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This document provides information for a Medical Insurance course including the instructor's contact information, course description, learning objectives, assignments, and schedule. The course is a 16-week hybrid lecture/lab class that will teach students how to code medical procedures, bill patients and insurance, compare insurance plans, and complete medical forms. Major assignments include completing insurance claims using case studies and simulation software, as well as interviewing a medical professional and summarizing the experience. The goal is for students to learn the basics of medical insurance billing.
This document provides information for a Medical Insurance course including the instructor's contact information, course description, learning objectives, assignments, and schedule. The course is a 16-week hybrid lecture/lab class that will teach students how to code medical procedures, bill patients and insurance, compare insurance plans, and complete medical forms. Major assignments include completing insurance claims using case studies and simulation software, as well as interviewing a medical professional and summarizing the experience. The goal is for students to learn the basics of medical insurance billing.
This document provides information for a Medical Insurance course including the instructor's contact information, course description, learning objectives, assignments, and schedule. The course is a 16-week hybrid lecture/lab class that will teach students how to code medical procedures, bill patients and insurance, compare insurance plans, and complete medical forms. Major assignments include completing insurance claims using case studies and simulation software, as well as interviewing a medical professional and summarizing the experience. The goal is for students to learn the basics of medical insurance billing.
Office location and hours The MDCA Program is located in Suite 434. The instructor assigned to this course can be reached by phone at (713)-718-7360 or (713)-718-7365 (secretary), Mr. George Kollie. Individual/group tutoring is available. Schedule the time with your instructor. Students will be seen during the instructors conference period as walkins or by scheduled appointments. Instructors office hours will be posted on the outside door of Room 432 and an appointment schedule will be left with the MDCA secretary.
Course Description MDCA 1343 emphasizes medical office coding procedures for payments/reimbursement by patient or third party.
Prerequisites None
Course Goal The course goal for MDCA 1343 is to provide allied health students who have minimum background in medical insurance with the basics of filing and coding medical insurance claims.
Student Learning Outcomes The student will be able to: 1. Code procedures performed during office visits 2. Bill patients or insurance carriers for visits/procedures 3. Compare and contrast insurance plans 4. Define common terms used to file third party reimbursement forms.
Learning objectives Students will: 1.1 Perform diagnostic coding accurately by using ICD-9 coding books 1.2 Perform procedural coding accurately using CPT coding books 2.1 Abstract from source document relevant information for completing claim form 2.2 Accurately complete claim form for a third party payer 3.1 Compare and contrast insurance plans 3.2 Using manage care policies and procedures complete a referral form 3.3 Recognize and recall terms used in filing third party reimbursement SCANS or Core Curriculum Statement and Other Standards Credit: 3 (3 lecture) Scans Competencies (C1. C2, C6, C5, C8, C15, C16, C17) CAAHEP VII. C (Cognitive) Managed Care/ Insurance (1-12) VII. P (Psychomotor/ Skills) Managed care/ Insurance (1-6) VII. A (Affective/ Behavior) Managed care / Insurance (1-3) VIII. C (Cognitive) Procedural and Diagnostic Coding (1-4) VIII. P (Psychomotor/ Skills) Procedural and Diagnostic Coding (1-2) VIII. A (Affective/Behavior) Procedural and Diagnostic Coding (1)
