.PREREQUISITE(S): Acceptance in Billing & Coding Specialist Program

CO-REQUISITE(S): MAST 2219

III.CREDIT HOURS:2LECTURE HOURS: 2

LABORATORY HOURS:0OBSERVATION HOURS:0

  1. COURSE DESCRIPTION:

This course continues emphasis on CPT and ICD-10coding skills, office and insurance collection strategies and introduces hospital billing concepts. The course includes capstone review, credentialing exam preparation, and may offer an optional, competitive entry practicum experience as site availability permits.

V.GRADING:

To satisfactorily complete this course, the student must achieve a grade of B or above according to the following system:

A (4.0) = 90% - 100%

B (3.0) = 80% - 89% *

C (2.0) = 70% - 79%

D (1.0) = 60% - 69%

F = 0 – 59%

*A minimum final grade of “B” is required to apply toward Medical Assistant Technology (MAST) and/or Allied Health Technology (ALTH) program completion.

VI. ADOPTED TEXT(S):

Insurance Handbook for the Medical Office & Workbook, 14th Edition (or most recent edition)

By: Marilyn T. Fordney

Elsevier, 2017

ISBN:978-0-323-31625-5 – Printed Paperback Textbook

ISBN: 978-0-323-31627-9–Printed Paperback Workbook

ISBN: 978-0-32-331691-0 – Printed Paperback Textbook/Workbook bundle

Hospital Billing, 2nd Edition (or most current edition)

By: Susan Magovern, Chestnut Hill Enterprises

McGraw Hill, 2009

ISBN:0-07-352089-6

Professional Review Guide for the CCS Examination, 1st Edition(or most current edition)

Patricia Schnering, RHIA, CCS

Cengage, 2017

ISBN: 1-305-6485-79

Professional Review Guide for the CCS-P Examination, 1st Edition(or most current edition)

Patricia Schnering, RHIA, CCS

Cengage, 2017

ISBN:1-305-64858-7

VII.COURSE OBJECTIVES:

  • To achieve proficient entry-level medical assisting skills for safe and effective performance of patient care in the ambulatory setting, with the understanding of their application to real life and/or on-the-job situations.

Health Science students will demonstrate critical thinking based on knowledge of academic subject matter required for competence in the profession. They will incorporate cognitive knowledge in performance of psychomotor and affective domains in their practice as medical professionals and in effective communication, both orally and written.

Upon completion of this course, the student will accomplish the following objectives:

Billing and Coding III (Term A)

  • Define credit and collection terminology and translate collection abbreviations.
  • Describe office billing procedures and define aging analysis.
  • Define collection process and possible solutions to collection problems.
  • Name qualifications necessary to work in the financial section of a hospital.
  • Define common terms related to hospital billing.
  • Demonstrate and apply concepts of entry-level upto advanced-level hospital billing practices, including hospital billing flow.
  • State the role of ICD-10-CM Volume 3 in hospital billing and identify categories in Volume 3.
  • State the general guidelines for completion of the paper (Uniform Bill [UB-92]) and transmission of the electronic claim form.
  • Describe the history and purpose of diagnostic related groups (DRGs) and identify how payment is made based on diagnosis related groups.
  • Complete accurate claim forms for each type of insurance presented using accurate coding techniques.
  • Successfully code ICD-10-CM/PCS, CPT and HCPCS Codes.
  • Demonstrate understanding of the various billing situations that arise when certain condition codes are used.
  • Explain the major categories of condition codes.
  • Explain the four categories of occurrence codes.
  • Explain when particular occurrence codes and occurrence span codes are used.
  • Demonstrate understanding of value codes and amounts.
  • Demonstrate understanding of the use of the two types of revenue codes.

Billing and Coding Capstone (Term B)

  • Describe what aspects of medical insurance billing & coding will be included on credentialing examinations.
  • Demonstrate the ability to complete mock certification examinations and cases.
  • Translate and review medical terminology related to medical billing & coding, reimbursement issues, overview of ICD-10 and CPT coding, and pathophysiology for each organ system.
  • Demonstrate the ability to prepare claim forms from mock patient cases.

