MEDA 149 Syllabus
Course Name:
Academic Term:
Medical Insurance
Procedures for Medical
Assisting
Spring
Course Number:
Year:
MEDA 149
2012
Contact Information
Instructor:
Sandy Erlewine, CMA (AAMA), CPC
E-mail:
Preferred at Angel Class Site WW e-mail
address TBA
Appt
Scheduled by appt via phone conference for
emergency situations only
Course Information
Class Day/Time:
Textbook:
Supplies:
On line Class Site at Walla Walla Comm College
Room:
NA
http://angel.wwcc.edu March 26-June 6, 2012
Health Insurance Today 3rd Edition by Janet Beik with workbook
Students will check out Coding Manuals later in the quarter at the live class
Credits:
5
Attendance Policy
Students are required to participate on the Discussion Forum and to complete quizzes and exams. Due to this
class being a 5-credit course, you should check the website daily during the week Monday-Friday; if possible
students are encouraged to check on Saturday or Sunday, you should at least once. Please note our week
starts on Mondays and ends on Mondays at 11:55 pm; except for Week 1; Memorial Day Week and Final
Week. You may access the class website 24 hours a day, 7 days a week. The new weekly assignments will be
available no later than 1pm on Mondays. Please watch for any changes to the class assignments as our
schedule is subject to change. Check information posted at weekly assignment summary at Lessons and
watch for course announcements at home page and e-mails. Please note some exams will be open book and
currently 2 exams are scheduled to be proctored (you will not be allowed to use your textbooks and notes). For
coding exams you will be using your CPT and ICD.9 manuals. I expect all homework and Discussion Forum
written responses to be correct in spelling and grammar. Points may be deducted for spelling and/or grammar
errors. Collaborate Sessions and (formerly Elluminate like a Webinar) dates and times to be announced
although there may be times when information about this class will be discussed in the MEDA 144 Collaborate
Sessions. Students will be required to log in and attend these sessions; if a student is unable to attend than
they will be required to view the video recording and send the instructor a 75-100 word report in a word
document that summaries the material that was covered; if a student misses more than 80% of the session
they will be required to view the recording and send a report on the material that they missed. Reports will be
submitted to the instructor via Angel (this class) e-mail sent as a word attachment. Reports will be due within
48 hours of the session (Mon would be due by Wed at 9 am and Wed would be due by Fri at 9 am). If a
student is unable to attend the session or view the recording they will be required to obtain notes from other
students as well as complete an alternate assignment. It is the student’s responsibility to notify the instructor if
they miss a session. During this quarter, there will be one “live class” that will be held at WWCC. Clarkston
students will be required to attend via I-TV (teleconferencing). Date and time TBA. It is the student’s
responsibility to contact the instructor if they have any questions or are unsure about how to proceed with the course.
Late Assignments/Make-up Policy
It is the student’s responsibility to notify the instructor of extenuating circumstances which may necessitate an
extension for assignments, quizzes, or exams PRIOR TO THE DUE DATE. All illnesses must be documented.
No due date extension will be given without prior notification. It is the student’s responsibility to obtain
advanced permission for a change in the schedule for an exam or quiz. No student will be allowed to make up
an exam without prior written approval from the instructor. Please note: Approval is not the same as
notification. The student must obtain an agreement from the instructor, prior to the scheduled exam, or quiz, in
order to be allowed to complete an exam, test, or quiz at an alternate time from the scheduled date and time.
Please watch for special instructions in regards to the proctored exams. Some of the exams will be proctored
and some won’t be. Currently, there are 2 proctored exams in this class. No assignments will be accepted
late for credit without agreement of the instructor obtained prior to the assignment due date.
. Cheating will not be tolerated. The instructor reserves the right to deny extensions as she/he sees fit.
Course Description
This course is an introduction to accurate billing procedures and provides a basic introduction to the medical
coding procedures used to obtain reimbursement for medical procedures or examination services. Topics
include health care insurance and preparation of an insurance claim for to receive reimbursement for a patient
encounter, and applying third party payor guidelines, the proper application of CPT, ICD-9-CM, and HCPCS
coding in the medical office.
Course Outcomes
1.
2.
3.
4.
5.
6.
7.
8.
9.
Follow third party payor guidelines
Complete an insurance claim form (CMS 1500) with a grade of “C” or higher.
Show basic understanding and perform billing and collection practices in an outpatient setting.
Define the purposes of the ICD-9-CM, CPT and HCPCS manuals.
Assign ICD.9-CM codes for the patient’s medical diagnosis, symptom, complaint, or condition.
Assign CPT codes for procedures and services the patient is having done.
Assign HCPCS codes for services the patient is receiving.
Understand the use and function of modifiers in CPT coding.
Understand the requirement for accuracy in all billing and coding procedures
Course Objectives
Upon completion of this course, students will:
 Identify and define types of insurance plans

