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MASTER SYLLABUS |
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| INSURANCE BILLING & CODING
OST 2945 |
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| Class Hours: 3.0 | Credit Hours: 3.0 | ||||||||
| Laboratory Hours: 0.0 | Revised: Spring 05 | ||||||||
| Catalog Course Description: | |||||||||
| A continuation of insurance coding with an emphasis on evaluation and management coding, use of modifiers, linkage of service codes to diagnoses codes, and hospital billing. Also covered is the use of billing software to enter patient information, process transactions and produce patient statements. | |||||||||
| Entry Level Standards: | |||||||||
| Students must be able to read, write, and reason at the college level. Successful completion of the Medical Insurance Coding I is required. | |||||||||
| Prerequisites: | |||||||||
| OST 2940 | |||||||||
| Textbook(s) and Other Course Materials: | |||||||||
| 1. The Next Step:
Advanced Medical Coding: A Worktext, by Carol J. Buck,
published by Saunders, 2004.
2. The Medical Manager, Student Edition Version 10 for Windows, by Richard Gartee, published by Thompson Delmar Learning, 2004. 3. ICD-9-CM with Volumes 1, 2 & 3 and HCPCS Level II and CPT-4 code books used in OST 2940 or current issue. 4. Medical dictionaries, medical terminology textbook, and/or anatomy and physiology textbooks will be helpful as references and may be used with exams. 5. Four (4) 1.44MB high-density, 3.5” diskettes |
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| I. Week/Unit/Topic Basis: | |||||||||
| Week | Topic | ||||||||
| 1 | Evaluation and Management
Services
Using Medical Manager |
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| 2 | Evaluation and Management
Documentation
Build the Patient File |
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| 3 | Evaluation and Management
Audit
Build the Patient File |
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| 4 | Medical Procedure
Coding
Post Entries |
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| 5 | Radiology Procedure
Coding
Application Exam – Using Medical Manager |
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| 6 | Pathology and Laboratory
Coding
Post Entries |
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| 7 | Integumentary System
Coding
Edit Prior Entries |
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| 8 | Exam – Diagnosis/Procedure
Coding
Edit Prior Entries |
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| 9 | Cardiovascular System
Coding
Office Management/Appointment Scheduling |
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| 10 | Digestive System,
Hemic/Lymphatic System and Mediastinum/Diaphragm Coding
Practice Management |
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| 11 | Respiratory System
Coding
Practice Management |
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| 12 | Urinary, Male Genital,
and Endocrine System Coding
Report Generation |
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| 13 | Female Genital System
and Maternity Care/Delivery Coding
Report Generation |
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| 14 | Application Exam – Data Entry Using Medical Manager | ||||||||
| 15 | Exam – Diagnosis and Procedure Code Assignment | ||||||||
| II. Course Objectives*: | |||||||||
| A. | Assign correct ICD, CPT, HCPCS, and modifier codes using patient chart data. (III, V, VI, VIII, X, XI, XII) | ||||||||
| B. | Use computer software to accurately complete CMS-1500 claim forms and follow the claims through reimbursement. (I, III, IV, V, VI, IX, X) | ||||||||
| *Roman numerals after course objectives reference goals of the OST program. | |||||||||
| III. Instructional Processes*: | |||||||||
| Students will: | |||||||||
| 1. | Use computer software that simulates medical office management tasks. (Technological Literacy Outcome) | ||||||||
| 2. | Increase competence regarding assignment of diagnoses and procedure/service codes by completing both workbook problems and chart analyses problems. (Communication Outcome and Problem Solving and Decision Making Outcome) | ||||||||
| 3. | Participate in classroom discussion for the purpose of supporting code assignments. (Communication Outcome and Personal Development Outcome) | ||||||||
| 4. | Initiate a personal library of reference materials including medical dictionaries, common abbreviations/eponyms, and coding references which will allow accurate interpretation of medical information. (Personal Development) | ||||||||
| 5. | Access Pellissippi State User Account (PSTCC Home Page = http://www.pstcc.edu) to find library resources pertaining to insurance coding. (Technological Literacy Outcome) | ||||||||
| 6. | Internalize the work ethic by regularly attending class, being punctual, being dependable, cooperating with the teacher and classmates, and acting in a professional matter while in class. (Professional Development Outcome) | ||||||||