VIII.COURSE METHODOLOGY:

This course may include a variety of learning experiences which may include, but is not limited to: lecture, class discussion and/or online discussion board, journaling, audio-visual materials, critical thinking exercises, chapter and workbook assignments, computer assisted learning, publisher supplemental materials, student projects/ presentations, group exercises/projects, research paper, skill demonstration, lab skills and peer practice, practical scenarios, human patient/client simulation, competency based examination (CBE), cognitive examinations (exams), and other as assigned by the instructor, may be utilized as appropriate to meet the course objectives.

Following procedure lecture, the instructor will demonstrate the psychomotor skill, and students will practice for return demonstration at required competency level. CBE will be utilized for skill competency in the lab and in the practicum site setting. Students must successfully pass 100% of the psychomotor and affective competencies, with a score of 85% or higher, within two demonstration attempts in order to pass the course and/or progress in the program (see XI. Evaluation).

CAMPUS COURSE / CAMPUS HYBRID / ONLINE/
INDEPENDENT STUDY
Attend/participate in course as scheduled / NA / NA
For each course credit hour (approximately 50 minutes) plan on approximately 2 hours outside class study/work / NA / NA
This course includes 1 Lab Hour (2 contact), and requires completion of out-of-class practice of competency skills to meet ODHE requirements / NA / NA
Classroom lecture, demonstration and skills practice, with supplemental resources, online skill video, skill practice (see schedule) / NA / NA
Complete all assignments and examinations within the due dates / NA / NA
Complete assigned discussion activities / NA / NA
Complete/turn in assigned reports and/or presentations / NA / NA
Skill Demonstration/CBE completed on campus with instructor / NA / NA
Lab practice/peer review completed on campus with/without instructor (as assigned) / NA / NA

Students are expected to apply information and knowledge gained in this course to other health science courses, including practicum assignments.

IX.COURSE OUTLINE:

Billing and Coding III (Term A)

Textbook Outline:

Insurance Handbook for the Medical Office (Introductory):

Chapter 16: Disability Income Insurance and Disability Benefit Programs

Chapter 17: Hospital Billing

Chapter 18: Seeking a Job and Attaining Professional Advancement

Hospital Billing, 2nd Edition:

Chapter 1: Introduction to Hospital Billing

Chapter 2: The Hospital Billing Process

Chapter 3: Hospital Insurance

Chapter 4: Medical Coding Basics

Chapter 5: Payment Methods and Billing Compliance

Chapter 6: Overview of the UB-04 Claim Form

Chapter 7: Provider Information

Chapter 8: Patient Information

Chapter 9: Condition Codes

Chapter 10: Occurrence Codes and Dates

Chapter 11: Value Codes and Changes

Chapter 12: Revenue Codes, Descriptions and Charges

Chapter 13: Payer, Insured, and Employer Information

Chapter 14: Diagnosis and Procedure Codes

Chapter 15: Physician Information, Remarks and Code-Code Field

Billing and Coding Capstone (Term B)

Professional Review Guide for the CCS Examination:

  1. Examination Study Strategies and Resources
  2. Coding Review
  3. Health Data Content and Standards
  4. Medical Science
  5. Classification Systems and Secondary Data Sources
  6. Medical Billing and Reimbursement Systems
  7. ICD-10-CM/PCS Coding
  8. CPT Coding

Professional Review Guide for the CCS-P Examination:

  1. Examination Study Strategies and Resources
  2. Coding Review
  3. Health Data Content and Standards
  4. Medical Science
  5. Classification Systems and Secondary Data Sources
  6. Medical Billing and Reimbursement Systems
  7. ICD-10-CM Coding
  8. CPT Coding

