Health Information Management

Cognitive:

1. Describe how to use the most current procedural coding system
2. Define upcoding and why is should be avoided.
3. Describe how to use the most current diagnostic coding classification system.
4. Describe how to use the most current HCPCS coding.
5. Explain both billing and payment options.
6. Identify procedures for preparing patient accounts.
7. Describe the impact of both the Fair Debt Collection Act and the Federal Truth in lending Act of 1968 as they apply to collections.
8. Discuss types of adjustments that may be made to a patient account.
9. Discuss principles of Electronic Medical Record (EMR).

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1. Describe the implications of HIPAA for the medical assistant in various medical settings.

Psychomotor:

1. Perform procedural coding.
2. Perform diagnostic coding.
3. Apply both manage care policies and procedures.
4. Apply third party guidelines.
5. Complete insurance claims form.
6. Obtain precertification including documentation.
7. Obtain preauthorization, including documentation.
8. Verify eligibility for managed care services.
9. Utilize computerized office billing systems.

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1. Completing a Medicare CMS-1500 (08-05) Claim Form.

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1. Computing the Medicare Fee Schedule.

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1. Current Procedure Terminology Coding.

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1. International Classification of Diseases, 9th Revision, Clinical Modification Coding.

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1. Explaining Fees in the First Telephone Interview.

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1. Identify Accounts Receivable Using Medical Office Stimulation Software (MOSS).

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1. Preparing Itemized Patient Accounts for Billing Using Medical Office Simulation Software (MOSS).

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1. Post/Record Adjustments Using Medical Office Simulation Software (MOSS).

Affective:

1. Work with physician to achieve the maximum reimbursement.
2. Demonstrate sensitivity and professionalism in handling accounts receivable activities with clients.
3. Demonstrate assertive communication with managed care and/or insurance providers.
4. Demonstrate sensitivity with both providers and patients.

5. Communicate in language the patent can understand regarding managed care and insurance plans.

1. Students will demonstrate the ability to apply coding and/or billing practices in healthcare organization. 2. Students will demonstrate entry level workplace readiness by applying skills/competencies under the supervision of a qualified clinical preceptor in a healthcare organization. 3. Students will demonstrate working knowledge of coding conventions and guidelines in a clinical practice setting.

At the conclusion of this course the student will be able to: 1. Apply diagnosis/procedure codes according to current guidelines. 2. Evaluate the accuracy of diagnostic and procedural coding. 3. Apply diagnostic/procedural groupings. 4. Evaluate the accuracy of diagnostic/procedural groupings. 5. Utilize software applications such as encoders in the completion of Health Information Management processes. 6. Analyze current regulations and established guidelines in clinical classification systems. 7. Determine accuracy of computer assisted coding assignment and recommend corrective action. 8. Identify discrepancies between supporting documentation and coded data. 9. Develop appropriate physician queries to resolve data and coding discrepancies. 10. Comply with ethical standards of practice.