Westerville City Schools COURSE OF STUDY
Introduction to Medical Coding and Reimbursement SCXXX
Recommended Grade Level: Grades 11, 12
Course Length: One Semester, 1 Period
Credits: .67 high school, 2 semester college hours
Course Weighting: 1.25
Course Description
This course provides an overview of hospital-based and physician-based medical coding and reimbursement principles. Students will be introduced to the role of a medical coder, explore professions within the Health Information Management Technology field, and differentiate between the common types of managed care healthcare insurance plans.
Course Rationale
Many healthcare facilities have reorganized and the job roles within these systems have adjusted to provide care and services based on patient needs. As a result, employment opportunities have been created for the individual who has documented competencies in a variety of health care skills. Multi-Skilled Health provides the flexibility for students to gain these important skills in health care. 1 The student has many options from which to choose in Multi-Skilled Health and this course provides an
opportunity to explore a Health Information Management path. Students completing this course along with additional coursework provided in the Health Pathway in conjunction with CSCC can earn a certificate which can also roll in to an Applied Associate’s Degree in Multi-Skilled Health. While this course may not have a direct degree credit transfer to four year institutions of higher education, the transcripted college credit may transfer as elective credit.
1Description from CSCC HIMT website: http://www.cscc.edu/academics/departments/multi-skilled/plan15-16.shtml
Westerville City Schools Mission To prepare students to contribute to the competitive and changing world in
Columbus State Community College Allied Health Professions Department
Health Information Management Technology
COURSE: HIMT 1274- Introduction to Medical Coding and Reimbursement CREDITS: 2 CLASS HOURS PER WEEK: 2 lecture
PREREQUISITES: None DESCRIPTION OF COURSE
This course provides an overview of hospital-based and physician-based medical coding and reimbursement principles. LEARNING TARGETS
STUDENT LEARNING OUTCOMES
Upon completion of this course, the student will be able to: • Discuss the role of a medical coder.
• Discuss the types of careers available to HIMT professionals.
• Discuss the credentials available to those who study medical coding and pass a certification exam. • Demonstrate an understanding of the purpose ofiCD-10-CM, ICD-10-PCS, and CPT-4 medical codes. • Demonstrate awareness of how codes are assigned using the ICD-1 0-CM code book.
• Demonstrate awareness of how codes are assigned using the ICD-10-PCS code book. • Demonstrate awareness of how codes are assigned using the CPT-4 code book. • Define healthcare reimbursement terms, phrases, and abbreviations.
• Differentiate between various government sponsored and voluntary healthcare insurance plans. • Differentiate between the common types of managed care healthcare insurance plans.
• Discuss common models of health insurance plans.
• Discuss and differentiate between varying healthcare reimbursement methodologies. EXPECTATIONS FOR LEARNING
INSTITUTIONAL LEARNING GOALS
Columbus State Community College's Institutional Learning Goals are an integral part of the curriculum and central to the mission of the college. The faculty at Columbus State has identified the following institutional learning goals:
November,
• Ethical Reasoning • Quantitative Skills • Scientific Literacy
• Technological Competence • Communication Competence • Cultural and Social Awareness • Professional & Life Skills
MATERIALS COURSE MATERIALS REQUIRED
• Access to a computer and reliable internet access.
• ICD-10-CM 2015: The Complete Official Draft Codebook; ISBN: 9781622020751 • ICD-10-PCS 2015: The Complete Official Draft Codebook; ISBN: 9781622020126 • CPT 2015 Professional Edition; ISBN: 9781622020263
INSTRUCTIONAL STRATEGIES GENERAL INSTRUCTIONAL METHODS
• Assigned Readings
• Guided study through assigned lessons.
• Reinforcement exercises- ICD-10-CM, ICD-10-PCS, and CPT-4 coding exercises. • Instructor available via e-mail to answer questions.
• Announcements and course material posted to Blackboard course site to assist students with their studies. • Online resources used to supplement material.
