EASTERN ARIZONA COLLEGE
Professional Practice in Coding and Billing
Course Design2014-2015
Course Information
Division Allied Health
Course Number HCE 216
Title Professional Practice in Coding and Billing
Credits 3
Developed by Dr. Stephen Cullen/Patricia A. Burke
Lecture/Lab Ratio 0 Lecture/6 Lab
Transfer Status ASU NAU UA
Pending Evaluation Pending Evaluation Pending Evaluation
Activity Course No
CIP Code 51.0700
Assessment Mode Portfolio
Semester Taught Upon Request
GE Category None
Separate Lab No
Awareness Course No
Intensive Writing Course No
Prerequisites
Prior or concurrent enrollment in HCE 214 required
Educational Value
This course is designed for students aspiring to enter the field of medical coding and billing.
Description
Designed to provide for student attainment of the entry-level competencies for medical coding and billing. Placement in a clinic, physician office, hospital, managed care organization, private billing, or insurance company setting is required for a minimum of 90 hours. In an actual work situation, students will perform both medical coding and billing competencies.
Supplies
Notebook Pen/Pencil
Competencies and Performance Standards
1. Recognize the role and responsibilities of an Insurance Specialist. Learning objectives
What you will learn as you master the competency:
a. Compare and contrast between medical etiquette and medical ethics. b. Outline Health Insurance Portability and Accountability.
c. Describe the Privacy Rule Confidentiality and Protected Health Information. d. List the seven basic components of a compliance plan.
Performance Standards
Competence will be demonstrated:
o through assigned activities
o through assignments identified by the instructor o through written exams
Performance will be satisfactory when:
o learner compares and contrasts between medical etiquette and medical ethics o learner outlines Health Insurance Portability and Accountability
o learner describes the Privacy Rule Confidentiality and Protected Health Information o learner lists the seven basic components of a compliance plan
2. Identify basics of health insurance. Learning objectives
What you will learn as you master the competency:
a. Describe the different type of health insurance coverage. b. Outline the documentation process.
c. List the principals of general principles of health record documentation. d. Reason for the development use of diagnostic codes.
e. List the rules for coding.
f. Define electronic data interchange.
g. Outlining the steps when receiving a payment or resolving insurance problems. h. Recite the stages of insurance collection.
Performance Standards
Competence will be demonstrated:
o through assigned activities
o through assignments identified by the instructor o through written exams
Performance will be satisfactory when:
o learner describes the different types of health insurance coverage o learner outlines the documentation process
o learner lists the principles of general principles of health record documentation o learner identifies the reason for the development use of diagnostic codes o learner lists the rules for coding
o learner defines electronic data interchange
o learner outlines the steps when receiving a payment or resolving insurance problems o learner recites the stages of insurance collection
3. Recognize health care payers. Learning objectives
What you will learn as you master the competency:
a. Describe the difference between Blue Plan, Private Insurance, and Managed Care Plans.
b. Identify the difference between Medicare and Medicaid.
c. Explain the structure of network-based managed care health insurance programs. d. Identify the TRICARE Program.
e. Explain the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA).
f. Identifies the laws and insurance coverage for Worker’s Compensation.
g. Explain how to process Disability Income Insurance and Disability Benefit Programs.
Performance Standards
Competence will be demonstrated:
o through assigned activities
o through assignments identified by the instructor o through written exams
Performance will be satisfactory when:
o learner describes the difference between Blue Plan, Private Insurance, and Managed Care Plans.
o learner identifies the difference between Medicare and Medicaid.
o learner explains the structure of network-based managed care health insurance programs.
o learner identifies the TRICARE Program.
o learner explains the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA).
o learner identifies the laws and insurance coverage for Worker’s Compensation. o learner explains how to process Disability Income Insurance and Disability Benefit
Programs.
4. Identifies the difference between Inpatient and Outpatient Billing. Learning objectives
What you will learn as you master the competency:
a. Define Inpatient Billing. b. Define Outpatient Billing.
c. Outline admissions procedures and major insurance programs. d. Define Inpatient ICD-9-CM Volume 3 Procedures.
e. Define Inpatient ICD-10-CM Volume 3 Tabular List. f. Define Outpatient Level I CPT coding System.
g. Define HCPCS Level II Medicare National Coding.
Performance Standards
Competence will be demonstrated:
o through assigned activities o through written exams
o through participation in class activities and discussions
Performance will be satisfactory when:
o learner defines inpatient billing o learner defines outpatient billing
o learner outlines admissions procedures and major insurance programs o learner defines inpatient ICD-9-CM Volume 3 Procedures
o learner defines Inpatient ICD-10-CM Volume 3 Tabular List o learner defines Outpatient Level I CPT Coding System o learner defines HCPCS Level II Medicare National Coding
5. Develop job seeking strategies and professional advancement. Learning objectives
What you will learn as you master the competency:
a. Outline ways to conduct on-line employment searches. b. Discuss elements of resumes.
c. Discuss elements of letters of recommendations. d. Discuss elements of letter of introduction.
e. Discuss elements of giving an effective interview. f. Discuss self-employment opportunities.
Performance Standards
Competence will be demonstrated:
o through assigned activities
o through participation in class activities and discussions o through written exams
Performance will be satisfactory when:
o learner outlines ways to conduct online employment searches o learner discusses elements of resumes
o learner discusses elements of letters of recommendations o learner discusses elements of letter of introduction
o learner discusses elements of giving an effective interview o learner discusses self-employment opportunities
Types of Instruction
Grading Information Grading Rationale
Skill performance of each competency will be assessed. Students must pass all critical criteria.
Grading Scale
