Course

Objective:

Learning Outcomes:

• Discuss the concept of managed care, managed care models, and the benefits of consumer-directed health plans.
• Demonstrate accurate assignment of codes in the HCPCS Level II code book.
• Discuss the importance of pharmacology in medical coding and the dangers of cloning medication lists.
• Demonstrate accurate application of coding guidelines and instructions to assign valid codes from the CPT code book.
• Summarize clinical documentation improvement (CDI) processes to ensure the accuracy and completeness of medical codes, the importance of coding for medical necessity, the benefits of a coding audit, and the use of an Encoder.
• Discuss data entry requirements for the CMS-1500 and UB-04 claim forms.
• Discuss the Blue Cross Blue Shield features that distinguish it from other health insurance companies and the data entry requirements for completing a Blue Shield claim.
• Explain the job responsibilities, work environment, qualifications, and benefits of certification for the field of medical billing and coding.
• Discuss commercial and government-sponsored health insurance, the terms and concepts related to health insurance, the importance of patient records in healthcare coding and reimbursement, and the features of the electronic health record (EHR).
• Discuss the concept of managed care, managed care models, and the benefits of consumer-directed health plans.
• Discuss federal laws/agencies/publications that affect healthcare (including the impact of the HIPAA Privacy and Security rules), fraud and abuse in medical billing, and the proper release of protected health information (PHI).
• Demonstrate accurate application of coding guidelines and conventions to assign valid codes from the ICD-10-CM code book.
• Demonstrate accurate assignment of codes in the HCPCS Level II code book.
• Explain commercial health insurance and the data entry requirements for completing a commercial insurance claim.
• Discuss the Blue Cross Blue Shield features that distinguish it from other health insurance companies and the data entry requirements for completing a Blue Shield claim.
• Discuss the Blue Cross Blue Shield features that distinguish it from other health insurance companies and the data entry requirements for completing a Blue Shield claim.
• Discuss effective study strategies for preparing for medical billing and coding certification exams.
• Summarize techniques and best practices for obtaining a job in medical billing and coding.

General Topics: