COURSE NAME/NUMBER:Front Office Procedures IlMEDA121
HOURS/CREDITS:4Credits
CLASS LOCATION/TIMES:Location:Building BRoom 109
Days: M,W,F
Times:12:10- 1:00
PREREQUISITES:Front Office Procedures I MEDA120
COURSE DESCRIPTION:This course is an introduction to insurance concepts and terminology. The course includes procedure and diagnostic coding principles; procedures in completing insurance forms for various state and private insurance organizations; and the basic similarities and differences between types of insurance. HIPAA laws are discussed in detail.
INSTRUCTOR:
OFFICE HOURS/CONTACT INFORMATION:
Office Hours: 7:30-8:00 a.m.; 2:30-3:00 p.m.
(By appointment)
Office Location: Building B, Room
Phone: (425) 235-2352 Ext. 5686
Email:
COURSE OBJECTIVES (Course Competencies):Upon successful completion of this course the student will be able to:
1.Define, spell, and pronounce the terms listed in the vocabulary.
2.Identify three purposes of the most current diagnostic coding system.
3.Describe how to use the most current diagnostic coding system.
4.Understand the importance of the Tabular Index, which contains the most specific coding information.
5.Comprehend and use instructional terms and symbols as defined in the ICD-9-CM.
6.Demonstrate the use of the Alphabetic Index in the selection of main and modifying terms and the appropriate code (or codes) or code ranges.
7.Explain where diagnostic information can be found and demonstrate how to abstract the diagnostic statement from the medical record.
8.Demonstrate the use of the Alphabetic Index in the selection of main and modifying terms and the appropriate code (or codes) or code ranges.
9.Perform diagnostic coding.
10.Understand and apply the basic coding rules in the use of the ICD-9-CM.
11.Explain the use of V and E codes.
12.Understand and apply the basic coding rules in the use of ICD-9-CM.
13.Identify four purposes of the CPT.
14.List the main sections of the CPT and describe their content.
15.Discuss the importance of modifiers.
16.List the main sections of the CPT and describe their content.
17.Describe the coding conventions, guidelines, and layout of the CPT manual and their importance.
18.Describe the steps for abstracting procedural data from clinical documentation.
19.Demonstrate an understanding of the selection of main and modifying terms.
20.Find codes in the Alphabetic Index of the CPT manual.
21.Demonstrate an understanding of the process and procedures of code selection.
22.Describe how to use the most current procedural coding system.
23.Explain the importance of correctly assigning evaluation and management codes.
24.Analyze and select codes using the CPT main text.
25.Discuss the purpose of health insurance.
26.Describe how to use the most current HCPCS coding.
27.Describe how to use the most current procedural coding system.
28.Define upcoding, and explain why it must be avoided.
29.Discuss the purpose of health insurance.
30.Identify types of insurance plans.
31.Explain the numerous classifications of insurance benefits.
32.Explain how insurance benefits are determined.
33.Identify models of managed care.
34.List and discuss other major third party payers.
35.Discuss workers’ compensation as it applies to patients.
36.Describe the procedures for implementing both managed care and insurance plans.
37.Discuss utilization review principles.
38.Explain the procedure for verifying insurance benefits.
39.Explain how to perform eligibility and verification of benefits procedures.
40.Explain how to obtain managed care referrals and precertification.
41.Explain how to perform a preauthorization procedure.
42.Discuss the referral process for patients in a managed care program.
43.Discuss the different types of fee schedules.
44.Demonstrate how insurance benefits are determined by calculating deductible and coinsurance payments.
45.Discuss the differences between paper claims and electronic claims.
46.Explain how to gather information for completing insurance claim forms.
47.Explain how to complete the 33 blocks of the CMS-1500 claim form.
48.Describe how to complete a CMS-1500 form appropriately for various federal, state, and commercial third-party payers.
49.Complete insurance claim forms.
50.Discuss methods of preventing the rejection of claims.
51.Differentiate between “clean” and “dirty” claims.
52.Describe ways of checking the status of claims.
ATTENDANCE AND MAKE-UP POLICY: Throughout the Medical Assistant Program, an outstanding work ethic is emphasized and encouraged. Participation and professionalism are essential to your success as a student and as a Medical Assistant. Ten percent of your grade involves participation and professionalism.Professionalism points will be deducted at a total of 1 point per 60 minutes of class time missed for each subject. Point deductions will be broken down in 15 minute increments. For example: 0-15 minutes = 0.25 points, 16 -30 minutes = 0.50 minutes, etc.
If you must be absent, make arrangements beforehand to have a fellow student obtain any handouts and reading assignments you miss. You are also responsible for getting assignments from a fellow student by phone or email when you are absent in order to complete an assignment on time. Students missing three (3) or more consecutive class days due to illness are required to submit a note from their healthcare provider certifying they are physically able toreturn to the classroom. The full attendance policy is outlined in your medical assistant packet.
NATURE OF THE COURSE: To accommodate a wide variety of learning and personal styles many different instructional approaches may be used including: lecture, group discussion, demonstrations, interactive exercises, role playing, video programs, computer based training, student research, self directed learning projects and collaborative teaching with Program Instructors.
