Catalog Course Search Details

 Department:    AHE

 Course #:    110

 Credits:    5

 Variable:     No

 IUs:    5.5

 CIP:    510801

 EPC:    381

 REV:    2018

 Course Description  

Use of the Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) manuals to properly code and process government and private insurance forms. Other procedure/diagnosis coding systems include: Diagnosis Related Groups (DRGs), Healthcare Common Procedure Coding System (HCPCS), Resource Based Relative Value Scale (RBRVS); and managed care referrals and pre-certifications.

 Prerequisite  

Prerequisite: AHE 102 (or AHE 160 and 161) and OFTEC 162 with minimum C grade, or department chair permission.

Contact Hours (based on 11 week quarter)

Lecture: 44

Lab: 22

Other: 0

Systems: 0

Clinical: 0

Intent: Distribution Requirement(s) Status:  

Vocational Preparatory Required for ATA degree, Required for certificate  

Equivalencies At Other Institutions

Learning Outcomes

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

1. Apply managed care insurance policies and procedures.
2. Apply third party insurance guidelines.
3. Obtain managed care insurance referrals and pre-certifications.
4. Perform procedural coding.
5. Perform diagnostic coding.
6. Complete insurance claim forms.
7. Use a physician�s fee schedule.
8. Discuss procedural/diagnostic coding.
9. Complete and maintain selected financial forms and records related to medical insurance.

General Education Learning Values & Outcomes

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

1. Information Literacy

Definition: Recognizing when information is needed and have the ability to locate, evaluate, and use effectively the needed information.

Outcomes: Students will be able to . . .
1.1 Determine the extent of information needed.
1.2 Access the needed information effectively, efficiently, ethically, and legally.
1.5 Effectively integrate and use information ethically and legally to accomplish a specific purpose.

2. Critical Thinking

Definition: The ability to think critically about the nature of knowledge within a discipline and about the ways in which that knowledge is constructed and validated and to be sensitive to the ways these processes often vary among disciplines.

Outcomes: Students will be able to . . .
2.3 Identify, interpret, and evaluate pertinent data and previous experience to reach conclusions.

10. Technology

Definition: Understanding the role of technology in society and using technology appropriately and effectively.

Outcomes: Students will be able to . . .
10.3 Use technology appropriate to the context and task to effectively retrieve and manage information, solve problems, and facilitate communication.

Course Contents

1. Introduction to types of insurance.
2. Discussion of various reporting procedures.
3. Creation of insurance claims for manual and electronic claims.
4. Primary and secondary carriers.
5. Insurance payment and rejection procedures.
6. Methods of reprocessing claims.
7. Universal insurance forms.
8. Methods to keep office/clinic staff current in medical coding.
9. Financial forms and records related to medical insurance.