Learning objectives Students will: 1.1 Perform diagnostic coding accurately by using ICD-9 coding books 1.2 Perform procedural coding accurately using CPT coding books 2.1 Abstract from source document relevant information for completing claim form 2.2 Accurately complete claim form for a third party payer 3.1 Compare and contrast insurance plans 3.2 Using manage care policies and procedures complete a referral form 3.3 Recognize and recall terms used in filing third party reimbursement SCANS or Core
Curriculum Statement and Other Standards Credit: 3 (3 lecture) Scans Competencies (C1. C2, C6, C5, C8, C15, C16, C17) CAAHEP VII. C (Cognitive) Managed Care/ Insurance (1-12) VII. P (Psychomotor/ Skills) Managed care/ Insurance (1-6) VII. A (Affective/ Behavior) Managed care / Insurance (1-3) VIII. C (Cognitive) Procedural and Diagnostic Coding (1-4) VIII. P (Psychomotor/ Skills) Procedural and Diagnostic Coding (1- 2) VIII. A (Affective/Behavior) Procedural and Diagnostic Coding (1)
MDCA 1343 Sixteen Week Calendar
Date Class To Assignments 08/25/2014 Week One 1 Orientation Chapter 1: Health insurance Specialist Career Orientation Peer Introduction Read Chapter One Complete chapter coursemate as homework Complete chapter quizzes on
09/01/2014 Week Two No Class Holiday Labor Day 2 Chapter 2: Introduction to health Insurance Chapter 3: Managed Health Care Lab Day No Class; chapter quizzes : Course mate quiz and Moodle quiz However Please read the following chapters 2& 3 09/08/2014 Week Three Exam 1 Lab A Chapters 1-3 3 Chapter4: Processing an Insurance Claim Read Chapter 4 Complete chapter review Complete chapter Course mate quiz and chapter quiz on Moodle 09/15/2014 Week Four 4 Chapter 5: Legal and Regulatory Issues Read chapter 5 Complete chapter coursemate Complete chapter quizzes on Moodle Interview Due 09/22/2014 Week Five 5 Chapter 6: ICD-9-CM Coding Chapter 6B; ICD- 9-CM Coding Read chapters 6A and 6B Complete the Coursemate quiz and Moodle quiz Soap Format Due 09/29/2014 Week Six 6 Chapter 7: CPT Coding Read chapter 7 Complete chapter coursemate Complete chapter quizzes on Moodle 10/06/2014 Week Seven 7 Chapter8: HCPCS Level II Coding Read chapter 8 Complete chapter coursemate Complete chapter quizzes on Moodle 10/13/2014 Week Eight 8 Midterm Exam Chapter 9: CMS Reimbursement Methodologies MidTerm Examination Chapters 1-8 Read chapter 9 Complete chapter coursemate Complete chapter quizzes on Moodle 10/20/2014 Week Nine 9 Exam 2 chaps 4- 7 Chapter 10: Coding for Medical Necessity Chapter 11: Essential CMS- 1500 Claim Instructions Read chapters 10-11 Complete chapter coursemate Complete chapter quizzes on Moodle 10/27/2014 Week Ten 10 Chapter 12: Commercial Insurance Read chapter 12 Complete chapter coursemate Complete chapter quizzes on Moodle
11/03/2014 Week Eleven Chapter 13: Blue Cross Blue Shield Read chapter 12 Complete chapter coursemate Complete chapter quizzes on Moodle 11/10/2014 Week Twelve 12 Chapter 14: Medicare Read chapters 14 Complete chapter coursemate Complete chapter quizzes on Moodle 11/17/2014 Week Thirteen 13 Chapter 15: Medicaid Read chapters 14 Complete chapter coursemate Complete chapter quizzes on Moodle 11/24/2014 Week Fourteen 14 Final Review Chapter 16: TRICARE Read Chapter 16 Complete chapter coursemate Complete chapter quizzes on Moodle SimCase studies due MOSS assignment due 12/01/2014 Week Fifteen 15 Chapter 17: Workers Compensation Read Chapters 15-17 Complete chapter reviews Complete chapter quizzes on Moodle SimCase studies due MOSS assignment due 12/08/2014 Week 16 Final Examination Final Examinations FINAL EXAMINATION
Major Assignment: ASSIGNMENTS for MDCA 1343
1. Using the case studies provided in Appendix I, students will create five (5) patient folders with all the required forms needed(Students may use any of the 20 cases provided). Each folder must have completed electronic CMS- 1500 form.
2. Following the general instructions and hints for Sim Claim Case Studies in Appendix I, students will complete claims using the SimClaim software for Case Studies 1-1 through 1-20. 3. Using the Appendix II in the textbook, students will complete five (5) claims using the SimClaim Software from Case Studies 2-1 through 2-20. Due date: 12/01/2014
4. Using the Appendix II in the textbook and the claim form from Appendix III in the textbook, students will also complete five manual CMS-1500 claim forms by typewriter. The manual claims may be the same Case Studies as in the assignment above. Due Date: 12/01/2014
