Southern State Community College
Curriculum Committee – November 2015
ALTH 2230 – Medical Billing & Coding III and Capstone
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I.
COURSE TITLE: Medical Billing & Coding III and Capstone
COURSE NUMBER: ALTH 2230
II.
CATALOG PREFIX: ALTH
PREREQUISITES: Acceptance in Billing & Coding Specialist Program
CO-REQUISITES: MAST 2219
III.
CREDIT HOURS: 2
LABORATORY HOURS: 0
IV.
COURSE DESCRIPTION:
LECTURE HOURS: 2
OBSERVATION HOURS: 0
This course continues emphasis on CPT and ICD-9 coding skills, office and insurance
collection strategies and introduces hospital billing concepts. The course includes capstone
review and credentialing exam preparation.
V.
GRADING:
Grades are accorded using the following schedule:
A = 90 – 100
B = 80 – 89
F = 0 – 79 Must repeat the course
VI. ADOPTED TEXT(S):
Insurance Handbook for the Medical Office & Workbook
Marilyn T. Fordney
13th edition, W. B. Saunders
ISBN# 978-1-4557-3325-5 (handbook)
ISBN# 978-1-4557-4811-2 (workbook)
Hospital Billing, 2nd Edition
By: Susan Magovern, Chestnut Hill Enterprises
Jean Jurek, Erie CC City CMPS-Buffalo, copyright 2009
ISBN# 139780073520896
CCS Coding Exam Review -The Certification Step
Carol J. Buck, MS, CPC-I, CPC, CPC-H, CCS-P
ISBN # 978-1-4160-3686-9
ALTH 2230 Billing & Coding III and Capstone
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Professional Review Guide for the CCS-P Examination
Patricia Schnering, RHIA, CCS
ISBN 13: 9781435419322
ISBN 10: 1435419324
VII.
COURSE OBJECTIVES:
At the completion of this course, the student will accomplish the following
objectives:
1.
2.
3.
4.
5.
6.
7.
Define credit and collection terminology and translate collection abbreviations
Describe office billing procedures and define aging analysis
Define collection process and possible solutions to collection problems
Name qualifications necessary to work in the financial section of a hospital.
Define common terms related to hospital billing
Entry level hospital billing practices including hospital billing flow
State the role of ICD-9-CM Volume 3 in hospital billing and identify categories in
Volume 3
8. State the general guidelines for completion of the paper (Uniform Bill [UB-92] and
transmission of the electronic claim form.
9. Describe the history and purpose of diagnostic related groups and identify how payment
is made based on diagnosis related groups.
10. Complete accurate claim forms for each type on insurance presented using accurate
coding techniques.
CAPSTONE:
1. Describe what aspects of medical insurance billing & coding will be included on their
credentialing examinations.
2. Successfully complete mock certification examinations and cases.
3. Successfully review medical terminology related to medical billing & coding,
reimbursement issues, overview of ICD-9 and CPT coding, and pathophysiology for
each organ system.
4. Successfully prepare claim forms from mock patient cases.
VIII. COURSE METHODOLOGY:
Class will include a variety of learning experiences which may include but not limited to:
lecture, discussion, journaling, group work, audio-visual materials, critical thinking
exercises, chapter and workbook assignments, publisher supplemental materials, computer
assisted learning, student presentation, student projects, research paper, skill demonstration,
skill competency, practical scenarios, human patient simulation, written tests, and other as
assigned by the instructor may be utilized as appropriate to meet the course objectives.
ALTH 2230 Billing & Coding III and Capstone
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Health Science students are expected to apply information and knowledge gained in this
course to other health science courses, including practicum assignments.
IX.
