Description:

Upon successful completion of this course, the student will develop medical transcription skills with emphasis on additional speed and accuracy. Students will apply language skills, decision-making skills and "common- sense" skills during the transcription process. Students will become familiar with the medical transcription profession, employment opportunities, the important role of the medical transcriptionist in the health care team, and personal attributes, knowledge and skills required to produce error-free documents according to the employer's and AAMT standards. 3 hrs. lecture/wk.

Supplies: Refer to the instructor's course syllabus for details about any supplies that may be required.

Textbook(s): For information see - http://bookstore.jccc.net

Course Fees: NONE

Course Objectives:

Upon successful completion of this course the student should be able to:

1. Define and use the proper medical insurance terms, concepts and acronyms.
2. Describe the medical billing process.
3. Identify and code accurately diagnoses using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding system.
4. Identify and code accurately professional services properly using the Current Procedural Terminology (CPT) code book.
5. Understand the importance of accurate coding and legal considerations.
6. Develop familiarity with the HCFA 1500 claim form.
7. Develop familiarity with numerous medical insurance programs and plans including
8. Medicare, Medicaid, Blue Shield, TriCare and Worker’s Compensation.
9. Develop an understanding of evolution of healthcare and development of managed care plans.

Content Outline & Competencies:

I. Introduction to Medical Insurance
   A. Discuss the medical billing process.
   B. Describe tasks and responsibilities of medical office insurance
staff.
   C. Discuss employment opportunities in medical billing field.
   D. Explain the necessity of standardization of procedural terminology
and the development of a procedural coding system.

II. Terminology
   A. Define and apply terms and concepts which apply to medical billing
and coding.
   B. Demonstrate use of basic insurance claim processing terms including
deductible, allowable and coinsurance.
   C. List and describe the methods of insurance reimbursement.

III. Diagnostic Coding
   A. Explain the purpose of coding diagnoses on insurance claim forms.
   B. List and apply the basic steps in coding diagnoses using the ICD-9
coding system.
   C. Identify and use the special terms, marks, abbreviations and symbols
used in the ICD-9 coding system.
   D. Code diagnoses using the ICD-9-CM coding system.

IV. Procedural Coding
   A. Explain the basic format of the CPT-4 system.
   B. List and apply the basic steps for coding procedures and services.
   C. Identify CPT modifiers and explain their significance.
   D. Explain the use of guidelines and symbols.
   E. Code procedures using the CPT-4 system.

V. Life Cycle of an Insurance Claim
   A. Describe the life cycle of an insurance claim.
   B. Define terms and phrases relating to an insurance claim.

VI. HCFA-1500 Claim Form
   A. Discuss general billing guidelines and instructions.
   B. Explain optical scanning guidelines and their importance.
   C. Discuss claim errors that delay processing.
   D. Discuss reporting restrictions and guidelines of items reported on
line 24 of HCFA-1500 claim form.
   E. Complete commercial primary insurance claim form.

VII. Managed Care
   A. Define managed care and discuss its evolution.
   B. List and describe managed care models.
   C. Discuss NCQA accreditation.

VIII. Blue Cross and Blue Shield Plans
   A. Discuss the history of Blue Cross and Blue Shield (BCBS) programs.
   B. List distinctive features that make the BCBS plans different from
other plans.
   C. Compare and contrast the advantages of being a BCBS participating
provider versus being a non-participating provider.
   D. Explain how claims for nationwide accounts are handled.
   E. Introduce both BCBS of Kansas and BCBS of Kansas City and describe
information that can be gained from each plan’s website including
patient eligibility and claim status.
   F. List types and names of BCBS plans available in Kansas City area.

IX. Medicare
   A. List and discuss the categories of persons eligible for Medicare
coverage.
   B. List and describe incentives developed by Congress to encourage
providers to participate with Medicare.
   C. Discuss the differences between Part A and Part B Medicare.
   D. Explain the billing sequence for Medicare patients with
employer-sponsored plans, Medigap, Medicare-Medicaid Crossover Plan, and
Medicare as secondary coverage.
   E. Discuss the provider’s legal responsibility for collecting the
patient’s deductible and coinsurance obligations.
   F. Discuss Advanced Beneficiary Notices.
   G. Discuss the role of Center for Medicare and Medicaid Services (CMS),
formerly known as HCFA.
   H. Describe the Resource-Based Relative Value Scale (BRVS).
   I. View and interpret a Medicare Explanation of Benefits form.
   J. Describe HCPCS codes and their use.
   K. List those medical conditions or circumstances where Medicare is not
the primary payer.
   L. View Medicare website.

X. Medicaid
   A. List persons eligible for Medicaid as stated in the federal
guidelines.
   B. Explain role of each state in determining eligibility and benefits.
   C. Discuss economic impact of Medicaid on each state.
   D. Contrast differences of claim filing requirements between Kansas and
Missouri.
   E. Complete a Medicaid claim form using Kansas Medicaid instructions.
   F. Discuss the importance of provider identification numbers.

XI. TriCare (CHAMPUS)
   A. List TriCare eligibility categories.
   B. Compare and contrast terminology used by TriCare to other insurance
plans.
   C. List the three levels of TriCare coverage.
   D. Discuss nonavailability statements.

XII. Worker’s Compensation
   A. Describe the correct billing procedures for worker’s compensation
cases.
   B. Discuss the First Report of Injury report.
   C. Discuss eligibility requirements for worker’s compensation
benefits.
   D. List classifications of on-the-job injuries.
   E. Discuss the enactment of the Occupational Safety and Health
Administration (OSHA) Act of 1970 and the use of Material Safety Data
Sheets (MSDS).

XIII. Legal and Regulatory Considerations
   A. Give examples and discuss breaches of confidentiality.
   B. State the importance of obtaining the patient’s signature for the
“Authorization for Release of Information.”
   C. List the components of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA).
   D. Outline the elements of a compliance program.
   E. Discuss HCFA’s Correct Coding Initiative (CCI).
   F. Describe bundling and unbundling.
   G. Discuss how to verify a legitimate telephone request for patient
information.
   H. Identify classification of patients not required to sign an
authorization to release
information.
   I. Compare and contrast fraud and abuse.

Methods of Evaluation of Competencies:

Evaluation of student mastery of course competencies will be accomplished using the following methods:

Exams (minimum of 3)            70% of grade
Case Studies                    15% of grade
Activities and Assignments      15% of grade
  TOTAL                        100%

   Grade Criteria:
   90 - 100% = A
   80 -  89% = B
   70 -  79% = C
   60 -  69% = D
    0 -  59% = F

Caveats: NONE

Disabilities:

If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.

JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.