ASSESSMENT ASSESSMENT
Columbus State Community College is committed to assessment (measurement) of student achievement of academic outcomes. This-process addresses the issues of what you need to learn in your program of study and if you are learning what you need to learn. The assessment program at Columbus State has four specific and interrelated purposes: (1) to improve student academic achievements; (2) to improve teaching strategies; (3) to document successes and identify opportunities for program improvement; (4) to provide evidence for institutional effectiveness. In class you are assessed and graded on your achievement of the
outcomes for this course. You may also be required to participate in broader assessment activities. STANDARDS AND METHODS FOR EVALUATION
Assignments- graded (combined 20% of course grade) ● Post to Discussion Board- Personal Introduction ● ICD-10-CM Coding Conventions
● ICD-1 0-CM Coding Guidelines ● ICD-1 0-CM Coding Exercises ● Selecting a Principal Diagnosis ● ICD-10-PCS Coding Conventions ● Building an ICD-10-PCS Code ● ICD-10-PCS Coding
● Selecting a Level of ElM Code ● Practice Locating Codes in CPT
● Practice Pathology and Laboratory Coding ● Medical Reimbursement
Four Graded Tests
● Intro and ICD-1 0-CM coding TEST (20% of course grade) ● ICD-10-PCS coding TEST (20% of course grade)
● CPT -4 coding TEST (20% of course grade)
● Medical Reimbursement TEST (20%of course grade) **Final course grades will be posted on CougarWeb.
GRADING SCALE
Grades: Final grades will be determined as follows:
Grades Weight
Assignments 20%
Intro and ICD-10-CM coding TEST 20%
ICD-10-PCS coding TEST 20%
CPT-4 coding TEST 20
Medical Reimbursement TEST 20%
Total 100%
November,
100-90 =A 89-80 = B 79-70 == c 60-69 =D
59-Below = E (failing grade) * Final course grades will be posted on Cougar Web. NOTE:
Students enrolled in HIMT, must maintain a minimum level of performance (no lower than a "C" grade) in each of the required technical courses in order to be eligible for further progress in the
HIMT Program. HIMT courses can only be repeated twice.
A minimum level of performance of 70% (no lower than a "C" grade) is required in this course in order for the course to meet prerequisite and IDMT graduation requirements.
This standard has been established to allow the student to gain knowledge needed to successfully achieve the course objectives. A grade below a "C" for this course will not meet prerequisite and graduation requirements for the HIMT program. ·
SPECIAL COURSE REQUIREMENTS
Special requirements for those students enrolled in the web-based course: 1. Reliable access to the internet.
2. Use of the CSCC student email address. ATTENDANCE POLICY
This course is web-based. Attendance means staying up to date with the course assignments, quizzes, and exams. It is your responsibility to check announcements on Blackboard at least twice a week and follow instructions posted. Due dates for course assignments, quizzes, and exams will be posted in the course syllabus and also in the announcements on Blackboard. It is your responsibility to ask questions (i.e., by e-m ailing the instructor, etc.) to clarify course content that you do not understand.
Staying current with course requirements and asking questions are important to your learning of the course material.
Non-participation and tardiness with work is considered to be nonprofessional. The key to your success in this course is to complete all course assignments and tests by the posted due dates and to ask questions when clarification is needed.
Students enrolled in this web-based course should plan to spend a minimum of 4 - 6 hours per week on their studies for this course. Receipt of assignments, quizzes, assessments, test, exam, etc. by the assigned due date will be used to determine your attendance.
Attendance Reporting: A student will be reported as not attending for financial aid reporting, if the student has missed submitting more than one posted quiz/assignment/assessment/activity by the due date and/or the student has missed a test. See Financial Aid Reporting information provided below in this syllabus.
