Catalog Course Search Details

 Department:    AHE

 Course #:    123

 Credits:    5

 Variable:     No

 IUs:    5

 CIP:    510801

 EPC:    381

 REV:    2019

 Course Description  

Application of professional skills in evaluating medical records for accuracy and completeness in various health care settings. Preparing UB-04 and CMS-1500 claims for health insurance plans. Covers assigning correct code numbers to diagnoses and procedures in an online coding practicum in preparation for the CRC certification exam.

 Prerequisite  

Prerequisite: AHE 122 with minimum C grade or department chair permission.

Contact Hours (based on 11 week quarter)

Lecture: 55

Lab: 0

Other: 0

Systems: 0

Clinical: 0

Intent: Distribution Requirement(s) Status:  

Vocational Preparatory Required for certificate  

Equivalencies At Other Institutions

Learning Outcomes

After completing this course, the student will be able to:

1. Describe the billing guidelines for medical/surgical services and procedures provided in the inpatient and outpatient setting.
2. Summarize the life cycle of an insurance claim and explain the processing steps to be completed before submitting to the insurance company.
3. Accurately prepare UB-04 and CMS-1500 claim forms in a manner that will minimize rejection by insurance companies.
4. Be familiar with patients' reimbursement calculations and payment methods to determine if the payment is correct.
5. Demonstrate the ability to accurately code procedures and diagnoses in an online coding practicum environment from selected outpatient case studies.

General Education Learning Values & Outcomes

Revised August 2008 and affects outlines for 2008 year 1 and later.

Course Contents

1. Organizing, analyzing, and technically evaluating a variety of health care records for billing purposes.
2. Assignment of correct codes to diagnoses.
3. Assignment of correct codes to procedures.
4. Correct completion of UB-04 and CMS-1500 claim forms.