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Official Course Description:
MCCCD Approval: 12-11-2007 |
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HCE227
2008 Spring – 2011 Summer
II |
L+L
3.0 Credit(s) 3.0 Period(s) 3.0 Load Occ |
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Insurance,
Billing and Coding |
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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: Acceptance into the
Medical Assisting or Medical Front Office program, or permission of Program
Director. Corequisites: HCC130 and (HCC145, or HCC145AA,
HCC145AB, and HCC145AC), or permission of Program Director. |
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Go to Competencies Go to Outline
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MCCCD
Official Course Competencies: |
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HCE227 2008
Spring – 2011 Summer II |
Insurance, Billing and Coding |
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1.
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Describe the important federal, state, and private health
insurance plans. (I) |
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2.
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Discuss legal issues affecting insurance claims and
medical records. (II) |
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3.
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Describe ethics as applied to insurance, coding and
billing. (III) |
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4.
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Explain the purpose of coding for professional services.
(IV, V) |
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5.
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Apply principles in diagnostic coding in a simulated
exercise. (V) |
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6.
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Apply principles of procedural coding in simulated
exercises. (IV) |
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7.
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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) |
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8.
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Use a manual bookkeeping system in simulated exercises.
(VII) |
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9.
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Explain accounting and banking procedures. (VIII) |
Go to Description Go to top of
Competencies
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MCCCD
Official Course Outline: |
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HCE227 2008
Spring – 2011 Summer II |
Insurance, Billing and Coding |
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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 |
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