STUDENT CODE OF CONDUCT
As an enrolled student at Columbus State Community College, you have agreed to abide by the
Student Code of Conduct as outlined in the Student Handbook. You should familiarize yourself with the student code. The Columbus State Community College expects you to exhibit high standards of academic integrity, respect and responsibility. Any confirmed incidence of misconduct, including plagiarism and other forms of cheating, will be treated seriously and in accordance with College Policy and Procedure 7-10.
AMERICANS WITH DISABILITIES ACT (ADA) POLICY
It is Columbus State policy to provide reasonable accommodations to students with disabilities as stated in the Americans with Disabilities Act (ADA} and Section 504 of the Rehabilitation Act.
If you would like to request such accommodations for access, please contact Disability Services:
101 Eibling Hall (614} 287-2570. Email or give your instructor a copy of your accommodations letter from Disability Services as soon as possible. Accommodations do not start until your instructor receives the letter, and accommodations are not retroactive. Delaware Campus students may contact an advisor in the Student Services Center on the first floor of Moeller Hall, (740) 203-8000.
INCLEMENT WEATHER OR OTHER EMERGENCIES
In the event of severe weather or other emergencies that could force the college to close or to cancel classes, such information will be broadcast on radio stations and television stations.
Students who reside in areas that fall under a Level Ill emergency should not attempt to drive to the college even if the college remains open.
Assignments due on a day the college is closed will be due the next scheduled class period. If an examination is scheduled for a day the campus is closed, the examination will be given on the next class day. If a laboratory is scheduled on the day the campus is closed, it will be made up at the next scheduled laboratory class. If necessary, laboratory make-up may be held on a Saturday.
November,
Students who miss a class because of weather-related problems with the class is held as scheduled are responsible for reading and other assignments as indicated. in the syllabus. If a laboratory or examination is missed, contact me as soon as possible to determine how to make up the missed exam or lab. Remember - it is the student's responsibility to keep up with reading and other assignments when a scheduled class does not meet, whatever the reason.
In the event the college is forced to close during Final Examination Week, for exams taken at the testing center and the deadlines for the tests/exam falls on the day the college is close, the exam/test deadline will be extended through the next day the college re-opened. Your instructor will post the new deadline for the exam/test in the announcement page of Blackboard.
FINANCIAL AID ATTENDANCE REPORTING
Columbus State is required by federal law to verify the enrollment of students who participate in Federal Title IV student aid programs and/or who receive educational benefits through the Department of Veterans Affairs. It is the responsibility of the College to identify students who do not commence attendance or who stop attendance in any course for which they are registered and paid. Non-attendance is reported quarterly by each instructor, and results in a student being administratively withdrawn from the class section. Please contact the Financial Aid Office for information regarding the impact of course withdrawals on financial aid eligibility.
TOBACCO FREE COLUMBUS STATE 2015
As a result of a proposal by the Ohio Board of Regents in 2012, Columbus State became a tobacco-free institution, as have colleges and universities across the nation, including The Ohio State University, which made the change in 2014. In an effort to support the health and wellbeing of all students, faculty, and staff, the College has adopted a tobacco free policy which prohibits the use of all tobacco-related products on College property. The primary emphasis of this approach is to focus on the elimination of tobacco use on all College property with cessation left as a choice for the individual. The effective date for the tobacco free policy was July 1, 2015.
AUDIO AND VIDEO RECORDING STATEMENT
Audio-and video-recording, transmission, or distribution of class content (e.g., lectures, discussions, demonstrations, etc.) is strictly prohibited unless the course instructor has provided written permission via the syllabus or a signed form. Authorization to record extends solely to students in that particular course. Transmitting, sharing, or distributing course content onto public, commercial, or social media sites is strictly prohibited.
