Health Science Technology Education

21st Century Standards Profile

Health Science Technology Education

Course Title: Fundamentals of Medical Reimbursement WVEIS Code 0722

Student’s Name______

School______Instructor______

Course Description: Within this course, students will focus on policies and procedures necessary for medical reimbursement. Students will gain basic knowledge of the healthcare delivery systems and medical terminology. Additional components of this course include an introduction to Medical Office Coding, ICD-9-CM, CPT-4 Coding, CPT-4 Sections, and auditing process. Current technology will be utilized to master course standards. Students will utilize problem-solving techniques and participate in hands-on activities to develop an understanding of course concepts. Teachers will provide each student with real world learning opportunities and instruction related to healthcare. The West Virginia Standards for 21st Century Learning include the following components: 21st Century Content Standards and 21st Century Learning Skills and Technology Tools. All West Virginia teachers are responsible for classroom instruction that integrates learning skills, technology tools, and content standards and objectives. Students are encouraged to become active members of Health Occupations Students of America (HOSA), the Career and Technical Student Organization (CTSO) for Health Science Technology Education students.

Level of Competence:

· Above Mastery: The student demonstrates exceptional and exemplary performance with distinctive and sophisticated application of knowledge and skills that exceed standard. The student can independently solve problems and is self-directed.

· Mastery: The student demonstrates competent and proficient performance and shows a thorough and effective application of knowledge and skills that meet standard. Application of knowledge and skills is thorough and effective and the student can work independently.

· Partial Mastery: The student demonstrates basic but inconsistent performance of fundamental knowledge and skills characterized by errors and/or omissions. Performance needs further development and supervision.

Content Standards and Objectives / Above Mastery / Mastery / Partial Mastery / Date / Comments
Standard 1: Health Care Systems
Objectives / The student will
HSTE.O.FMR.1.1 / examine healthcare delivery system
(i.e. public, private, government, and
non-profit).
HSTE.O.FMR.1.2 / determine factors influencing
healthcare delivery systems.
HSTE.O.FMR.1.3 / articulate the impact of emerging
issues such as technology,
epidemiology, bioethics, and
socioeconomics on healthcare
delivery systems.
Standard 2: Medical Terminology
Objectives / The student will
HSTE.O.FMR.2.1 / interpret commonly used medical
roots, prefixes, and suffixes.
HSTE.O.FMR.2.2 / interpret commonly used
abbreviations.
HSTE.O.FMR.2.3 / implement standard medical terms
and abbreviations in written and oral
communications to interpret,
transcribe, and communicate
information, data, and observations.
Standard 3: Introduction to Medical Office Coding
Objectives / The student will
HSTE.O.FMR.3.1 / examine the evolution of medical
insurance in this country.
HSTE.O.FMR.3.2 / determine the significance of
diagnostic-related groups.
HSTE.O.FMR.3.3 / compare types of codes used in
healthcare.
HSTE.O.FMR.3.4 / examine documentation tools used in
the coding process.
HSTE.O.FMR.3.5 / demonstrate proper technique for
determining the physician’s
diagnosis.
Standard 4: ICD-90-CM Coding
Objectives / The student will
HSTE.O.FMR.4.1 / examine the ICD-9-CM code book
format.
HSTE.O.FMR.4.2 / determine symbols, punctuation, and
abbreviations used in ICD-9-CM
codes.
HSTE.O.FMR.4.3 / articulate steps for accurate coding from the ICD-9-CM code book.
HSTE.O.FMR.4.4 / examine the HCFA guideline for ICD-
9-CM coding.
HSTE.O.FMR.4.5 / distinguish the purpose for V codes
and E codes.
HSTE.O.FMR.4.6 / utilize Drug and Chemical Tables
found in the ICD-9-CM code book.
HSTE.O.FMR.4.7 / demonstrate the procedure for
coding special complexities.
Standard 5: CPT-4 Coding
Objectives / The student will
HSTE.O.FMR.5.1 / demonstrate the proper technique for
determining codeable procedures
and services.
HSTE.O.FMR.5.2 / characterize the CPT-4 code book
format.
HSTE.O.FMR.5.3 / distinguish the signs and symbols
used in the CPT-4 code book.
HSTE.O.FMR.5.4 / determine the use of modifiers to
CPT-4 codes.
HSTE.O.FMR.5.5 / compare starred, global, and unlisted
CPT-4 codes.
Standard 6: CPT-4 Sections
Objectives / The student will
HSTE.O.FMR.6.1 / apply the concepts of evaluation and
management coding.
HSTE.O.FMR.6.2 / apply the principle elements of
anesthesia coding.
HSTE.O.FMR.6.3 / apply the surgery coding guidelines.
HSTE.O.FMR.6.4 / determine types of pathology services and explain proper application of coding rules for each category of services.
HSTE.O.FMR.6.5 / articulate the proper coding
guidelines for each subsection of the
medicine services.
HSTE.O.FMR.6.6 / implement the rules and application
of modifiers to the coding process.
HSTE.O.FMR.6.7 / code a sample claim form.
Standard 7: Reimbursement and Auditing
Objectives / The student will
HSTE.O.FMR.7.1 / examine reimbursement methods.
HSTE.O.FMR.7.2 / articulate the purpose of third party
contracts and their effect on
coding.
HSTE.O.FMR.7.3 / determine the components for
payment calculations and
reimbursement calculations.
HSTE.O.FMR.7.4 / abstract information from the
patients’ medical records and
complete claim forms.
HSTE.O.FMR.7.5 / recognize internal and external
obstacles to accurate and timely
reimbursement.
HSTE.O.FMR.7.6 / relate the auditing process, including
the purpose of audits.
Standard 8: Technology
Objectives / The student will
HSTE.O.FMR.8.1 / implement the use of software and
hardware.
HSTE.O.FMR.8.2 / utilize the Internet as a resource/
research tool.
Standard 9: Career and Technical Student Organization
Objectives / The student will
HSTE.O.FMR.9.1 / participate in the local chapter of the
appropriate Career and Technical
Student Organization (CTSO).
HSTE.O.FMR.9.2 / use parliamentary procedures in
chapter meetings.
HSTE.O.FMR.9.3 / demonstrate team membership/
leadership and problem solving
skills.
HSTE.O.FMR.9.4 / participate in local, state, and
national projects impacting
healthcare and healthcare education.