COURSE OUTLINE:
Chapter 10 Office and Insurance Collection Strategies
Chapter 17 Hospital Billing & Chapter 1 Intro to Hospital billing &
Chapter 2 The Hospital Billing Process
Chapter 3 Hospital Insurance and Chapter 4 Medical Coding Basics
Chapter 5 Payment Methods and Billing Compliance
Chapter 6 Overview of he UB 04 Claim Form & Chapter 7 Provider Information
Chapter 8 Patient Information Chapter 9 Condition Codes
Chapter 10 Occurrence Codes/Dates Chapter 11 Value Codes and Amounts
Chapter 12 Revenue Codes, Descriptions and Amounts
Chapter 13 Payer, Insured and Employer Information
Chapter 14 Diagnosis and Procedure Codes
Chapter 15 Physician Information, remarks, and Code-Code Field
Chapter 16 The UB 04 Form Filler
Chapter 17 Case Studies
Sample Calendar Outline:
WEEK 1
WEEK 2
WEEK 3
WEEK 4 `
WEEK 5
WEEK 6
WEEK 7
WEEK 8
WEEK 9
WEEK 10
WEEK 11
WEEK 12
WEEK 13
WEEK 14
WEEK 15
WEEK 16
Chapter 10 Office and Insurance Collection Strategies
Coding Quiz and Chapter CCS Review Unit 1
Quiz Chapter 10; CCS Review Unit 1 Test 17 Hospital Billing & Chapter 1
Intro to Hospital billing and Unit 2 CCS Review
Quiz Chapter 17/1 and Unit 2 test; Chapter 2 The Hospital Billing Process
Chapter 3 Hospital Insurance and Chapter 4 Medical Coding Basics
Cont. Ch3/4
QUIZ 2-4; Unit 3 CCS review
Chapter 5 Payment Methods and Billing Compliance
Chapter 6 Overview of the UB 04 Claim Form; Unit 3 CCS review test
QUIZ 5 & 6; Chapter 7 Provider Information
Chapter 8 Patient Information CCS-P Case Test
Quiz 7 & 8; Chapter 9 Condition Codes Coding review tests
Chapter 10 Occurrence Codes/Dates CCS and CCS-P Testing
Chapter 11 Value Codes and Amounts
Quiz 9/10/11; Chapter 12 Revenue Codes, Descriptions and Amounts
Chapter 13 Payer, Insured and Employer Information Review CCS-P
Quiz 12/13; Chapter 14 Diagnosis and Procedure Codes
Chapter 15 Physician Information, remarks, and Code-Code Field
Quiz 14/15; Chapter 16 The UB 04 Form Filler Review CCS-P
Chapter 17 Case Studies Review tests
Final
Spelling test will be given as designated by the instructor.
ALTH 2230 Billing & Coding III and Capstone
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An optional, competitive entry practicum opportunity may be available based on site needs.
All practicum requirements and competitive entry guidelines must be completed prior to
participation. See your program director in Week 1 of the term if you are interested should
this optional opportunity be available this term.
X.
OTHER REQUIRED BOOKS, SOFTWARE AND MATERIALS:
Current Taber Medical Dictionary recommended
One USB Storage Device
Specific texts are needed for the CCA credential exam. The full list is available at
www.AHIMA.org:
Current AMA CPT® Professional
Current ICD-10-CM Draft Edition and Current ICD-10-PCS Draft Edition
Current PCS Standard Edition
Available in bundle:
2015 ICD-10-CM Draft Edition, 2015 ICD-10-PCS Draft Edition, 2015 PCS
Standard Edition and CPT 2015 Standard Edition Package
ISBN # 9780323224369
HESI Exit Exam for Billing & Coding Voucher (See Program Director)
Elsevier
ISBN: (Pending Publisher Assignment)
It is highly recommended that students have a home computer, printer, internet access and
USB storage device. Other as determined by instructor (refer to instructor requirements)
XI.
EVALUATION:
Successful attainment of the objectives of this course will be measured by the student
passing all skill competency-based exams (CBE), written assignments, and a final course
grade of A or B. Students will be graded on his/her performance of the competency-based
skills listed in the course description. Students must pass all class tests before the
competency score will be averaged into the final grade as a score.
Honesty and integrity are major elements in professional behavior and are expected of each
Health Science Division student. Cheating is considered unacceptable behavior within all
Health Science Division courses. Students having academic difficulties should seek
guidance assistance from the instructor, academic advisor, or college counselor.
ALTH 2230 Billing & Coding III and Capstone
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A student observed or found to be cheating on a test or assignment in any Health Science
Division course will be given a “zero” on the test or assignment. A written report of the
incident, signed by the instructor and the student, will be placed in the student’s permanent
file. This notice will remain on file and in effect for the remainder of the student’s
enrollment in the Health Science Division. Should a second incident of cheating occur in
any Health Science Division course, the student will be given a failing grade for the course
and will be dismissed from the Health Science Division for one year and possibly from
SSCC, as per college guidelines.
The “zero” grade for dishonesty will not be used as the drop grade in a course in which a
drop grade option is given. If a student allows another student to copy or “cheat off” of their
work than the same ramifications will be given to that student as well. The student
witnessing cheating is morally obligated to report the incident to the instructor.
Knowledge of content is evaluated by written exam, student performance of competency
based skills, assignments, and work projects per instructor. All exams are comprehensive. A
quiz may be given at instructors’ discretion. Competency-based skill performance is
required on each skill discussed and demonstrated. After completion of this course, the
student will be requested to complete a form to assist in evaluation of course content and
instruction.
