Mar 21, 2023  
2022-2023 Catalog 
2022-2023 Catalog

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. 

Course Outcomes
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
F/S (N)