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 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

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    Visit Charges and Compliance Billing

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

    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.

    HIPAA and Medical Records

    • Summarize the purposes and provisions of HIPAA.
    • 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

    Diagnostic Coding

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

    Procedural Coding: Introduction to CPT

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

    Summarizing the Medical Billing Process

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

    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

    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
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    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.