| *Strategies and outcomes listed after instructional processes reference Pellissippi State's goals for strengthening general education knowledge and skills, connecting course work to experiences beyond the classroom, and encouraging students to take active and responsible roles in the educational process. | |||||||||
| IV. Expectations for Student Performance*: | |||||||||
| Upon successful completion of this course, the student should be able to: | |||||||||
| 1. | Solve medical coding problems in the simulated setting of a medical office and hospital. (A, B) | ||||||||
| 2. | Use computer software packages to complete CMS-1500 claim forms. (B) | ||||||||
| 3. | Accurately assign modifiers. (A) | ||||||||
| 4. | Assign diagnoses and service/procedure codes with greater accuracy. (A) | ||||||||
| 5. | Assign Evaluation and Management CPT codes based upon patient chart information. (A, B) | ||||||||
| 6. | Abstract surgical reports. (A, B) | ||||||||
| 7. | Understand the use and assignment of APC and DRG codes. (A) | ||||||||
| 8. | Use HCPCS codes. (A) | ||||||||
| 9. | Link diagnoses codes to service codes. (A, B) | ||||||||
| 10. | Review and compare inpatient and outpatient billing practices. (A, B) | ||||||||
| *Letters after performance expectations reference the course objectives listed above. | |||||||||
| V. Evaluation: | |||||||||
| A. Testing Procedures: 60% of final grade | |||||||||
| There will be four (4) exams given during the semester. Two will consist of objective questions in the form of multiple choice, true/false, short answer, or short essay covering the class discussion, text and a guest speaker. The additional two exams will consist of classroom assessment activities to be completed on the PC. Diskettes and/or printouts will be collected for grading. | |||||||||
| B. Laboratory Expectations: | |||||||||
| This college-level course is structured as a lecture-format class. You will be expected to do lab work in addition to class time to complete assignments. Time will be allowed to work on assignments in class. The open lab is available at the main campus. Check posted hours. | |||||||||
| C. Field Work: | |||||||||
| None | |||||||||
| D. Other Evaluation Methods: 40% of final grade | |||||||||
| Class
work, homework, weekly quizzes, and participation make up 40% of the final
grade. Each student is expected to complete all assignments.
In order for grades to be calculated, all assigned work must be submitted
by the designated date.
Plan 2-4 hours of study for each one-hour of class. If you are experiencing problems, please consult the instructor. |
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| E. Grading Scale: | |||||||||
| A
93-100
B+ 90-92 B 85-89 C+ 80-84 C 75-79 D 70-74 F less than 69 Grades for the course will be based on the percentage shown above for the tests, homework, participation and final exam. In order for grades to be calculated, all assigned work must be submitted in a timely fashion. Assigned work must be turned in by date designated. |
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| VI. Policies: | |||||||||
| A. Attendance Policy: | |||||||||
| Pellissippi State Technical Community College expects students to attend all scheduled instructional activities. As a minimum, students in all courses must be present for at least 75 percent of their scheduled class and laboratory meetings in order to receive credit for the course. [NOTE: No differentiation is noted for excused/unexcused absences. These will be treated as an absence.] (Pellissippi State, 2004-2006 Catalog, page 83) | |||||||||
| B. Academic Dishonesty: | |||||||||
| Plagiarism, cheating, and other forms of academic dishonesty are prohibited. Students guilty of academic misconduct, either directly or indirectly through participation or assistance, are immediately responsible to the instructor of the class. In addition to other possible disciplinary sanctions which may be imposed through the regular Pellissippi State procedures as a result of academic misconduct, the instructor has the authority to assign an F or a zero for the exercise or examination or to assign an F in the course. (Pellissippi State, 2004-2006 Catalog, pages 62-63) | |||||||||
| C. Accommodations for disabilities: | |||||||||
| If you
need accommodation because of a disability, if you have emergency medical
information to share, or if you need special arrangements in case the building
must be evacuated, please inform the instructor immediately. Privately
after class or in the instructor's office.
To request accommodations students must register with Services for Students with Disabilities: Goins 127 or 131, Phone: (865) 539-7153 or (865) 694-6751 Voice/TDD. |
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| D. Other Policies: | |||||||||
| Computer
Usage Guidelines:
College-owned or –operated computing resources are provided for use by students of Pellissippi State. All students are responsible for the usage of Pellissippi State’s computing resources in an effective, efficient, ethical and lawful manner. (Pellissippi State, 2004-2006 Catalog, pages 67-70) Proficiency Credit by Examination (CBE):
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