SAMPLE COURSE SCHEDULE *

WEEK / TOPIC/CONTENT / EVALUATION / LEARNING OBJECTIVE
1 /
  • Topic: Syllabus, Class Rules;Disability Income Insurance and Disability Benefit Program (16)
  • Topic: Hospital Billing (17)
  • Topic: Seeking a Job and Attaining Professional Advancement (18)
  • Homework: As Assigned
/
  • Exam Questions
  • Assignment:Billing/Coding Claims and Coding Exercises
/ 4,5, 6, 7, 10 (Billing and Coding III Objectives)
2 /
  • Exam:Chapter16,17,18
  • Topic: Introduction to HospitalBilling (1)
  • Topic: The Hospital Billing Process (2)
  • Topic: Hospital Insurance (3)
  • Homework: As Assigned
/
  • Exam Questions
/ 4, 5, 6, 7 (Billing and Coding III Objectives)
3 /
  • Exam:Chapter1,2,3
  • Topic: Medical Coding Basics (4)
  • Topic: Payment Methods and Billing and Compliance (5)
  • Homework: As Assigned
/
  • Exam Questions
  • Assignment: Worksheet and Coding Exercises ICD-10-CM/CPS, CPT and HCPCS. DRGs
/ 1, 2, 3, 4, 9, 11 (Billing and Coding III Objectives)
4 /
  • Exam:Chapter4,5
  • Topic: Overview of the UB-04 Claim Form (6)
  • Topic: Provider Information (8)
  • Topic: Patient Information (9)
  • Homework: As Assigned
/
  • Exam Questions
  • Assignment: UB-04 Claim Form
/ 8 (Billing and Coding III Objectives)
5 /
  • Exam: Chapter 6,8
  • Topic: Condition Codes (10)
  • Topic: Chapter 10: Occurrence Codes and Dates
  • Homework: As Assigned
/
  • Exam Questions
/ 12, 13, 14, 15 (Billing and Coding III Objectives)
6 /
  • Exam: Chapter9,10
  • Topic: Value Codes and Charges (11)
  • Topic: Revenue Codes, Descriptions, and Charges (12)
  • Homework: As Assigned
/
  • Exam Questions
/ 16, 17 (Billing and Coding III Objectives)
7 /
  • Exam: Chapter11,12
  • Topic: Payer, Insured, and Employer Information (13)
  • Topic: Diagnosis and Procedure Codes (14)
  • Topic: Physician Information, Remarks and Code-Code Field (15)
  • Homework: As Assigned
/
  • Exam Questions
  • Assignment:
  • Billing/Coding Claims and Coding Exercises
/ 6, 10 (Billing and Coding III Objectives)
8 /
  • Exam: Chapter 13,14,15
  • MIDTERM EXAM: Accumulative
  • Topic: Coding and Claims Review
  • Homework: As Assigned
/
  • Exam Questions
  • Midterm: Accumulative Questions from All Previous Chapters
  • Assignment: Worksheet and Coding/Claims Exercises ICD-10-CM/CPS, CPT and HCPCS. DRGs
/ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17
(Billing and Coding III Objectives)
9 /
  • Topic: I Examination Study Strategies and Resources (CCS Examination Book)
  • Topic: II Coding Review (CCS Examination Book)
  • Homework: As Assigned
/
  • Exam Questions
/ 1, 2, 3 (Billing and Coding Capstone Objectives
10 /
  • Exam: I, II Review Book (CCS)
  • Topic: III Health Data Content and Standards (CCS Examination Book)
  • Topic: IV Medical Science (CCS Examination Book)
  • Homework: As Assigned
/
  • Exam Questions
/ 2, 3 Billing and Coding Capstone Objectives)
11 /
  • Exam: III, IV Review Book (CCS)
  • Topic: V Classification Systems and Secondary Data Sources (CCS Examination Book)
  • Topic: VI Medical Billing and Reimbursement Systems (CCS Examination Book)
  • Homework: As Assigned
/
  • Exam Questions
/ 2, 3, 4 (Billing and Coding Capstone Objectives)
12 /
  • Exam: V, VI Review Book (CCS)
  • Topic: VII ICD-10-CM/PCS Coding (CCS Examination Book)
  • Topic: VIII: CPT Coding (CCS Examination Book)
  • Homework: As Assigned
/
  • Exam Questions
  • Assignment: Worksheet and Coding/Claims Exercises ICD-10-CM/CPS, CPT and HCPCS
/ 2, 3, 4 (Billing and Coding Capstone Objectives)
13 /
  • Exam: VII, VIII Review Book (CCS)
  • Topic: I Examination Study Strategies and Resources (CCS-P Examination Book)
  • Topic: II Coding Review (CCS-P Examination Book)
  • Topic: III Health Data Contend and Standards (CCS-P Examination Book)
  • Topic: IV Medical Science (CCS-P Examination Book)
  • Homework: As Assigned
/
  • Exam Questions
/ 1, 2, 3 (Billing and Coding Capstone Objectives
14 /
  • Exam: I, II, III, IV (CCS-P)
  • Topic: V Classification Systems and Secondary Data Sources (CCS-P Examination Book)
  • Topic: VI Medical Billing and Reimbursement Systems (CCS-P Examination Book)
  • Topic: VII ICD-10-CM Coding
  • Topic: VIII CPT Coding
  • Homework: As Assigned
/
  • Exam Questions
  • Assignment: Worksheet and Coding/Claims Exercises ICD-10-CM/CPS, CPT and HCPCS
/ 2, 3, 4 (Billing and Coding Capstone Objectives)
15 /
  • Exam: V, VI, VII, VIII (CCS-P)
  • Homework: As Assigned
/
  • Exam Questions
  • Assignment: Worksheet and Coding/Claims Exercises ICD-10-CM/CPS, CPT and HCPCS
/ 2, 3, 4 ( Billing and Coding Capstone Objectives)
16 / FINAL EXAM /
  • Exam Questions/Coding Questions