TITLE IX:
Columbus State Community College is committed to creating a learning and working environment that is free of bias, discrimination, and harassment by providing open communication and mutual respect. If you have encountered sexual
harassment, sexual misconduct, sexual assault, or discrimination based on race, color, religion, age, national origin, ancestry, sex, sexual orientation, gender identity and expression, genetic information (GINA), military status or disability, please contact one of the following people:
Renee Fambro, Director of Equity & Title IX, rfambro@cscc.edu Danette Vance, Deputy Title IX Coordinator, dvance1@cscc.edu Joan Cook, Deputy Title IX Coordinator, jcook60@cscc.edu
Darla Van Horn, Deputy Compliance Coordinator, dvanhorn@cscc.edu
For additional information about your options at Columbus State Community College or to file a complaint online,
please visit our webpage at: http://www.cscc.edu/services/title-ix/
SCOPE AND SEQUENCE COURSE OUTLINE:
Units of Instruction
Unit 1: Introduction to Medical Coding and Reimbursement ● What is medical coding?
● Careers in Health Information Management ● Coding Credentials
● Health Record as a Source Document ● ICD-9-CM and Legacy Data
Unit 2: Introduction to ICD-10-CM ● ICD-10-CM Coding Conventions
● I CD-1 0-CM General Coding Guidelines
● ICD-10-CM Code Structure, Index, and Tabular List ● Navigating the ICD-10-CM Coding Manual
● Selection of Principal Diagnosis ● Reporting Additional Diagnoses Unit 3: Introduction to ICD-10-PCS
● ICD-10-PCS Coding Conventions
● ICD-10-PCS Code Structure, Index, and Tables ● ICD-10-PCS Medical Surgical Section
November,
Unit 4: Introduction to CPT Coding
● CPT Coding Manual- tour through the manual ● Evaluation and Management- Guidelines
● Evaluation and Management Categories and Subcategories ● Key Components of an Evaluation and Management Code ● How to Select an Evaluation and Management Code Level ● Surgical Coding Guidelines
● Surgical Packages
● How to Look Up a CPT Code
● Pathology & Laboratory: Laboratory Panels, Surgical Pathology, Laboratory Tests ● Introduction to Healthcare Common Procedure Coding System (HCPCS)
Unit 5: Medical Reimbursement
● Review of the Medical Reimbursement Process ● CMS 1500 and UB-04 Reimbursement Forms
● Health Insurance Review of Process and Key Terms ● Medicare and Medicaid
● Reimbursement Methodologies ● Accountable Care Organizations
COLUMBUS STATE COMMUNITY COLLEGE
HEALTH INFORMATION MANAGEMENT TECHNOLOGY
HIMT 1274- Introduction to Medical Coding and Reimbursement UNITS OF INSTRUCTION AND COURSE SCHEDULE:
Week 1:
Unit of Instruction:
● What is medical coding?
● Careers in Health Information Management ● Coding Credentials
● Health Record as a Source Document ● ICD-9-CM and Legacy Data
Learning Objectives/Goals:
● Understand the purpose and function of medical coding
● Identify career paths in the field of Health Information Management
● Identify coding credential options available through the American Health Information ● Management Association and the Academy of Professional Coders
● Identify documents within a health record that are used as a basis for coding diagnoses ● and procedures
● Identify the fact that the U.S. is currently undertaking a transition from the ICD-9-CM ● code set to the ICD-10-CM/PCS code set
● Realize that legacy ICD-9-CM codes may be seen in health records processed prior to ● October 1, 2015.
Assignment(s):
*PRINT and READ the SYLLABUS
Step 1: Listen/View "What is medical coding?" Step 2: Careers in HIM- review linked material Step 3: Coding Credentials -review linked material Step 4: Listen/View Interview- Medical Coder
Step 5: The Health Record as a Source Document - review linked material Step 6: ICD-9-CM and Legacy Data -review linked material
Step 7: Post personal introduction to Discussion Board on Blackboard Assessment(s):
Activity Due
Discussion Board on Blackboard- Personal Introduction Week 2:
Unit of Instruction:
● ICD-10-CM Coding Conventions
● ICD-10-CM General Coding Guidelines
● ICD-1 0-CM Code Structure, Index, and Tabular List ● Navigating the ICD-10-CM Coding Manual
November,
Learning 0bjectives/Goals:
● Describe the code structure of an ICD-1 0-CM code. ● Identify the category characters of a ICD-1 0-CM code. ● Identify the the main term in a diagnosis statement
● Locate Alphabetical Index in the ICD-1 0-CM coding manual. ● Locate the Tabular List in the ICD-1 0-CM coding manual.
