Mar 21, 2023
MA 214 - Physician Office Coding and Reimbursement
Credit Hours: 2
This course introduces students to the principles of ICD-10-CM and CPT-4-PC coding systems as applicable to the physician’s office using the MEDENT Cloud TLS Electronic Health Records (EHR) Practice Management System (PMS) in a Microsoft Windows environment. Students will also learn the fundamentals of the Healthcare Common Procedure Coding Systems II (HCPCS Level II) and related managed care and third-party reimbursement systems, the effects of upcoding and downcoding, medical necessity, patient referrals, insurance verification, prior authorization, and claim tracking.
Upon completion of this course, students will be able to:
- identify the current procedural and diagnostic coding systems, including Healthcare Common Procedure Coding Systems II (HCPCS Level II);
- identify the effects of upcoding and downcoding;
- define medical necessity and utilize medical necessity guidelines;
- perform diagnostic and procedural coding;
- identify types of third-party plans and the steps for filing a third-party claim;
- identify managed care requirements for patient referrals;
- identify processes for insurance verification, eligibility for services, precertification, prior authorization, claim tracking, claim denials and appeals;
- identify fraud and abuse as they relate to third-party reimbursement; and
- identify the purpose and components of the Explanation of Benefits (EOB) and Remittance Advice (RA) Statements.
Prerequisites: Completion of all developmental English; OF 102
Corequisites: MA 213