5. Project is worth 30% for your final grade and is due 12/01/2014. NO late work accepted under any circumstances.
CLASS SOAP FORMAT : Due date 09/22/ 2014 Instruction: Review the following SOAP notes, then select and code the Diagnose S: Patient complains of stomach pain, 3 days duration. She still also stated that her legs still painful from the knee down. O: Ht 5 6; Wt 164; BP 122/82; pulse 92 and regular; temp 97.0F, oral; chest normal; heart normal . The Doppler arteriogram of lower extremity taken last week at the hospital is reported as within limits bilaterally. A: Another episode of atrophic gastritis. Leg pain. P: Carafate 1 g. Take 1 tablet qid before meals and at bedtime. #120 tabs
Moss Assignment 1. Using the case studies in the Appendix C of the workbook Case Studies for Medical Office Simulation Software 2.0 MOSS you will complete a total of 6 case studies. You completed the first one in lab all ready. 2. You will print the Insurance prebilling worksheet, the test version transmission screen status report, a provider payment advice and final print screen of the verification of posting and post. 3. You may place these in a purple folder to be graded. Each document should have your names printed on it for when you print screen and/or save it. No name items will be accepted. 4. You will be divided into groups to complete this assignment. The first group A_H will complete case studies 1, 3, 5, 7, 9, 10 and the last group I-Z will complete case studies 1, 24,6, 8, 10. 5. Case studies will be due on October27, 2014 the day of class. No later.
Interview Assignment Interview of a Professional Due Date: September 15 , 2014 The student will submit a three-page, double-spaced, word-processed report on an interview of a professional; the paper should be in paragraph form (not written in a question/answer format). Each paragraph should include a minimum of three complete sentences, containing no typographical or grammatical errors. The last paragraph of the paper should summarize the students reaction to the interview and whether the student would be interested in having this professionals position (along with why or why not). Also, the student should predict where she or he will be in 10 years (in terms of family, employment, and so on).
Classroom Practical Application
1. Discuss and research the web link http://www.irp.com and click on the Medicare DRG calculator link and summary what you have discovered and learned.
2. Discuss why you feel that coding is a Medical Necessity. October 30, 2014 MOVIE DAY : DAMAGED CARE Watch the movie and answer the following questions as it relates to the Movie. This is your understanding of the movie.
1. When is it necessary to ration health care? Who does it? How can it be done ethically and compassionately? Give two examples from the movie.
2. Where does the money go in the health care system? If health care dollars are "scarce," can we ethically defend their use for non-health care expenditures, such as the sculpture portrayed in the movie?
3. How does the organizational culture affect the decision-making and ethics of the individuals within it? When is a system or organization unethical? Can one be ethical in an unethical system? Give examples from the movie.
4. Can we expect individuals to make moral decisions when the costs (professional and personal) are too great? Give examples from the movie.
5. Who was Linda Peeno and what was her role in the movie?
6. List some abuse of the Insurance Industries? Due on October 16 , 2014
Instructional Methods MDCA 1343 courses involve the uses of lectures, PowerPoint presentation, videos, virtual simulation, visual aid, and medical computer software.
Student Assignments Assignments have been developed that will enhance your learning skills. To better understand a topic, you will be given assignments on key information that you will need to remember for your success in your career as a Medical Assistant. There are two special assignments for this course that must be completed for you to achieve success in this course along with two major exams. The Student SimClaim software CD along with the Encoder Pro is designed to help students learn how to complete insurance claim forms for a variety of facilities. The Encoder Pro allows the student to look up ICD-9CM, CPT and HCPCS level II codes quickly and accurately. Students will be required to successfully complete the following:
Final Exam The test will consist of one hundred (100) multiple choice questions, which will include all chapters of the textbook. Questions will include knowledge and comprehension questions covering medical
billing, coding, reimbursement, definitions and terminology. Questions will also include practical applications scenarios, coding identifications and completing a CMS-1500 form.
Final Lab Practical Portfolio Students are required to complete the twenty (20) cases studies from the Sim Claim software CD which accompanies their textbook .They are also to complete chapters 9-14 of the stop and practice exercise, chapter reviews 9- 14 (typed), and manual CMS-1500 forms. Manual CMS forms will be provided by your instructor. Students are to complete five (5) of the 20 case studies manually using the typewriter. Upon completion of this simulation the student will create a portfolio dividing their work into three sections Manual CMS-1500, Electronic CMS-1500, Review Questions and Stop and Practice.
1. Portfolio should be neatly organized using the efolio on the Eagle online 2. All content of the portfolio will be submitted via the efolio except for the manual forms and the folders 3. No partial work will be accepted nor will any disorganized folio be accepted. You must include a summary of your work experience in your efolio. 4. Project is worth 30% of your overall grade. 5. Manual forms are due on 12/01/2014 @ 9:00 a.m. 6. Using the case studies provided in Appendix 1 students will create five (5) patient folders with all the required forms needed. (Students may use any of the 20 cases provided.). 7. Each folder must consist of a completed CMS-1500 form for that particular patient whether the patient is new or established. Forms needed are located in Appendix 3 of your textbook. 8. Students will complete five manual CMS-1500 forms from Appendix 1 using a typewriter. 9. There will be no specific homework assignment for this course except completion of stop and practice and review exercises in the textbook. 10. Student will use lab time to help them to complete their assignment; so please use your time wisely 11. Software can be installed on your personal computers or desktop at home so there are no excuses for not completing your work on time and none will be accepted. 12. This software also allows you to save your work on a flash drive or to the hard drive you are working on.
