Revised Fall 2005-2006
SYLLABUS
MAT 220
3 Credit Hours
Medical Office Insurance
3 Contact Hours
Course Description
In this course emphasis is placed on insurance procedures with advanced diagnostic and
procedural coding in the outpatient facility. Study will include correct completion of
insurance forms, ICD-9-CM and CPT coding. Upon completion, students should be able to
demonstrate proficiency in coding for reimbursement.
Course Textbook, Manuals, or Other Required Materials
American Medical Association. CPT 2005 Professional Edition. Chicago:AMA
Press, 2005.
Buck, Carol J. Saunders 2005 ICD-9-CM Volumes 1,2,3 and HCPCS Level II.
Philadelphia: Elsevier, 2005.
Rowell, J., Green, M., and Burke, R. Understanding Health Insurance. A Guide to
Professional Billing, 7th ed. New York: Thomson Delmar Learning, 2004.
Rowell, J., Green, M., and Burke, R. Workbook to Accompany Understanding Health
Insurance. A Guide to Professional Billing, 7th ed. New York: Thomson Delmar
Learning, 2004.
Computer disk
Prerequisite:
MAT 101, MAT 120, MAT 121, college level computer course, and/or as required by
program.
Course Learning Outcomes
A.
Students will learn to code diagnoses using ICD-9-CM coding system.
B.
Students will learn to code procedures using CPT-4 coding system.
C.
Students will learn how to complete an insurance claim form.
Outline of Course Topics
A.
Health Insurance Specialist – Roles and Responsibilities
B.
Introduction to Health Insurance
C.
Managed Care
D.
Life Cycle of an Insurance Claim
E.
Legal and Regulatory Issues
F.
ICD-9-CM Coding
G.
CPT-4 Coding
H.
HCPCS Coding
I.
CMS Reimbursement Issues
J.
Coding for Medical Necessity
K.
Essential Claim Instructions
L.
Commercial Insurance, Blue Cross, Medicare, Medicaid, Tricare, Workers
Compensation
Methods of Instruction
A.
Lectures
B.
Class Discussion
C.
Computer Tutorials
D.
Audiovisual presentations – Powerpoint
Evaluation and Assessment
A.
Course Grade Assessment
1.
Quizzes
2.
Self-study cases – computer lab
3.
Examinations
4.
Class participation
5.
The individual instructor and/or department will determine grades based upon
the following: A=90-100%, B=80-89%, C=70-79%, D=60-69%, and F=below
60%.
B.
Departmental Assessment of Learning Outcomes
1.
The student will demonstrate competence in ICD-9CM coding by correctly
coding 9 out of 10 diagnoses on a written quiz.
2.
Given written patient scenarios in a classroom setting, the student will
correctly code at least five (5) procedures.
3.
In a classroom exercise, the student will demonstrate the ability to accurately
complete both electronic and paper insurance claim forms.
C.
Use of Assessment Findings
During the Fall in-service of the year following the scheduled review of this course, a
committee will review all course assessment materials submitted by instructors and
division chair. The committee will send a report of any recommended curriculum
changes to the division chair, who will then submit them to the Curriculum
Committee. Upon approval by the Curriculum Committee, a copy will be filed with
the Office of Institutional Planning and Assessment.
Attendance
Students are expected to attend all classes for which they are registered. Students who are
unable to attend class regularly, regardless of the reason or circumstance, should withdraw
from that class before poor attendance interferes with the student’s ability to achieve the
objectives required in the course. Withdrawal from class can affect eligibility for federal
financial aid.
Statement of Discrimination/Harassment
The College and the Alabama State Board of Education are committed to providing both
employment and educational environments free of harassment or discrimination related to
an individual’s race, color, gender, religion, national origin, age or disability. Such
harassment is a violation of State Board of Education policy. Any practice or behavior that
constitutes harassment or discrimination will not be tolerated.
Statement of Adherence to ADA Guidelines
Instructors will adhere to the Americans with Disabilities Act and/or Section 504 of the
Rehabilitation Act (1973) and will publish the following statement on course outlines given
to students at the beginning of each semester; “Any individual who qualifies for reasonable
accommodations under the Americans with Disabilities Act and/or Section 504 of the
Rehabilitation Act (1973) should notify the instructor immediately.”