This course gives medical assisting students advanced training in procedural and diagnostic coding and medical billing practices. Topics covered include ICD, HCPCS, and CPT coding and hospital and outpatient billing and coding procedures. NOTE: Students need to have entry codes to register. This class may include students from multiple sections.
Course Outcomes
Competencies/Objectives/Outcomes/Methods of Assessment/Assignment:
Medical Business Practices
VIII. Third Party Reimbursement
- VIII.P.1. Interpret information on an insurance card
- VIII.P.2. Verify eligibility for services
- VIII.P.3. Obtain precertification or preauthorization with documentation
- VIII.P.4. Complete an insurance claim form
- VIII.P.5. Assist a patient in understanding an Explanation of Benefits (EOB)
IX. Procedural and Diagnostic Coding
- IX.C.1. Identify the current procedural and diagnostic coding systems, including Healthcare Common Procedure Coding Systems II (HCPCS Level II) • IX.C.2. Identify the effects of:
a. upcoding
b. downcoding - IX.C.3. Define medical necessity
- IX.P.1. Perform procedural coding
- IX.P.2. Perform diagnostic coding
- IX.P.3. Utilize medical necessity guidelines
- A.7. Demonstrate tactfulness