Medical Coding and Billing

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Students will learn the fundamentals of medical coding and billing and are prepared to take the Certified Professional Coder (CPC) exam from the American Association of Professional Coders (AAPC). Program topics include medical terminology; anatomy and physiology; introduction to computer systems; computer applications in healthcare technologies; health information management systems; reimbursement cycle management process; insurance plans; health law; HIPAA; diagnostic and procedural coding; coding compliance and auditing; physician and hospital billing; Medicare, Medicaid, and TRICARE. Students receive training on ICD-10-CM/PCS, CPT, and HCPCS code assignment.

Program Purpose

Prepares student for national certification and have the technical skills needed to enter the healthcare industry as an entry-level medical coder/biller.

Learning Outcomes

• Outline the typical responsibilities of a medical biller/coder, describe the personal and professional ethics required for success in this profession, and describe the career opportunities available to appropriately trained personnel.
• Describe how to build a strong base of medical terminology and anatomy and physiology and use this knowledge to accurately identify and describe body planes, anatomical directions, and the major structures and functions of all body systems.
• Describe the purpose and impact of the Healthcare Portability and Accountability Act (HIPAA) and explain how professionals can learn about changes to the laws and regulations that affect them.
• Compare and contrast the major types of government and commercial insurance health plans, including Medicare, Medicaid, Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Point-of-Service (POS) plans.
• Explain the purpose of medical coding and accurately code diagnoses and procedures using industry-standard coding systems published by the World Health Organization (WHO) and the American Medical Association (AMA).
• Accurately assign ICD-10-CM/PCS, CPT, and HCPCS codes for diagnoses, procedures, and medical services as part of the insurance reimbursement process.
• Summarize the life cycle of a typical insurance claim and explain the processing steps that must be completed before claims and other forms can be submitted to the insurance company.
• Describe the typical billing guidelines for medical records.

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