Assessments Major exams (4) 15% of your final grade Weekly quizzes (9) 15% of your final grade Homework 10% of your final grade Final Exam 30% of your final grade Final Exam Portfolio 30% of your final grade
HCC Policy Statement - ADA Services to Students with Disabilities Students who require reasonable accommodations for disabilities are encouraged to report to Dr. Raj Gupta at 713-718-7631 to make necessary arrangements. Faculty is only authorized to provide accommodations by the Disability Support Service Office Students who are requesting special testing accommodations must first contact the appropriate (most convenient) DSS office for assistance: Disability Support Services Offices: System: 713.718.5165 Central: 713.718.6164 also for Deaf and Hard of Hearing Services and Students Outside of the HCC District service areas. Northwest: 713.718.5422 Northeast: 713.718.8420
Southeast: 713.718.7218 Southwest: 713.718.7909
After student accommodation letters have been approved by the DSS office and submitted to DE Counseling for processing, students will receive an email confirmation informing them of the Instructional Support Specialist assigned to their professor
HCC Policy Statement: Academic Honesty Students are responsible for conducting themselves with honor and integrity in fulfilling course requirements. Penalties and or/ disciplinary proceedings may be initiated by College System officials against a student accused of scholastic dishonesty. The following statement is an excerpt from the Student Conduct section of the College System catalog: Scholastic dishonesty includes, but is not limited to, cheating on test, plagiarism, and collusion. Cheating on a test includes: Copying from another students test paper; Using, during a test, materials not authorized by the person giving the test; Collaborating with another student during a test without authority; Knowingly using, buying, selling, stealing, transporting, or soliciting in whole or part the contents of an unadministered test; Bribing another person to obtain a test that is to be administered.
Plagiarism means the appropriation of anothers work and the unacknowledged incorporation of that work in ones own written work for credit. Collusion means the unauthorized collaboration with another person in preparing written work offered for credit.
HCC Policy Statements Class Attendance Students are responsible for attending 90% of the class including lecture/lab. Class attendance equals class success.
HCC Course Withdrawal Policy It is the responsibility of the student to officially drop or withdraw from a course. Failure to officially withdraw may result in the student receiving a grade of F in the course. The final day for withdrawal is October 31, 2014 at 4:30 p.m. If you feel that you cannot complete this course, you will need to withdraw from the course prior to the final date of withdrawal. Before, you withdraw from your course; please take the time to meet with the instructor to discuss why you feel it is necessary to do so. The instructor may be able to provide you with suggestions that would enable you to complete the course. Your success is very important. Beginning in fall 2007, the Texas Legislature passed a law limiting first time entering freshmen to no more than SIX total course withdrawals throughout their educational career in obtaining a certificate and/or degree.
To help students avoid having to drop/withdraw from any class, HCC has instituted an Early Alert process by which your professor may alert you and HCC counselors that you might fail a class because of excessive absences and/or poor academic performance. It is your responsibility to visit with your professor or a counselor to learn about what, if any, HCC interventions might be available to assist you online tutoring, child care, financial aid, job placement, etc. to stay in class and improve your academic performance.
If you plan on withdrawing from your class, you MUST contact a HCC counselor or your professor prior to withdrawing (dropping) the class for approval and this must be done PRIOR to the withdrawal deadline to receive a W on your transcript. **Final withdrawal deadlines vary each semester and/or depending on class length, please visit the online registration calendars, HCC schedule of classes and catalog, any HCC Registration Office, or any HCC counselor to determine class withdrawal deadlines on October 31, 2014 @ 4:30 p.m. Remember to allow a 24-hour response time when communicating via email and/or telephone with a professor and/or counselor. Do not submit a request to discuss withdrawal options less than a day before the deadline. If you do not withdraw before the deadline, you will receive the grade that you are making in the class as your final grade.