COURSE OUTLINE: See attached document
GRADING: Grades are based on the following weighted categories and assigned the corresponding decimal grade:
Professionalism/Participation10%
Homework15%
Quizzes20%
Mid Term/Paper25%
Final Exam30%
TEXT:Young, Alexandra Patricia. Kinn’s The Medical Assistant, An Applied Learning Approach. Eleventh Edition.Dallas, Saunders, 2011.
Young, Alexandra Patricia. Kinn’s The Medical Assistant Study Guide. Eleventh Edition.Dallas, Saunders, 2011.
ADDITIONAL MATERIALS:
Pens: Blue or black ink; no erasable or gel pens
Pencils
Calendar for assignments
USB Drive to store work
RESOURCES:
EMERGENCY INSTRUCTIONS FOR INCLEMENT WEATHER: In case of weather closure of the RTC Campus, class will be cancelled. Call the school at (425) 235-2352 and choose option 9 for weather closure information. Information will also be available on the website ( and local television and radio stations.
CLASSROOM MANAGEMENT POLICIES:
Renton Technical College recognizes and values diversity between students on campus, including cultural diversity, diversity of age, life style, race, religion, and financial backgrounds. Students are expected to listen respectfully to others and conduct themselves professionally in the classroom, at clinical sites, and at all campus related activities.
Certain behaviors will not be tolerated. Students engaging in those behaviors will be asked to leave the classroom and appropriate disciplinary steps will be taken. Certain behaviors will not be tolerated. Students engaging in those behaviors will be asked to leave the classroom and appropriate disciplinary steps will be taken. Students will also lose all their professionalism points for the day. Examples are:
- Unprofessional or disruptive behavior
- Sleeping in class
- Inappropriate attire
- Foul language
- Sexual harassment
Cheating and Plagiarism: As outlined in the Allied Health Department Handbook, Renton Technical College has a zero tolerance policy towards cheating and plagiarism. On a paper or presentation, if wording is taken directly from any source without giving credit to the source, the student will receive a zero (0) on that paper or presentation. When there is doubt, the instructor will make the final judgment on whether plagiarism has occurred.
Disciplinary action includes, but is not limited to, the student receiving a zero (0) on a test, paper or presentation up to and including immediate expulsion from the program.
Reading Assignments: The student is responsible for reading all assigned material prior to the lecture. Much more can be gained from the classroom discussion if there is some basic familiarity with the content.
Questions: If you do not understand something during a lecture and do not want to ask a question in front of the entire class, talk to your instructor or other students when there is free time within the classroom. (There will be frequent opportunities at the end of class sessions to get clarification) Asking classmates questions while other classroom information is taking place is disruptive to the entire class and theinstructor. It also causes students to miss what is currently being discussed.
Quizzes: There will be quizzes given approximately once a week. A Pop Quiz could be given at any point when the instructor needs to evaluate how much information is being assimilated by the students. Pop Quizzes cannot be madeup.If you are absent on the day of a scheduled quiz, you must make up the quiz the day you return to school to receive credit. In addition, if you are more than 10 minutes late for a quiz you will need to make it up by arrangement with the instructor. The highest possible grade for a make-up quiz is 90%.
NOTE:If your class is a hybrid quizzes will be administered on line. These quizzes will be timed and available on specified days as noted in the course outline. Quizzes not taken during the available time frame can only be made up at the discretion of the instructor. DO NOT wait until the last minute to take your quizzes.
Mid Term and Final: There will be a mid-term given after which the student and instructor will meet and discuss progress as necessary. A final exam will be given during the last week of the quarter. You will lose one letter grade for every day the final examination is not taken from the date it is offered to the rest of the class. The mid-term and cumulative final will be proctored and may be administered in any form (written, oral, online, etc.).
Homework: is due on the assigned date and must be complete to earn homework points. Incomplete homework must be submitted within one school day of the due date to receive points. If a student is absent on the day homework is due the homework is considered late and must be submitted the day the student returns to earn points. Points are earned as follows:
Submitted on time and complete10 points
Submitted late and complete 5 points
Note: Information contained in this syllabus is subject to change.
Allied Health Grading Scale 2011
Decimal Grade / Grade Percent / Letter Grade Equivalent4.0 / 100 / A
3.9 / 99
3.8 / 98 / A-
3.7 / 97
3.6 / 96
3.5 / 95
3.4 / 94 / B+
3.3 / 93
3.2 / 92
3.1 / 91 / B
3.0 / 90
2.9 / 89
2.8 / 88 / B-
2.7 / 87
2.6 / 86
2.5 / 85
2.4 / 84 / C+
2.3 / 83
2.2 / 82
2.1 / 81 / C
2.0 / 80
1.9 / 79 / C-
1.8 / 78
1.7 / 77
1.6 / 76
1.5 / 75
1.4 / 74 / D+
1.3 / 73
1.2 / 72
1.1 / 71 / D
1.0 / 70
0.9 / 69 / D-
0.8 / 68
0.7 / 67
0.0 / 66 or less / F
Note:Students must earn at least a grade or 2.0 (80%) in each course to continue in the Medical Assistant Program.
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Front Office Procedures Il
MEDA 121
Revised January 2013