hcr220 | undergraduate

Claims Preparation I: Clean Bills Of Health

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Medical records processing revolves around insurance and reimbursement. This course focuses on the background, knowledge and skills related to basic billing duties, HIPAA regulations, patient encounters, and the preparation, compliance, and transmission of claims. Students are introduced to the current state and future direction of the major diagnostic and procedural coding systems.

This undergraduate-level course is 9 weeks This course is available as part of a degree or certificate program. To enroll, speak with an Enrollment Representative.

Course details:

Credits: 3
Continuing education units: XX
Professional development units: XX
Duration: 9 weeks

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    Summarizing the Medical Billing Process

    • Relate HIPAA, ICD, CPT and HCPCS to the medical billing process
    • Illustrate the billing process using the CMS 1500 form
    • Discuss social, legal and ethical ramifications of HIPAA violations

    Introduction to the Medical Billing Process

    • Compare and contrast features of various health plans.
    • Explain capitation and fee-for-service payment methods.
    • Explain the basic steps in the medical billing process.

    Procedural Coding: Introduction to HCPCS

    • Explain HCPCS coding steps in the billing process
    • Compare permanent codes and temporary codes
    • Apply Level II HCPCS modifiers

    HIPAA and Medical Records

    • Relate ethics and etiquette standards for medical record keeping to HIPAA
    • Debate how medical compliance plans limit liability.
    • Discuss the relationship between medical records documentation and billing
    • Summarize the purposes and provisions of HIPAA.

    Patient Encounters and Billing Information

    • Describe factors that determine patient eligibility
    • Describe patient charges, billing procedures, and transactions
    • Discuss strategies to improve the patient intake process

    Diagnostic Coding

    • Discuss V and E Codes
    • Determine appropriate diagnosis code categories
    • Explain the purposes of the Alphabetic Index and Tabular List

    Procedural Coding: Introduction to CPT

    • Describe CPT coding categories.
    • Identify CPT modifiers
    • Assign appropriate Evaluation and Management (E/M) codes

    Visit Charges and Compliance Billing

    • Discuss the impact of the Medicare National Correct Coding Initiative on medical billing and coding processes
    • Evaluate billing compliance strategies
    • Relate physician and payer fees to medical compliance

    Health Care Claim Preparation and Transmission

    • Compare the role of HIPAA 837 with CMS-1500 in the claim process
    • Explain the importance of preparing and submitting "clean claims"
    • Complete a CMS-1500 claim form.
    Tuition for individual courses varies. For more information, please call or chat live with an Enrollment Representative.

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    Teacher Rate: For some courses, special tuition rates are available for current, certified P-12 teachers and administrators. Please speak with an Enrollment Representative today for more details.

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    While widely available, not all programs are available in all locations or in both online and on-campus formats. Please check with a University Enrollment Representative.

    Transferability of credit is at the discretion of the receiving institution. It is the student’s responsibility to confirm whether or not credits earned at University of Phoenix will be accepted by another institution of the student’s choice.