Description

Contra Costa Medical Career College’s Billing and Coding course thoroughly prepares students to code patients’ medical records correctly and optimize reimbursement for a full range of medical services. Students are introduced to several techniques for finding and applying the correct codes in today’s standard coding systems. Topics covered include: current procedural terminology, international classification of diseases, clinical modification, healthcare procedure coding system, resource-based relative value scale, insurance form preparation, Medicare, Medicaid, Tricare, Blue Cross/Blue Shield, Workers’ Compensation, No Fault, HMO’s, diagnosis-related groups, peer review organizations, and ambulatory patient groups.
Nature of the Work

In the past, a medical assistant working in a physician’s office performed both administrative and clinical duties.  Then, as decades passed, he or she performed either one or the other.  Now, due to changes in government regulations and standards for the insurance industry, specific medical assisting job tasks have become specialized.  In a medical practice, it is commonplace to find administrative duties shared by a number of employees. (Certified Medical Administrative Assistant, bookkeeper, file clerk, Certified Billing & Coding Specialists, etc.)  In clinics and large practices, it is common to find a billing department made up of many people, within the department, such as a Medicare billing specialist, Medicaid billing specialist, coding specialist, insurance counselor, collection manager and medical and financial records manager.  (Fordney, 2004 Insurance Handbook for the Medical Office.)

Coding Specialists assign a code to each diagnosis and procedure. They consult classification manuals and also rely on their knowledge of disease processes. Technicians then use computer software to assign the patient to one of several hundred “diagnosis-related groups,” or DRGs. The DRG determines the amount for which Medicare or other insurance programs using the DRG system will reimburse the hospital if the patient is covered. Technicians who specialize in coding are called health information coders, medical record coders, coder/abstractors, or coding specialists. In addition to the DRG system, coders use other coding systems, such as those geared towards ambulatory settings or long-term care.

 Billing & Coding Specialists’ duties vary with the size of the facility. In large to medium-sized facilities, technicians may specialize in one aspect of health information, or supervise health information clerks and Transcriptionists while a medical records and health information administrator manages the department. In small facilities, a credentialed medical records and health information technician sometimes manages the department.  (US Department of Labor, Occupational Outlook Handbook.)
Significant Points:

• This is one of the few health occupations in which there is limited contact with patients.
• Job prospects should be very good, particularly in offices of physicians.

Upon completion of the course, the student should be able to:

• Discuss an insurance company claim process.
• Discuss the process for obtaining authorization for additional treatment by a healthcare specialist.
• Discuss the authorization process for a patient requesting an initial appointment with a health care specialist.
• Discuss the difference between the terms “primary diagnosis” and “principal diagnosis”.
• Identify and properly use special terms, marks, abbreviations, and symbols used in ICD-9-CM coding system.
• Explain the format of the CPT system.
• Discuss the qualifications for a “preventative medicine visit”.
• Define the following terms, phrase and abbreviations:
• Medical necessity
• Subjective, Objective Assessments
  • Plan
  • Operative report
  • OP notes
• Code diagnoses and procedures from source documents to complete insurance information on the CMS-1500 claim form. (Formerly HCFA-1500)
• State the four processing steps that must occur before a completed form can be mailed to the insurance company.
• Explain function of National Blue Cross and Blue Shield Association.
• List six categories of persons eligible for Medicare coverage.
• List and define seven types of insurance programs that are primary to Medicare.
• State the deadline for filing Medicare claims.
• List Medicaid federal guidelines.
• List services covered under the federal portion of Medicaid assistance.
• Explain how to verify a patient’s Medicaid eligibility.
• List Tricare eligibility categories; List six services that are not covered by Tricare.
• Demonstrate understanding of HIPAA Compliance, PHI, and Confidentiality
• List and define the levels of Tricare coverage.
• List the categories of workers covered by the federal compensation program.
• List and describe types of workers compensation available at state level.
• Describe the correct billing procedures for workers compensation cases.
• Describe how to set up a filing system for completed claim forms.

Working Conditions

Billing & Coding Specialists usually work a 40-hour week. Some overtime may be required. In hospitals—where health information departments often are open 24 hours a day, 7 days a week—specialists may work day, evening, and night shifts. Billing & Coding Specialists work in pleasant and comfortable offices. This is one of the few health occupations in which there is little or limited contact with patients. Because accuracy is essential in their jobs, technicians must pay close attention to detail. Technicians who work at computer monitors for prolonged periods must guard against eyestrain and muscle pain.

Employment

In 2007, thirty-seven percent of all Billing and Coding jobs were in hospitals. The rest were mostly in offices of physicians, nursing care facilities, outpatient care centers, and home healthcare services. Insurance firms that deal in health matters employ a small number of health information technicians to tabulate and analyze health information. Public health departments also hire technicians to supervise data collection from healthcare institutions and to assist in research.

Job Outlook

Job prospects should be very good. Employment of Billing & Coding Specialists is expected to grow much faster than the average for all occupations through 2012, due to rapid growth in the number of medical tests, treatments, and procedures that will be increasingly scrutinized by third-party payers, regulators, courts, and consumers.

Although employment growth in hospitals will not keep pace with growth in other healthcare industries, many new jobs will nevertheless be created. The fastest employment growth and a majority of the new jobs are expected in offices of physicians, due to increasing demand for detailed records, especially in large group practices. Rapid growth also is expected in nursing care facilities, home healthcare services, and outpatient care centers. Additional job openings will result from the need to replace technicians who retire or leave the occupation permanently.

2010 Class Schedule - Billing & Coding