Catalog Course Search Details

 Department:    AHE

 Course #:    110

 Credits:    5

 Variable:     No

 IUs:    5.5

 CIP:    510801

 EPC:    381

 REV:    2021

 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 OBT 162 with a "C" or higher.

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 in the outpatient setting.
5. Perform diagnostic coding in the outpatient setting.
6. Complete insurance claim forms.
7. Compare and contrast the top five government and commercial insurance health plans in the U.S.
8. Discuss 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.

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.