Define, apply and follow 3rd party guidelines for claims submission

Identify and demonstrate the ability to adhere to managed care policies and procedures

Describe utilization review principles
 Identify the process and perform the procedures utilized to obtain managed care referrals, precertification, and
inpatient/outpatient admissions and procedures.

Describe the importance the accurate billing and collection practices and procedures in the outpatient setting
 Define and demonstrate the procedures for accurate claims submission to obtain reimbursement for medical services provided
which includes completion of a CMS 1500 billing form.

Discuss types of physician fee schedules

Define Diagnosis-Related Groups (DRGs) and the process of RBRVS.

Demonstrate procedures to verify eligibility for medical services.

Identify and define the purposes of the ICD-9-CM, ICD-10-CM, CPT, and HCPCS coding manuals.

Define terminology specific to insurance billing and coding.

Demonstrate appropriate usage of the ICD-9-CM, CPT, and HCPCS manuals to accurately apply codes for
procedures rendered and to identify diagnoses.

Practice the process of working with a physician (via simulation) to obtain maximum reimbursement for each patient
Pre-requisites: Please see MA Handbook
Teaching Methods: One Live Class; and Collaborate (Webinar Sessions)
Online via Internet: Written Lectures, Website Assignments which include exams and quizzes
and Written Assignments.
Evaluation and Grading Policy
Homework/Quizzes
35% All quizzes and assignment Students must achieve a cumulative homework grade of C or higher
CMS Assignment must be completed at a grade of C or higher.
Exams (proctored and open
book)
60% Students must achieve a cumulative exam grade of C or higher
Discussion
Forum/participation
5% This includes Collaborate Session and Live Class participation
Total
100%
Percentage / Grade Requirements
A
A-
93 -100%
90 - 92%
B+ 87- 89%
B 83 - 86%
B- 80 - 84%
C+
C
C-
77 - 79%
73 - 76%
70- 72%
D+ 67- 69%
D 60 - 66%
F 59% Or lower
Plagiarism Policy: Plagiarism is stealing and will not be tolerated Please refer to the MA and Walla Walla
Community College Handbook
Honesty and Integrity:
Health care professions require a high degree of honesty and integrity. Students are expected to conduct
themselves in the classroom as they would in the place of employment. Because knowledge gained in the
classroom, lab, or externship directly impacts the student’s future ability to safely provide patient care, all
breaches of ethical behavior are considered extremely serious. Please see MA handbook for information
about a violation.
Students shall:
1. complete all examinations using only their own knowledge. Students shall not refer to others’ answers, old
examinations, class notes, or other references while completing the examination unless specifically permitted
by the instructor.
2. use their own knowledge to write papers or compile research information. They shall not plagiarize, quote,
or copy other work without giving proper recognition as stated in a standard manual on style.
3. be accurate and truthful in all verbal communications.
4. respect the opinions of faculty and other students, even when they are not in agreement. Students shall
demonstrate self-control and speak professionally at all times.
5. use language that is respectful to others. The student shall not use profanity.
6. If a student is discovered cheating in any way, they will receive a zero for that assignment. Please refer to
MA handbook if this student has had a previous violation in this class or another class in this program.
Professionalism
The professional behaviors of personal hygiene, timeliness, professional judgment, interpersonal skills, and
teamwork may be as important in determining whether a student will be a good health care professional as
academic and clinical abilities. Health care professionals must have the ability to interact well with other
members of the health care team.
TENTATIVE CLASS SCHEDULE
Please see Angel class site
Notes:
Course Adaptations. If you need course adaptations or accommodations because of a disability, if you have emergency
medical information to share with me, or if you need special arrangements in case the building must be evacuated, please
e-mail me.
Student Rights and Responsibilities. The current WWCC catalog reviews your rights and responsibilities as a student.
It also defines various violations (cheating, plagiarizing, etc.) and outlines disciplinary actions.