*The instructor reserves the right to adjust, rearrange, and/or maintain a different schedule of work (assignments, projects, exercises, exams/quizzes) to fulfill the objectives of the course and/or to revise course syllabus as needed according to circumstances during the semester. Changes will be announced/posted 24 hours prior to implementation; students are advised to read all announcements as they arrive.

X.OTHER REQUIRED BOOKS, SOFTWARE AND MATERIALS:

It is highly recommended that students have:

  • A desktop PC, laptop or tablet (see Southern State Community College (SSCC) website minimum computer requirement recommendations; iOS/Android will not meet all requirements/recommendations)
  • A working printer
  • High speed internet access (not all required software/online resources are compatible with iOS/Android)
  • A medical dictionary
  • Other as determined by instructor to meet course objectives (refer to instructor syllabus)
  • One USB storage device for personal use/backup
  • Current Taber Medical Dictionary recommended

* Specific coding books are required for the AHIMA CCA and CCS credentialing exams. The full list of required coding books is updated regularly and must be reviewed at prior to attending the AHIMA approved testing center:

Per AHIMA Site – CCA and CCS Credentials Exam:

All candidates are required to bring the following code books to the test center:

1. ICD-10-CM code book (2017)

2. ICD-10-PCS code book (2017)

3. CPT code book (2017) – AMA only

OPTIONAL: 2017 ICD-10-CM Guidelines for Coding and Reporting

CCS-P Exam: Elsevier: HCPCS Level II Standard or Professional Edition

AHIMA Approved (or most recent approved editions):

AMA CPT® - 2017 Deluxe or Professional or Standard

Elsevier: ICD-10-CM and PCS Code Books - 2017 Professional

AHIMA Approved (or most recent approved editions) - Available in bundle:

Elsevier 2017 ICD-10-CM Professional, ICD-10-PCS Professional, HCPCS Professional Edition, and AMA CPT Deluxe or Professional or Standard Edition Package

ISBN: 978-0-323-39739-1 – Package above Professional Edition

XI.EVALUATION:

This course maintains a no extension, no make-up policy for all course content (i.e., no make-up tests will be given). If you do not complete the course requirements as outlined, exceptions will not be made. The medical professional charged with care of others must remain diligent to meet career responsibilities and deadlines daily.