● Use the Alphabetical Index in the ICD-10-CM book to locate the correct tabular listing. ● Utilize the Tabular List in the ICD-10-CM book to identify diagnosis codes.
● Assign ICD-1 0-CM codes Assignment(s):
Step 1: Glossary of Terms- review and learn terms Step 2: Flashcards- practice memorizing glossary terms
Step 3: I CD-1 0-CM Coding Conventions - review linked material and assigned code book pages Step 4: Assignment ICD-1 0-CM Coding Conventions- complete and submit
Step 5: ICD-1 0-CM General Coding Guidelines - review linked material Step 6: Assignment ICD-10-CM Coding Guidelines- complete and submit
Step 7: ICD-1 0-CM Code Structure, Index, and Tabular List- review linked material Step 8: How to Navigate the ICD-10-CM Coding Manual- view/listen
Step 9: Assignment ICD-10-CM Coding Exercises Assessment(s):
Assignment: Coding Conventions Assignment: Coding Guidelines
Assignment: ICD~10-CM coding Exercises I
Week 3:
Unit of Instruction:
● Selection of ICD-10-CM Principal Diagnosis ● Reporting ICD-10-CM Additional Diagnoses Learning 0bjectives/Goals:
● Understand the considerations of symptoms, signs, and ill-defined conditions and their role when selecting a principal diagnosis in ICD-1 0-CM.
● Select a principal diagnosis when two or more interrelated conditions are present, each potentially meeting the definition of a principal diagnosis in ICD-1 0-CM.
● Select a principal diagnosis in ICD-1 0-CM after a planned treatment or procedure is not carried out during the patient visit. ● Select a principal diagnosis in ICD-1 0-CM when a condition is documented as "uncertain" in an inpatient setting.
● Define additional (secondary) diagnoses in ICD-10-CM.
● Identify when ICD-1 0-CM history codes may be used as additional diagnoses.
● State whether or not laboratory and other diagnostic results are coded as additional diagnoses in ICD-1 0-CM. Assignment(s):
Step 1: Selection of Principal Diagnosis - review linked material Step 2: Reporting Additional Diagnoses- review linked material Step 3: Assignment Selecting Principal Diagnosis
Step 4: TEST- Units 1 and 2: Introduction and ICD-10-CM Assessment(s):
TEST: Units 1 and 2 Week 4
Unit of Instruction:
● ICD-10-PCS Coding Conventions
● ICD-10-PCS Code Structure, Index, and Tables ● ICD-10-PCS Medical Surgical Section
● Navigating the ICD-10-PCS Coding Manual Learning Objectives/Goals:
● Describe the code structure of an ICD-10-PCS code.
● List what each character of a I CD-1 0-PCS code stands for.
● Identify the term a coder would use to look up a code given a procedural statement. ● Locate tables in the ICD-10-PCS coding manual.
● Use the Index in the ICD-10-PCS book to locate the correct table need to build a code. ● Utilize the tables in the ICD-10-PCS book to build procedure codes.
