SYLLABUS. Departmental Syllabus. Billing and Coding MEDA0180. Departmental Syllabus. Departmental Syllabus. Departmental Syllabus

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1 SYLLABUS DATE OF LAST REVIEW: 04/2014 CIP CODE: SEMESTER: COURSE TITLE: COURSE NUMBER: Billing and Coding MEDA0180 CREDIT HOURS: 3 INSTRUCTOR: OFFICE LOCATION: OFFICE HOURS: TELEPHONE: PRE-REQUISITE(S): KCKCC-issued accounts are the official means for electronically communicating with our students. None REQUIRED TEXT AND MATERIALS: Please check with the KCKCC-TEC bookstore, for the required text for your particular class. COURSE DESCRIPTION: This course introduces the student to the medical insurance system and related billing and coding. Students learn how to complete and submit electronic and paper insurance claim forms, perform referrals, and apply the correct procedure and diagnostic codes. METHOD OF INSTRUCTION: A variety of instructional methods may be used depending on content area. These include but are not limited to: lecture, multimedia, cooperative/collaborative learning, labs and demonstrations, projects and presentations, speeches, debates, panels, conferencing, performances, and learning experiences outside the classroom. Methodology will be selected to best meet student needs.

2 COURSE OUTLINE: I. Claim Forms A. Complete B. Guidelines C. Manually and electronic claims D. Data management E. Achieve maximum reimbursement II. Communication with providers, patients and payers A. Patient s level of understanding B. Responses from the patient C. Assertive communication D. Sensitivity E. Communicate in laymen s terms III. Procedure Coding A. Overview B. Upcoding C. Perform coding IV. Diagnostic Coding A. Overview B. Perform coding V. Healthcare Common Procedure Coding System (HCPCS) A. Overview B. Perform coding VI. Third party claims A. Guidelines B. Complete claim forms VII. Utilization Review A. Principles B. Benefits VIII. Referrals A. Precertification B. Preauthorization C. Referral process in a managed care IX. Models of Managed Care A. Identify models B. Implementation C. Eligibility verification D. Policies and procedures

3 X. Insurance Plans A. Types i. Government 1. Medicare/Medicaid 2. Military/Civilian Health and Medical Program of the Veteran s Administration (CHAMPVA) 3. Worker s Compensation ii. Private 1. Managed Care 2. Indemnity 3. Self-Insured B. Implementation C. Provider fee schedules D. Resource-Based Relative Value Scale (RBRVS) E. Diagnosis-related Groups (DRGs) EXPECTED LEARNING OUTCOMES: A. The student will be able to complete insurance claim forms. B. The student will be able to communicate with providers, patients and payers. C. The student will be able to apply the correct procedure code. D. The student will be able to apply the correct diagnostic code. E. The student will be able to apply the correct Heath Care Common Procedure Coding System (HCPCS). F. The student will be able to apply guidelines for third party claims. G. The student will be able to explain utilization review. H. The student will be able to perform referrals. I. The student will be able to summarize models of managed care. J. The student will be able to summarize types of insurance plans. COURSE COMPETENCIES: The student will be able to complete insurance claim forms. 1. The student will be able to complete insurance claims forms. 2. The student will be able to describe how guidelines are used in processing an insurance claim. 3. The student will be able to compare processes for filing insurance claims both manually and electronically. 4. The student will be able to work with provider to achieve maximum reimbursement.

4 The student will be able to communicate with providers, patients and payers. 5. Demonstrate empathy in communicating with patients, family, and staff 6. Explain both billing and payment options 7. The student will be able to recognize the patient s level of understanding in communications. 8. The student will be able to look for appropriate responses from the patient. 9. The student will be able to demonstrate assertive communication with managed care and/or insurance providers. 10. The student will be able to demonstrate sensitivity in communication with both providers and patients. 11. The student will be able to communicate in language the patient can understand regarding managed care and insurance plans. The student will be able to apply the correct procedure code. 12. The student will be able to describe how to use the most current procedural coding system. 13. The student will be able to define upcoding and why it should be avoided. 14. The student will be able to perform Procedural coding. The student will be able to apply the correct diagnostic code. 15. The student will be able to describe how to use the most current diagnostic coding classification system. 16. The student will be able to perform diagnostic coding. The student will be able to apply the correct HealthCare Common Procedure Coding System (HCPCS). 17. The student will be able to use the current HCPCS coding system. 18. The student will be able to perform HCPCS coding. The student will be able to apply guidelines for third party claims. 19. The student will be able to describe guidelines for third party claims. 20. The student will be able to apply third party guidelines. 21. The student will be able to complete third party claim forms. The student will be able to explain utilization review. 22. The student will be able to discuss utilization review principles. 23. The student will be able to explain how it benefits the organization and the patient. The student will be able to perform referrals. 24. The student will be able to complete precertification, including documentation. 25. The student will be able to complete preauthorization, including documentation. 26. The student will be able to discuss referral process for patients in a managed care program. The student will be able to summarize models of managed care. 27. The student will be able to identify models of managed care. 28. The student will be able to describe procedures for implementing managed care. 29. The student will be able to verify eligibility for managed care services. 30. The student will be able to apply both managed care policies and procedures.

5 The student will be able to summarize types of insurance plans. 31. The student will be able to identify different insurance models. 32. The student will be able to identify types of insurance plans. 33. The student will be able to discuss workers compensation as it applied to patients. 34. The student will be able to describe procedures for implementing both managed care and insurance plans. 35. The student will be able to discuss types of physicians fee schedules. 36. The student will be able to describe the concept of Resource-Based Relative Value Scales (RBRVS). 37. The student will be able to define Diagnosis-related Groups (DRGs). ASSESSMENT OF LEARNER OUTCOMES: Assessment methods include, but may not be limited to: written tests, simulations, homework assignments, attendance and observation of professional behavior. SPECIAL NOTES: This syllabus is subject to change at the discretion of the instructor. Material included is intended to provide an outline of the course and rules that the instructor will adhere to in evaluating the student s progress. However, this syllabus is not intended to be a legal contract. Questions regarding the syllabus are welcome any time. Kansas City Kansas Community College is committed to an appreciation of diversity with respect for the differences among the diverse groups comprising our students, faculty, and staff that is free of bigotry and discrimination. Kansas City Kansas Community College is committed to providing a multicultural education and environment that reflects and respects diversity and that seeks to increase understanding. Kansas City Kansas Community College offers equal educational opportunity to all students as well as serving as an equal opportunity employer for all personnel. Various laws, including Title IX of the Educational Amendments of 1972, require the college s policy on non-discrimination be administered without regard to race, color, age, sex, religion, national origin, physical handicap, or veteran status and that such policy be made known. All enrolled students at Kansas City Kansas Community College are subject to follow all rules, conditions, policies and procedures as described in both the Student Code of Conduct as well as the Student Handbook. All Students are expected to review both of these documents and to understand their responsibilities with regard to academic conduct and policies. The Student Code of Conduct and the Student Handbook can be found on the KCKCC website. Kansas City Kansas Community College complies with the Americans with Disabilities Act. If you need accommodations due to a documented disability, please contact the disabilities services office at (913)

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