Students must earn a passing average score of 80% on exams. Failure to achieve 80% average score on exams will result in failure of the course. A minimum final grade of “B” is required for this course to apply toward MAST/ALTH program completion (refer to V. GRADING, page 1, and Sample Final Grade Percentage Calculation below).

Knowledge of content is evaluated through performance of outlined core curriculum objectives by written examination (may be comprehensive), competency based examination, performance of assignments, work projects, etcetera, to meet core curriculum objectives, per instructor (refer to Evaluation below).

Evaluation may include:

  • Demonstration of safe psychomotor skills when providing patient/client care.
  • Demonstration of listening skills, and respect, for diversity during interactions with patients/clients and families
  • Demonstration of assertive verbal and nonverbal communication skills with patients/clients, families and team members
  • Practice of correct medical terminology to communicate and document patient/client information
  • Providing patient/client care in accordance with regulations, policies, laws and patient/client rights
  • Following health and safety policy and procedures to prevent injury and illness
  • Textbook Reading: Students are to come to class prepared for lecture. Read all assigned chapters before coming to class.
  • Examination: All exams may be comprehensive; quizzes are not. Quizzes may be utilized at the discretion of the instructor. Students must earn a passing average score of 80% on examinations. Failure to obtain the required 80% average will result in failure of the course (refer to V. GRADING, page 1, and Sample Final Grade Percentage Calculation below).
  • Competency Based Examination (CBE): Competency-based skill performance is required on each psychomotor skill presented in the course (return demonstration is not an assessment of a skill explanation; demonstration of the skill set is required). Students must successfully pass 100% of all the psychomotor and affective competencies within two demonstration attempts, earning a minimum required score of 85%, in order to pass the course and/or progress in the program. A second attempt will have an automatic 10 point deduction (90% maximum score available). Failure to obtain the required 85% passage on each CBE will result in failure of the course (refer to Addendum: Competency Based Examination Procedure and Protocols).
  • Scenarios: May include discussion or role-playing or both. Objective: the student will learn professional behavior (affective domain CBE), through the use of scenarios to demonstrate communication, critical thinking skills and understanding of their applicationto real life and/or on-the-job situations. Students must successfully pass 100% of the affective competencies within two demonstration attempts, with a minimum required score of 85%, in order to pass the course and/or progress in the program. Failure to obtain the required 85% passage on each CBE will result in failure of the course (refer to Addendum: Competency Based Examination Procedure and Protocols).
  • Written Communication: Accurate spelling is required and will be graded. Spelling exams/quizzes may be administered at the discretion of the instructor. Points will be deducted on all course related work, exams, correspondence, assignments, quizzes, etcetera (including text and email), for incorrect spelling, punctuation and/or grammar.
  • Participation: Evaluated by contribution(s) to class discussion; come prepared.
  • Exercises/Assignments: Reinforce course content, cognitive objectives, and critical thinking skills. As assigned by the course instructor (refer to instructor syllabus/rubric).
  • Professionalism: Professionalism is required in both behavior and attire:
  • Classroom attire – professional casual (refer to program handbook)
  • Lab attire – scrubs/lab coat (refer to program handbook)

Sample Coursework (assignments may be added/graded to meet core objectives):

Coursework/ Exercises/Quiz(as assigned; refer to instructor syllabus)

Competency Based Examinations (as assigned per core curriculum)

Chapter Examinations (100 points)151500 points

Case Studies (100 points) 6 600points

Coding Quiz (100 points) 1 100points

Professionalism 1 100 points

Midterm (100 points) 1 100 points