November,
● Assign ICD-10-PCS codes. Assignment(s):
Step 1: Glossary of 'Terms- review and learn
Step 2: Flashcards- practice memorizing glossary terms
Step 3: ICD-1 0-PCS Coding Conventions -review conventions in coding book Step 4: Assignment ICD-10-PCS Coding Conventions
Step 5: ICD-1 0-PCS Code Structure, Index, and Tables- review linked material Step 6: Assignment Building an ICD-10-PCS Code
Step 7: ICD-1 0-PCS Medical Surgical Section- review linked material Step 8: How to Navigate the ICD-10-PCS Coding Manual- view/listen Step 9: Assignment ICD-10-PCS Coding- complete and submit Step 10: Test: Unit 3: ICD-10-PCS
Week 5
Unit of Instruction:
● CPT Coding Manual- tour through the manual Learning Objectives/Goals:
● Learn key terms related to CPT -4 coding
● Understand the organization of the CPT -4 coding manual Assignment(s):
Step 1: Glossary of Terms- review and learn
Step 2: Flashcards- practice memorizing glossary terms Step 3: CPT Coding Manual Tour -listen/view
Week 6
Unit of Instruction:
● Evaluation and Management- Guidelines
● Evaluation and Management Categories and Subcategories ● Key Components of an Evaluation and Management Code ● How to Select an Evaluation and Management Code Level
Learning Objectives/Goals:
● Identify the category and subcategory levels of an E&M code ● Define a "new patient" in regards to E&M coding.
● Define the history of present illness.
● Identify the seven elements documented in the history of present illness. ● Define the review of systems.
● List the key components of an E&M level code. ● List the 4 types of history.
● List the 4 types of examination.
● List the 4 types of medical decision making.
● Identify services that are reported by using codes from the Evaluation and Management section of the CPT book. ● Identify the categories and subcategories included in the Evaluation and Management section of the CPT book. ● Locate instructional notes within the CPT book.
● Locate the instructions for a selecting a level of ElM service in the guidelines. ● Identify the 3 key components of an E&M code
● Locate Categories and subcategories of E&M codes that require documentation of the key components 13 ● List the 4 types of histories
● List the type of documentation found in the history ● List the 4 types of physical examinations
● List the 4 types of medical decision making
● Locate the instructions for selecting a level of E&M service in the E&M guidelines
● Cite the steps to assigning an E&M code that requires documentation of the key components ● Apply the "meet or exceeds" rule in selection of the correct level of E&M code.
Assignment(s):
Step 1: Evaluation and Management Guidelines - review linked material
Step 2: Evaluation and Management Categories and Subcategories- review linked material Step 3: Key Components of an Evaluation and Management Code -review linked material Step 4: How to Select an Evaluation and Management Code Level- review linked material Step 5: Worksheet for Selecting a Level of ElM Code - complete and submit answers in Step 6 Step 6: Assignment Selecting a Level of E/M Code- complete and submit
November, Week 7
Unit of Instruction:
● Surgical Coding Guidelines ● Surgical Packages
● How to Look Up a CPT Code
● Pathology & Laboratory: Laboratory Panels, Surgical Pathology, Laboratory Tests Learning Objectives/Goals:
● Locate the surgical guidelines in the CPT code book ● List the services included in CPT's surgical package. ● Define a "separate procedure".
● Define what is meant by surgical package ● List the components of CPT's surgical package ● List the components in Medicare's surgical package ● Locate codes in the body of the CPT book.
● Verify codes in the body of the CPT book
● Identify medical documents used to support CPT code assignment. ● List the four ways main terms are listed in the index. ·
● Recognize a range of code listed in the index of the CPT book ● Code laboratory panels.
● Code surgical pathology services provided.
● Identify what is meant by "the specimen is the unit of service" ● Look up and code common laboratory tests.
Assignment(s):
Step 1: Surgical Coding Guidelines- complete fill-in-the-blank lesson Step 2: Surgical Packages- review linked material
Step 3: How to Look Up a Code -review linked material Step 4: Assignment Practice Locating Codes in CPT
Step 5: Pathology & Laboratory: Laboratory Panels, Surgical Pathology, Laboratory Tests- review linked material Step 6: Assignment Practice Pathology and Laboratory Coding
Week 8
Unit of Instruction:
● Introduction to Healthcare Common Procedure Coding System (HCPCS) Learning Objectives/Goals:
● Write what HCPCS stands for. ● List the two levels of HCPCS codes.
