Course Title: Introduction to Health Insurance & Diagnostic Coding

KADUCEUS

COURSE SYLLABUS

COURSE NUMBER: Kaduceus Medical Billing and Coding 1 (MBC1) -- Coursework 101

COURSE TITLE: INTRODUCTION TO HEALTH INSURANCE & DIAGNOSTIC CODING

INSTRUCTOR: CONCEPCION (CONNIE) GARZA FALL 2012

Phone: (956) 254-5300 Ext. 1078

Instructor E-mail: Conference Hours: 1:10 – 2:00 pm

INSTRUCTOR’S CLASS SCHEDULE AND ROOMS:

1ST PERIOD: CP1 and CP 2 - Room 313

2ND PERIOD: Medical Billing and Coding - Room 313

3RD PERIOD: Medical Billing and Coding - Room 313

Lunch

4TH PERIOD: Conference Period – RM 313 and Quad Area Workroom

5TH PERIOD: Off Campus

COURSE PREREQUISITE(S):

Medical Terminology, Algebra I AND English I

ACADEMIC CLOCK HOURS:

Total clock hours: 30 (15 lecture hours; 15 lab hours)

COURSE DESCRIPTION:

This course introduces students to the history of health insurance. Students will also be introduced to the conception and development of diagnostic coding. Upon successful completion the student will be able to explain the role of a medical biller and coder.

INSTRUCTIONAL MATERIALS AND REFERENCES:

1)  Understanding Health Insurance, Ninth edition, Michelle A. Green, and JoAnn C. Rowell, 2008 Delmar, Cengage Learning & Accompanying Software: StudyWare

2)  Kaduceus Student Manual, 2008 Kaduceus Inc.

3)  Website: www.kaduceusinc.com

4)  Computerized Medical Office, Cindy Correa, 2005 Thompson Delmar & Accompanying Software: Medical Office Simulation Software (MOSS)

5)  International Classification of Diseases with Clinical Modifications (ICD-9-CM) with HCPCS, 2008 American Medical Association

TEACHING STRATEGIES:

May include any or all of the following: Lecture, lab activity, worksheet exercises, computer exercises that may include use of the internet/search engines, group discussion, critical thinking assignments, certification exam practice questions, weekly examinations, group project, simulations and oral presentations.

TOPICAL OUTLINE:

Lesson 1 Introduction to Health Insurance

Lesson 2 Development of an Insurance Claim

Lesson 3 Introduction to ICD-9-CM Coding

Computerized Medical Office (CMO) & Medical Office Simulation Software (MOSS)

Unit 1 Introduction to Computers

Unit 2 Medical Practice Management Software

Unit 3 Basic Management Concepts for Medical Administrative Staff

LEARNING OBJECTIVES:

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

Los Fresnos High School does not discriminate on the basis of gender, race, color, national origin, religion, age or disability in provision of services, programs or activities.

·  Define key terms

·  State the difference between medical care and health care.

·  Differentiate among automobile, disability, and liability insurance.

·  Discuss the history of health care reimbursement from 1860-present.

·  Identify and explain the impact of significant events in the history of health care reimbursement.

·  Interpret health insurance coverage statistics.

·  Facilitate the registration and insurance claims process for a new or established patient.

·  Discuss the development and life cycle of an insurance claim.

·  Determine insurance coverage when a patient has more than one policy or a child is covered by both parents.

·  Differentiate between manual and electronic claims processing procedures.

·  Detail the processing of a claim by an insurance company.

·  Interpret information on a remittance advice.

·  Maintain a medical practice’s insurance claim files.

·  Identify problems that result in delinquent claims, and resolve those problems.

·  Explain the purpose of reporting diagnosis codes on insurance claims.

·  Identify and properly use ICD-9-CM’s Coding conventions.

·  Use of ICD-9-CM reference book.

·  Identify types of c computers common in medical environments

·  Identify components of a personal computer

·  Explain the data processing cycle and how it applies to computer tasks

·  Differentiate between software and hardware

·  Discuss common software used in the medical workplace and its function(s)

·  Identify common hardware devices and their function(s)

·  Demonstrate basic skills for using Microsoft Windows

·  Explain how to manage files in a Windows environment

·  Discuss the eight basic components of a medical practice management software application and their functions

·  Explain the advantages and disadvantages of computerization in the medical office

·  Understand the Health insurance Portability and Accountability Act (HIPAA) regarding privacy of electronic records

·  Demonstrate the logon procedure and navigation of Delmar Cengage Learning’s Medical Office Simulation Software (MOSS)

·  Demonstrate proper input of data using MOSS.

Important Class Information:

Attendance/Tardy Policy-Students are required to attend class everyday (See Student Handbook). Students are considered and counted ABSENT after 20 minutes of class instructional time.

Grading Policy – A midterm and semester exam will be given in this class. Grades will be calculated according to district policy (See Student Handbook).

Students are aware of the following:

Your success in this program consists of several components.

·  50% of your grade is met through your participation and work assignment.

