CLUSTERHealth Science Education

COURSEMedical Assistant Administrative Procedures II

WVEIS CODE0736

COURSE DESCRIPTION

Instructional content will focus on policies and procedures necessary for medical reimbursement. Students will be introduced to medical office coding, ICD-9-CM, CPT-4 Coding, CPT-4 Sections and the purpose of the auditing processes. *This course is recommended as an elective for the Allied Health SciencesConcentration (Medical Assisting Specialization).

SKILL SETS

Medical Terminology

Medical Insurance Claims

ICD-9-CM Coding

CPT-4 Coding

CPT-4 Sections

Reimbursement and Auditing

Medical Assistant Administrative Procedures II WVEIS 0736

Skill Set / Medical Terminology
Knowledge Objectives
0736.1 / Students will demonstrate knowledge of
  • medical terminology as necessary to interpret and submit medical insurance claims.

Performance Objectives
0736.2
0736.3
0736.4 / Students will
  • interpret commonly used health insurance terms.
  • interpret commonly used abbreviations.
  • use standard medical terms and abbreviations to interpret and submit medical insurance claims.

Skill Set / Medical Insurance Claims
Knowledge Objectives
0736.5 / Students will demonstrate knowledge of
  • basic coding used to complete and submit medical insurance claims.

Performance Objectives
0736.6
0736.7
0736.8
0736.9
0736.10
0736.11 / Students will
  • examine the evolution of medical insurance.
  • determine the significance of diagnosis-related groups.
  • recognize the origin and function of coding.
  • differentiate the types of codes used in health care.
  • analyze the documentation tools used in the coding process.
  • utilize the proper technique for determining the physician’s diagnosis.

Skill Set / ICD-9-CM Coding
Knowledge Objectives
0736.12 / Students will demonstrate knowledge of
  • basic concepts of ICD-9-CM coding.

Performance Objectives
0736.13
0736.14
0736.15
0736.16
0736.17
0736.18
0736.19 / Students will
  • examine the ICD-9-CM code book format.
  • use correct symbols, punctuation and abbreviations in the ICD-9-CM code book.
  • utilize the steps for accurate coding from the ICD-9-CM code book.
  • implement the CMS guidelines for ICD-9-CM coding.
  • determine the purpose for V codes and E codes.
  • use the Drug and Chemical Tables found in the ICD-9-CM code book.
  • demonstrate the procedure for coding special complexities.

Skill Set / CPT-4 Coding
Knowledge Objectives
0736.20 / Students will demonstrate knowledge of
  • basic concepts of CPT-4 coding.

Performance Objectives
0736.21
0736.22
0736.23
0736.24
0736.25 / Students will
  • demonstrate the technique for determining when procedures and services can be coded.
  • examine the CPT-4 code book format.
  • use the CPT-4 code book signs and symbols.
  • determine the use of modifiers to CPT-4 codes.
  • compare starred, global and unlisted CPT-4 codes.

Skill Set / CPT-4 Sections
Knowledge Objectives
0736.26 / Students will demonstrate knowledge of
  • basic concepts of CPT-4 sections coding.

Performance Objectives
0736.27
0736.28
0736.29
0736.30
0736.31
0736.32
0736.33 / Students will
  • utilize the concepts of evaluation and management coding.
  • apply the principle elements of anesthesia coding.
  • implement the surgery coding guidelines.
  • examine coding rules for pathology services.
  • select the coding guidelines for medicine services.
  • articulate the rules and application of modifiers to the coding process.
  • code a sample claim form.

Skill Set / Reimbursement and Auditing
Knowledge Objectives
0736.34 / Students will demonstrate knowledge of
  • reimbursement and auditing processes.

Performance Objectives
0736.35
0736.36
0736.37
0736.38
0736.39
0736.40 / Students will
  • distinguish reimbursement methods.
  • articulate the purpose of third party contracts.
  • demonstrate components for reimbursement calculations.
  • complete a claim form.
  • examine internal and external obstacles to accurate and timely reimbursement.
  • determine the purpose of audits.