Maricopa Community Colleges  HCE227   20016-20076 
Official Course Description: MCCCD Approval: 04/24/01
HCE227 20016-20076 L+L 3 Credit(s) 3 Period(s)
Insurance, Billing and Coding
Application of insurance, coding and billing. Includes legal and ethical issues, federal, state and private insurance claims, procedural and diagnostic coding, and banking and accounting principles.
Prerequisites: None. Corequisites: HCC130, HCC145 or permission of program director.
Go to Competencies    Go to Outline
 
MCCCD Official Course Competencies:
 
HCE227   20016-20076 Insurance, Billing and Coding
1. Describe the important federal, state, and private health insurance plans. (I)
2. Discuss legal issues affecting insurance claims and medical records. (II)
3. Describe ethics as applied to insurance, coding and billing. (III)
4. Explain the purpose of coding for professional services. (IV, V)
5. Apply principles in diagnostic coding in a simulated exercise. (V)
6. Apply principles of procedural coding in simulated exercises. (IV)
7. Apply the steps in filing an insurance claim using the correct Current Procedural Terminology (CPT-4) and International Classification of Diseases (ICD-9) codes in simulated situations. (VI)
8. Use a manual bookkeeping system in simulated exercises. (VII)
9. Explain accounting and banking procedures. (VIII)
Go to Description    Go to top of Competencies
 
MCCCD Official Course Outline:
 
HCE227   20016-20076 Insurance, Billing and Coding
    I. Insurance Policies
        A. Federal
        B. State
        C. Private
        D. Choices
          1. Group
          2. Individual
          3. Prepayment, co-payment, and deductibles
      II. Legal Issues
          A. Subpoena of witness and records
          B. Types of insurance fraud and abuse
          C. Arbitration/appeals
          D. Forgery
          E. Medical professional liability prevention
          F. State Board of Medical Examiners and Insurance Commissioners
        III. Ethics for Insurance, Coding, and Billing
            A. Importance of insurance claim completion, coding and billing
            B. Current knowledge
          IV. Procedural Coding
              A. Purpose
              B. Terminology
              C. Evaluation and management of coding
                1. Complexity of examination
                2. Consultations
                3. Unlisted procedures
              D. Documentation of patient history
            V. Diagnostic Coding
                A. Purpose
                B. Terminology
                C. Major Diagnostic Criteria (MDC) and Modifiers
                D. Supplementary classifications
                  1. V codes
                  2. E codes
              VI. Filing an Insurance Claim
                  A. Health Insurance Claim Form (HCFA-1500)
                  B. Steps in filing
                  C. Conclusion of process
                VII. Manual Bookkeeping System
                    A. Day sheet
                    B. Charge slip
                    C. Receipt
                    D. Ledger
                      1. Peg board
                      2. Accounting data sheets
                    E. Petty cash
                  VIII. Accounting and Banking Procedures
                      A. Checkbook/banking
                      B. Collections
                  Go to Description    Go to top of Competencies    Go to top of Outline