·  The other 50% consists of all classroom instruction, projects, major & daily work as well as classroom instruction.

1.  You MUST retain employment.

2.  Student will be required to keep a personal portfolio.

·  Students are subject for removal of the program under the following conditions:

1.  should they quit without a proper two week notice,

2.  have employment terminated,

3.  Do not meet the minimal hours needed throughout the workweek (15 – 20 hours per week).

4.  Additionally, should any student not find another job site within 10 days of termination; they are also subject for immediate removal.

5.  Student cannot exceed THREE discipline referrals.

6.  Serious infractions are subject to immediate removal.

Assignments:

Make-up Work – Students are responsible for any notes, class assignments and tests missed due to an absence or tardy. Students must make arrangements with teacher to make-up missed work on the day he/she returns to school. Work assigned prior to an absence is due when the student returns; otherwise, the assignment is considered late (See Student Handbook).

Late Work – A one-day limit will be allowed for late assignments. There will be up to a 30% penalty for the first day assignment is late (See Student Handbook)

Class Rules:

·  Be on time & come prepared

·  RESPECT! Teacher, students & property

·  No talking or getting up while lecturing

·  Do not roll around the classroom in chairs

·  Do not sit or place feet on top of counters

·  Keep your desk area clean

·  Appropriate CDs are allowed with headphones only

(While teacher is not lecturing & DO NOT BRING CD PLAYERS!)

·  Check your computer before/after class.

(Changes must be reported so you will not be blamed)

·  Food and drinks are NOT allowed

·  Students are dismissed by the teacher-not the bell.

·  Bullying of any kind will not be tolerated!

Electronic Devices In Class Policy

Cellular phones, pagers, CD players, radios, and similar devices are prohibited in the classroom. Calculators and computers are prohibited during examinations and quizzes, unless specified. Reasonable laptop-size computers may be used in lecture for the purpose of taking notes.

Consequences:

1st time – warning

2nd time - morning or lunch detention

3rd time – parent conference

4th time – office referral

***Serious infractions will result in automatic office referral. Bullying of any kind will not be tolerated!

***Computer hacking and/or damaging computer equipment will also result in automatic office referral.

Tutorial

Monday – Friday 8:00 – 8:20 am and by appointment

REMINDER: DRUG DETECTION DOGS ARE PRESENT ON CAMPUS.

Materials needed for class

Folder

Paper

Pen & Pencil

Acknowledgement of Receipt of

Medical Billing and Coding 1 - Syllabus

Coursework 101

I, ______(Print your name), acknowledge that I have received the syllabus for Coursework 101 - MBC1 - Introduction to Medical Health Insurance & Diagnostic Coding and that my instructor has reviewed it with me.

______

Student Signature Date

NCCT Code of Ethics

All candidates agree to abide by the following Code of Ethics as NCCT professionals:

·  I shall strive to remain current in my knowledge and skills by participating in continuing education activities within my professional discipline.

·  I shall solve problems that are within my capabilities and will display the wisdom to seek help when they are beyond my skills or abilities.

·  I shall adhere to all safeguards in the workplace, for the health and well being of those I serve, as well as my own.

·  I shall be honest in the performance of my role responsibilities and in all professional

interactions with others. If I make mistakes, I will own up to them and work to make them right.

·  I shall respect and obey the law, and all regulations within the law, that serve to protect the public in connection to matters of practice related to my professional responsibilities.

·  I shall protect the confidences and privacy of those who use my services within the

constraints of the law and the obligations of my profession and workplace.

In making this pledge, I agree to uphold the high standards of professional behavior at all times in the role as a Nationally Certified Insurance Coding Specialist (NCICS), as certified by NCCT.

______

Student Signature Date

INSTRUCTOR: Ms. Concepcion (Connie) Garza

PHONE: (956) 254-5300 Ext. 1078

E-MAIL:

Dear Parents,

I am happy to have your child as a student this year. It is my goal to prepare him/her for the academic challenges they will face in the future. In order to maximize learning time in my class, it will be necessary to have the cooperation of all my students. Therefore, I have issued each student a class syllabus that contains vital information regarding my Kaduceus Medical Billing and Coding class. Although I have reviewed my policies with your child during class, I am requesting that you take some time to review it as well so that you are aware of what I expect of your child.

Should you have any questions, concerns, or comments please feel free to call me or send me a note. Please detach the bottom stub and have your child return it to me.

Sincerely,

Connie Garza

Concepcion (Connie) Garza

CTE/CO-OP Teacher-Coordinator

BPA Sponsor

Date ______

I have read the above information and understand the guidelines for the course.

My child understands fully that he/her is responsible for complying with the class

Rules, abiding by the homework and makeup work policy, and bringing all materials to work daily.

Student (Please Print) ______Date______

Parent’s Name (Please Print) ______

Signature of Parent ______Date______

Home Phone ______Work Phone______

Cell Phone ______

Email: ______

Los Fresnos High School does not discriminate on the basis of gender, race, color, national origin, religion, age or disability in provision of services, programs or activities.