STANDARD COMPETENCIES:

 

 I.      Identify the correct primary diagnoses; follow ICD-9 rules and regulations and code accurately by utilizing resources appropriately. (I)

 II.     List the components of the evaluation and management codes, distinguish the different levels of service, and identify the specific categories and subcategories.  Identify when modifiers are needed and use the appropriate code.  (II)

 III.    Accurately and completely classify procedures applicable to:

         A.      Anesthesia

         B.      Integument system

         C.      Orthopedics

         D.      Cardiology

         E.      OB/GYN

         F.      Radiology

         G.      Pathology

         H.      Lab

 IV.     Define and distinguish what codes are HCPCS.  Accurately and completely code supplies using HCPCS. (III)

 V.      Prepare a ledger card showing charges, payments and adjustments and how the patient balance is affected.  Identify the types of bookkeeping systems and billing cycles and know their advantages and disadvantages.  Explain account aging and the purpose of the aging analysis.  (IV)

 VI.     Abstract information from the patient medical record to complete the HCFA 1500 form correctly.  Differentiate between a participating and non- participating provider.  Define and explain the two types of Medicare coverage.  Define and explain the functions of managed care organizations and other third party payers and how they affect health care and reimbursement.  (V)

 VII.    Discuss the need for insurance claim follow-up.  Identify problem claims and know how to request a review or pursue an appeal.  Pinpoint discrepancies in billing and documentation.  Recognize and identify audit flags, compliance concepts, and evaluation and management code guidelines.  (VI)

 TOPICAL OUTLINE:

 

 I.      ICD-9 Coding

 II.     CPT Coding

 III.    HCPCS Coding

 IV.     Billing and Collection

 V.      Filing a HCFA-1500 Claim Form

 VI.     Reimbursement, Auditing and Appeals