Syllabus for Medical Front Office Customized Job Skills Training –
AHE 105 – Insurance Billing and Coding, Medisoft and Medical Terminology
Fall Quarter 2006
Class begins – January 2, 2007
Class Ends – March 15, 2007
Student Coordinator/Instructor: Jennifer Evans
Office location: Aviation Building
Office phone number: 206-768-6646
Cell phone number: 206-228-7561
Office hours: Due to schedule, by appointment only
Program hours: 9:00-4:30 Monday through Thursday and 9:00-12:00 on Friday
AHE 105 Class Hours:
Monday and Wednesday 10:00 – 12:30 and 1:00-4:30 Lunch is from 12:30-1:00
Go to www.medoffice.blogspot.com for copies of policies.
All absences must be called into either office or cell number before the start of class or emailed to Jennifer Evans Coordinator/Instructor.
If you have a documented disability and are in need of support services or accommodations, please contact Disability Support Services in the Robert Smith Building, Room RS 12 (763-5137) for assistance in developing a plan to address your academic needs.
This course develops vocabulary skills of pronunciation, meaning, and spelling of common medical terms. Students will acquire a vocabulary of common medical terms by learning to identify root forms, prefixes, suffixes, combining forms and abbreviations for medical terms, medical procedures and therapeutic interventions used in medicine.
This course also provides a foundation in the principles and practices of medical billing and insurance processing, using ICD-9, CPT codes and HCPCS codes, to complete insurance forms, and medical record information to complete appropriate patient paperwork. This course also utilizes MediSoft for electronic billing and coding management. Work will be completed by hands-on in both classroom and lab setting.
Prerequisites: A keyboarding score of 35 wpm or better, or by Coordinator approval. Students must be able to read and understand college level text and follow both written and oral instructions. If a student is in need of tutoring due to a documented learning or physical disability, please contact Special Student Services and the Instructor.
Required texts and materials:
Medical Insurance Billing and Coding – An Essentials Worktext, by Marilyn T. Fordney and Linda L. French, Saunders, 2003
Patient Billing – Using MediSoft Advanced 4th Edition, Susan Sanderson, Glencoe, 2003
Mastering Healthcare Terminology, Betsy Shiland; Mosby; 2004
Outline of topics in AHE 105 Introduction to Medical Insurance, Coding, MediSoft and Medical Terminology
Medical Insurance, Billing and Coding
1. Career and Professionalism
a. Roles and Responsibilities
2. Patient Scheduling
a. Check in patients
b. The steps in scheduling patient appointments
c. Determine urgency of appointment.
d. Handling cancellations.
e. Understand the appointment matrix.
3. Basics of Medical Insurance
a. Understand the types of reimbursement.
b. Knowledge of insurance vocabulary.
c. Be familiar with insurance forms and how to complete them.
d. Medicare and Medicaid basics
e. Insurance abuse and fraud implications
f. Documents and the Insurance Claim Cycle.
g. The reimbursement cycle
h. Types of office documents in insurance
4. Medical Insurance Coding
a. Vocabulary of coding
b. Be familiar with ICD-9CM codes and CPT codes.
c. Be familiar with how to complete the HFCA-1500 form.
d. Seriousness of coding errors
5. Coding Procedures
a. Evaluation and Management
b. Anesthesia, surgery and radiology
c. Pathology/Laboratory and Medicine
6. Claim Submission
a. Billing cycle.
b. Legal ramifications of overdue accounts.
c. Aging accounts.
d. Truth in Lending
e. Data Storage
7. CMS 1500 forms Completion and Submission
8. Managed Care and Private Insurance
9. Government Insurance Programs
c. TRICARE and CHAMPVA
d. Worker’s Comp and Disability Programs
10. Billing and Collections
11. Tracking Reimbursement
12. Medical Practice Simulations
13. Insurance Software Challenge
Work with Medisoft software and be able to navigate through the various databases with confidence.
1. Enter and edit new patient records.
2. Input and edit patient cases.
3. Enter insurance information.
4. Input data based on codes and information from the superbill.
5. Make deposits from patients and insurance companies.
6. Apply payments to patient accounts.
7. Print receipts.
8. Print reports.
9. Schedule appointments on the computer.
12. Search for appointment dates.
13. Print appointment reports.
1. Understand connotations of Greek and Latin prefixes, suffixes, and combining forms.
2. Identify plural forms.
3. Know abbreviations.
4. Use a medical dictionary and other reference sources proficiently.
5. Pronounce words correctly.
6. Importance of correct spelling and pronouncing of terms.
7. Have a working knowledge of the body system and the applicable medical terms.
8. Know common medical terms associated with the integumentary system, musculoskeletal system, gastrointestinal system, urinary system, male and female reproductive systems, blood, lymphatic and immune systems, cardiovascular system, respiratory system, nervous system, mental and behavioral health, eyes and ears, endocrine systems and oncology, as well as diagnoses, procedures, pathology, surgical, and pharmacology areas.
9. Identify and use appropriate medical terms and Medical Abbreviations in other medically related paperwork
SSCC STUDENT LEARNING OUTCOMES are the knowledge and abilities every student graduating with a certificate or degree from South Seattle Community College will have. Students will achieve these outcomes as well as the specific curriculum outcomes for their academic or technical area of study.
o Read and listen actively to learn and communicate
o Speak and write effectively for personal, academic, and career purposes
o Use arithmetic and other basic mathematical operations as required by program of study
o Apply quantitative skills for personal, academic, and career purposes
o Identify, interpret, and utilize higher level mathematical and cognitive skills (for those students who choose to move beyond the minimum requirements as stated above)
3. Human Relations
o Use social interactive skills to work in groups effectively
o Recognize the diversity of cultural influences and values
4. Critical Thinking and Problem-Solving
º Think critically in evaluating information, solving problems, and making decisions
o Select and use appropriate technological tools for personal, academic, and career tasks.
6. Personal Responsibility
o Be motivated and able to continue learning and adapt to change
o Value one's own skills, abilities, ideas, and art
o Take pride in one's work
o Manage personal health and safety
o Be aware of civic and environmental issues
7. Information Literacy
o Access and evaluate information from a variety of sources and contexts, including technology
o Use information to achieve personal, academic, and career goals, as well as to participate in a democratic society.
Grading and evaluations
Grading is based on the following grading system for all insurance forms:
Each form related assignment will have a number grade of 0-100 based on the amount of errors per document.
0 errors = 100
1 error = 90
2 errors = 80
3 errors = 70
4 errors = 60
5 errors = 50
6 errors = 40
7 errors = 30
8 errors = 20
9 errors = 10
10 errors = no credit
Quizzes, projects/portfolios and exams equal 50% of your overall grade
All homework and in class assignments equal 50% of your overall grade.
Quizzes and Exams will be either on computer or on paper. There will be NO late tests given.
All study questions are worth 50 points per chapter. If you would like 25 extra points, you may type both the question and answer for all of the study questions. This format serves the purpose to assist you with studying. There will be NO late homework accepted.
A final grade of 80 % (2.0) or below is unacceptable and will result in a non-passing grade for this class. A non-passing grade for any class will result in not passing the Medical Office program.
Timeline for class assignments
Please refer to the tentative timeline for specific details. This document will be given separately.