Medical Assisting Administrative Procedures II

Medical Assisting Administrative Procedures IIWVEIS Code 0736

Within this course students will focus on policies and procedures necessary for medical reimbursement. Students will gain a working knowledge of the systems theory in health care. 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 are provided the opportunity to participate in a Career and Technical Student Organization (CTSO).

Standard 1:Health Care Systems (0736.S.1)

Students will describe and apply the systems theory to health care.

Health Care Systems Objectives

Students will:

0736.1.1Describe systems theory and its components.

0736.1.2Construct a general systems model using inputs, throughputs and feed back loops.

0736.1.3Explain the function of systems theory model.

0736.1.4Describe how systems theory relates to health care.

0736.1.5List the factors that affect the health care system and predict their influence.

0736.1.6Construct a systems model depicting the interdependence of health care professionals.

0736.1.7Analyze the cause and effect of change in the health care system based on the influence of:

technology, epidemiology, bio-ethics, socio-economics, and various forms of complimentary (non-traditional) medicine.

Standard 2:Medical Terminology (0736.S.2)

Students will understand basic medical terminology necessary to interpret and submit medical insurance claims.

Medical Terminology Objectives

Students will:

0736.2.1Interpret commonly used medical roots, prefixes and suffixes.

0736.2.2Interpret commonly used abbreviations.

0736.2.3Incorporate 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 (0736.S.3)

Students will discuss knowledge of medical office coding principles.

Medical Office Coding Objectives

Students will:

0736.3.1Describe the evolution of medical insurance in this country.

0736.3.2Explain the significance of diagnosis-related groups.

0736.3.3Define coding and discuss its origin and function.

0736.3.4Categorize the types of codes used in health care.

0736.3.5Examine and analyze the documentation tools used in the coding process.

0736.3.6Demonstrate the proper technique for determining the physician’s diagnosis.

Standard 4:ICD-9-CM Coding (0736.S.4)

Students will interpret and apply basic concepts for ICD-9-CM coding.

ICD-9-CM Coding Objectives

Students will:

0736.4.1Summarize the ICD-9-CM code book format.

0736.4.2Describe the symbols, punctuation, and abbreviations used in ICD-9-CM codes.

0736.4.3Discuss the steps for accurate coding from the ICD-9-CM code book.

0736.4.4Describe the HCFA guideline for ICD-9-CM coding.

0736.4.5Explain the purpose for V codes and E codes.

0736.4.6Use the Drug and Chemical Tables found in the ICD-9-CM code book.

0736.4.7Demonstrate the procedure for coding special complexities.

Standard 5:CPT-4 Coding (0736.S.5)

Students will interpret and apply basic concepts of CPT-4 coding.

CPT-4 Coding Objectives

Students will:

0736.5.1Demonstrate the proper technique for determining codeable procedures and services.

0736.5.2Summarize the CPT-4 code book format.

0736.5.3Identify and understand the signs and symbols used in the CPT-4 code book.

0736.5.4Discuss the use of modifiers to CPT-4 codes.

0736.5.5Compare starred, global, and unlisted CPT-4 codes.

Standard 6:CPT-4 Sections (0736.S.6)

Students will interpret and apply CPT-4 code sections.

CPT-4 Sections Objectives

Students will:

0736.6.1Apply the concepts of evaluation and management coding.

0736.6.2Understand and apply the principle elements of anesthesia coding.

0736.6.3Apply the surgery coding guidelines.

0736.6.4Identify types of pathology services and explain proper application of coding rules for each category of services.

0736.6.5Identify the proper coding guidelines for each subsection of the medicine services.

0736.6.6Discuss the rules and application of modifiers to the coding process.

0736.6.7Code a sample claim form.

Standard 7:Reimbursement and Auditing (0736.S.7)

Students will describe reimbursement and auditing processes.

Reimbursement and Auditing Objectives

Students will:

0736.7.1Identify and describe the different reimbursement methods.

0736.7.2Summarize the purpose of third party contracts and their effect on coding.

0736.7.3Explain the components for payment calculations and reimbursement calculations.

0736.7.4Abstract information from the patients’ medical records and complete claim forms.

0736.7.5Recognize internal and external obstacles to accurate and timely reimbursement.

0736.7.6Describe the auditing process, including the purpose of audits.

Standard 8:Technology (0736.S.8)

Students will apply knowledge of computers and their use within the health care system.

Technology Objectives

Students will:

0736.8.1Integrate the use of software, hardware, and the Internet to practice and master standards identified in the course.

0736.8.2Utilize the Internet as a resource/research tool.

Standard 9:Student Organizations (0736.S.9)

Students will participate in a Career and Technical Student Organization (CTSO).

Student Organizations Objectives

Students will:

0736.9.1Participate in Health Occupations Students of America (HOSA) or SkillsUSA/Vocational Industrial Clubs of America (SkillsUSA/VICA).

0736.9.2Apply parliamentary procedure in organizational meetings.

0736.9.3Demonstrate team membership skills, such as cooperation and leadership.

0736.9.4Take part in local, state, and national health care and education projects.