Class participation will be evaluated by the students’ ability to contribute to class discussion.
Points will be deducted on all assignments and quizzes for incorrect spelling or grammar.
Students must earn a passing average score of 80% on exams and must pass all
competencies with accuracy rate of 85%. Failure in either of these areas will result in failure
of the course.
The student will also be graded on his/her performance of competency based skills. A grade
of “S” will be recorded for satisfactory performance and a grade of “U” will be recorded for
unsatisfactory performance.
No make-up tests will be given.
Final Grade Percentage Calculation Sample:
Quiz grades
Case studies
Coding quiz
Final exam
XII.
= 60% of final grade
= 20% of final grade
= 10% of final grade
= 10% of final grade
SPECIFIC MANAGEMENT RQUIREMENTS:
Students will be required to complete a written test at the times designated in the Course
Schedule. Students are required to participate in all class activities.
ALTH 2230 Billing & Coding III and Capstone
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To meet the objectives of each course students must attend all scheduled classes. At the
beginning of the quarter all instructors will pass out a “Class Schedule”, which lists all class
meetings. If a student must miss class due to extenuating circumstances, than the student is
expected to call and inform the instructor by either talking with the instructor, e-mail, or
leaving a message should the instructor not be available.
Students will be allowed three (3) class absences. Absences over three times will result in a
drop of one letter grade from the final grade; the third absence will reduce a final grade of A
to a B, a B to a C (therefore removing a student from the program) or may drop the D to an
F, requiring repeat of the course. Two instances of significant tardiness or leaving early will
be considered equivalent to an absence for purposes of this calculation.
Students may withdraw from classes up to and including the week before final exams by
giving written notice of their intent to withdraw to the Student Services Office. Attendance
in class is an important part of the learning process. Excess absence may result in a failure.
Faculty may count attendance as part of the grading policy and a failure to officially
withdraw may result in a failing grade. Withdrawal from classes may affect the student’s
academic status and/or financial aid. See the FEE SCHEDULE section of the College
Catalog for the policy on refunds and financial aid.
Faculty may recommend that the College withdraw students who have missed 6 classes,
20%, of the total scheduled classes of a course and issue a grade of WI to the student.
Any student who misses a scheduled competency, either demonstration or checkoff must
make an appointment, within one week of return to school, with the instructor to make up
this portion of the class. Failure to do so will result in a “Fail” for the competency,
therefore failure of the course. It is the students’ responsibility to make arrangements for
this.
XIII. OTHER INFORMATION:
Classroom Conduct: Civility in the classroom is very important. As professionals, we
expect students to conduct themselves in a courteous and respectful manner. Disruptive,
rude, sarcastic, obscene or disrespectful speech or behavior have a negative impact on
everyone, and will not be tolerated. Students need to remember that the online discussion
boards and chat rooms in the online course are considered classrooms and the same rules
apply. Students will use these tools in the online classroom for information that pertains to
the course; it is not to be used for personal exchanges of a social nature. If you engage in
any such conduct you will be asked to leave and you will receive a “zero” for any work
completed on that day. The instructor reserves the right to permanently remove a student
from the class for inappropriate conduct after consultation with the Department coordinator
and Academic Dean.
Inclement Weather: In the event of campus delay (when this class start time is impacted by
said delay) the class will begin at the scheduled campus opening time to complete any
remaining class time permitted.
ALTH 2230 Billing & Coding III and Capstone
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FERPA: Work submitted in this class may be seen by others when being distributed,
during group project work, or if it is chosen for demonstration purposes. Other instructors
may also see your work during the evaluation/feedback process. Student assignments and
exams are kept on file for review by various accrediting boards of both program and
Institutional Boards. On occasion papers may be traded with another student or work-study
for grading purposes.
There is also a possibility that your papers may be submitted electronically to other entities
to determine if references are cited appropriately. Plagiarism is a serious offense. Work
submitted by the student must be the students’ own creation. The instructor reserves the
right to fail any student who submits plagiarized or duplicated work. A grade of “zero” will
automatically be given to the duplicated submissions. The instructor will be the sole judge
in such cases. If a student cannot demonstrate conclusively that a work was not copied or
plagiarized or, in the case of the original author, was copied without consent, the penalty
will stand.
DISABILITIES: Students with disabilities may visit the SSCC homepage and select
“Current Students” for detailed information or contact the Disabilities Service Office, at
800-628-7722 or 937-393-3431, extension 2604.