● Explain how to use the HCPCS (National) Coding Manual. ● Note how the term HCPCS is used in every day practice. Assignment(s):
Step 1: Introduction to HCPCS -review linked material Step 2: Take Unit 4 Test: CPT Coding
Assessment(s):
TEST: Unit 4: CPT Coding I July 19, 2015 Week 9
Unit of Instruction:
● Review of the Medical Reimbursement Process ● CMS 1500 and UB-04 Reimbursement Forms
● Health Insurance Review of Process and Key Terms ● Medicare and Medicaid
Learning Objectives/Goals:
● Define what the CMS 1500 form is.
● State who uses the CMS 1500 to bill for services. ● Define 837P (professional).
● Identify what type(s) of medical codes are reported on the CMS 1500. ● Define what the UB04 form is.
● State who uses the UB04 form to bill for services. ● Define 8371 (Institutional).
November,
● Identify what type(s) of medical codes are reported on the UB04. ● Define the following terms:
o Affordable Care Act o Obamacare ·
o premium o Co pay o Coinsurance o Deductible
o Out of Pocket Maximum o formulary
o provider network
● Describe a situation where the patient might not have a choice but to go out of network for a service he/she needs. ● Define the following terms: Describe how an HMO, PPO and EPO differ from one another. Primary care physician in
network out of network
● Cite the advantages and disadvantages of a fee for service plan. ● Describe the main components of a fee for service plan.
● Describe a point of service plan
● Cite the names used to refer to the Patient Protection and Affordable Care Act. ● Discuss reasons what the Affordable care Act passed?
● Cite aspects of healthcare coverage stayed the same under the Affordable Care Act. ● Cite aspects of health care coverage that changed as a result of the Affordable Care Act. ● Define the health insurance market place.
● List the type of care is covered by all healthcare plans as a provision of the Affordable Care Act. ● Define a Health Saving Account.
● Cite the advantages of a health saving account.
● Cite the main components of a health savings account. ● State when the Medicare and Medicaid was created. ● State the population covered by Medicare.
● State the population covered by Medicaid. ● State who funds Medicare.
● State who funds Medicaid.
● State the type of coverage provided by Medicare part A, Part B, Part C and Part D. ● Define the purpose of the supplemental policy.
Assignment(s):
Step 1: Watch "The Medical Reimbursement Process" Step 2: Glossary of Terms- review and learn
Step 3: Flashcards - practice memorizing glossary terms Step 4: CMS 1500 at a glance- review linked material Step 5: UB-04 Overview - review linked material Step 6: Health Insurance- review linked material
Step 7: Medicare and Medicaid - review linked material Week 10: July 27- August 2, 2015
Unit of Instruction:
● Reimbursement Methodologies ● Accountable Care Organizations Learning Objectives/Goals:
● State the reimbursement methodology used for each of the types of payment systems. ● State the code set(s) use for each reimbursement methodology (i.e. MS-DRG, APC,RBRVS) ● Describe the MS-DRG (Medicare Severity Diagnosis Related Groups)system.
● State what MS-DRG stands for.
● Describe APCs (Ambulatory Payment Classifications). ● State what APC stands for.
● Describe RBRVS (Resource based relative value Scale). ● State what RBRVS stands for.
● Cite the components that are used to determine the RBRVS payments. ● Determine what MS-DRGs, APCs and RBRVS have in common
● Describe what is meant by an accountable care organization.
● Name the legislative act that created accountable care organizations. ● Define the term patient centered medical home.
Assignment(s):
Step 1: Reimbursement Methodologies -review linked material Step 2: Accountable Care Organizations- review linked material Step 3: Assignment Medical Reimbursement
November,
Step 4: Take Unit 5 Test: Medical Reimbursement Assessment(s):
Assignment: Medical Reimbursement TEST