Repeat Course Fee The State of Texas encourages students to complete college without having to repeat failed classes. To increase student success, students who repeat the same course more than twice, are required to pay extra tuition. The purpose of this extra tuition fee is to encourage students to pass their courses and to graduate. Effective fall 2006, HCC will charge a higher tuition rate to students registering the third or subsequent time for a course. If you are considering course withdrawal because you are not earning passing grades, confer with your instructor/counselor as early as possible about your study habits, reading and writing homework, test taking skills, attendance, course participation, and opportunities for tutoring or other assistance that might be available.
HCC Student Service Information
Earl y Alert: HCC has instituted an Early Alert process by which your professor will alert you through counselors of concerns that you might fail a class because of excessive absences and/or poor academic performance.
For DE students: Much information can be found on the DE Student Services website: de.hccs.edu. Advising or counseling can be accomplished through our online request form AskDECounseling. Counselors and Student Services Associates (SSA) can assist students with admissions, registration, entrance testing requirements, degree planning, transfer issues, and career counseling. In-person, confidential sessions, can also be scheduled to provide brief counseling and community referrals to address personal concerns impacting academic success.
Virtual Classroom Conduct As with on-campus classes, all students in HCC Distance Education courses are required to follow all HCC Policies & Procedures, the Student Code of Conduct, the Student Handbook, and relevant sections of the Texas Education Code when interacting and communicating in a virtual classroom with faculty and fellow students. Students who violate these policies and guidelines will be subject to disciplinary action that could include denial of access to course-related email, discussion groups, and chat rooms or being removed from the class.
Classroom Behavior As your instructor and as a student in this class, it is our shared responsibility to develop and maintain a positive learning environment for everyone. Your instructor takes this responsibility very seriously and will inform members of the class if their behavior makes it difficult for him/her to carry out this task. As a fellow learner, you are asked to respect the learning needs of your classmates and assist your instructor achieve this critical goal.
Use of Camera and/or Recording Devices As a student active in the learning community of this course, it is your responsibility to be respectful of the learning atmosphere in your classroom. To show respect of your fellow students and instructor, you will turn off your phone and other electronic devices, and will not use these devices in the classroom unless you receive permission from the instructor. Use of recording devices, including camera phones and tape recorders, is prohibited in classrooms, laboratories, faculty offices, and other locations where instruction, tutoring, or testing occurs. Students with disabilities who need to use a recording device as a reasonable accommodation should contact the Office for Students with Disabilities for information regarding reasonable accommodations
Instructor Requirements As your Instructor, it is my responsibility to: Provide the grading scale and detailed grading formula explaining how student grades are to be derived Facilitate an effective learning environment through class activities, discussions, and lectures Description of any special projects or assignments Inform students of policies such as attendance, withdrawal, tardiness and make up Provide the course outline and class calendar which will include a description of any special projects or assignments Arrange to meet with individual students before and after class as required
To be successful in this class, it is the students responsibility to: Attend class and participate in class discussions and activities Read and comprehend the textbook Complete the required assignments and exams: Ask for help when there is a question or problem Keep copies of all paperwork, including this syllabus, handouts and all assignments Passing all written examinations, quizzes and assignments with a minimum grade average of 75% Pass all skill competencies with 90% proficiency Be in class attendance 90% of the time
Program/Discipline Requirements Using the experience from the textbook in medical reimbursement and coding field the students will practice skills learned during the course at the midterm and submit a Midterm Lab Practical Skill portfolio (manual/ computer) worth 25% This project will also include creating five (5) patient folder with the completed forms required for a new patient or an established patient. Patients will be assigned by your instructor. The students will also submit a Final Lab Practice (portfolio) which will include manual and computer skills used from the SimClaim software case studies (20 cases) worth 30%.
Grading Your instructor will conduct quizzes, exams, and assessments that you can use to determine how successful you are at achieving the course learning outcomes (mastery of course content and skills) outlined in the syllabus. If you find you are not mastering the material and skills, you are encouraged to reflect on how you study and prepare for each class. Your instructor welcomes a dialogue on what you discover and may be able to assist you in finding resources on campus that will improve your performance.
Assessments Major exams (4) 15% of your final grade Weekly quizzes (9) 15% of your final grade Homework 10% of your final grade Final Exam 30% of your final grade Final Exam Portfolio 30% of your final grade
EGLS3 -- Evaluation for Greater Learning Student Survey System At Houston Community College, professors believe that thoughtful student feedback is necessary to improve teaching and learning. During a designated time, you will be asked to answer a short online survey of research-based questions related to instruction. The anonymous results of the survey will be made available to your professors and division chairs for continual improvement of instruction. Look for the survey as part of the Houston Community College Student System online near the end of the term.