MEDICAL CODING AND BILLING

Approximate Completion Time – 4.5 months day/ 4.5 months night

Admissions Requirements:

Students applying for this program are required to:

  1.  interview with an admission counselor;
  2. be at least 17 years of age (applicants under the age of 18 require written permission from a parent or legal guardian in order to enroll); and
  3. present proof of secondary education (high school diploma or GED certificate)

Program Description:

The Medical Coding and Billing program (360 clock hours) prepares students for entry level employment as medical coder, medical biller, claims examiner, or related occupation. Medical coding and billing is in high demand as patient records are being increasingly scrutinized by insurance companies and regulators. Medical billing and coding workers are the health care professionals in charge of processing patient data such as treatment records and related insurance information. This program enables you to seek entry-level jobs at employers, such as private medical offices, clinics, hospitals, government agencies, nursing facilities, insurance companies, health consulting firms and other health related facilities. This program is designed to offer a balanced knowledge of medical science, technical ability and coding experience.

 

Subject# Subject Title Clock Hours

Lec/Lab

Total

Clock Hours

MTY 101 Medical Terminology 20/20 40
MOA 102 Medical Office Administration 20/20 40
MCB 103 Introduction to Coding 20/20 40
MCB 104 Health Claim Forms 20/20 40
MCB 105 Introduction to Health Claims Examining 08/32 40
MCB 106 Health Claims Examining and Processing 08/32 40
MCB 107 Dental Claims Examining 20/20 40
MCB 108 Advanced Coding 16/24 40
MCB 109 Medical Record Coder Clinical Practice 08/32 40
    Total Hours 360

Medical Coder and Biller Employment Requirements

The graduate of the Medical Coding and Billing program is eligible to take a national certification exam. National Certification is not necessary for employment as a biller and coder, and a certification test is not mandatory, but all graduates are encouraged to take the certification test in order to receive national certification as a medical biller and coder.

 Program Costs

Registration Fee – $100.00

Tuition, Books, Uniforms – $5900.00

MedCA National Certification Examinations

Institute does not pay costs related to MedCA national certification. These costs are paid directly to MedCA by students.

Subject Descriptions

MTY 101 Medical Terminology; pre-requisite – none

In this phase the students will get familiar with medical terms, including prefixes, root words, and suffixes. The student will study provider and medical abbreviations as well as disease, psychology and treatment methodology. This course will emphasize studying the following body systems: urinary, integumentary, musculoskeletal, respiratory, cardiovascular, digestive, reproductive, nervous, endocrine, eyes, ears, nose and throat. (Lec 20 clock hrs/Lab 20 hrs)

 

MOA 102 Medical Office Administration; pre-requisite – MTY101

This course is designed to introduce the beginning student to the basic principles of insurance terminology, health insurance and medical billing. In addition, the student will contemplate the impact of health insurance on today’s economy. We will also cover the different departments within an insurance company and operations. This phase will also give the student the opportunity to understand the importance of legal issues that affect the medical biller and health claims examiner. Students will be taught fundamentals of health information technology to provide them with the importance of written communication skills, accounts receivable management, supportive documentation, and customer service. (Lec 20 clock hrs/ Lab 20 hrs)

MCB 103 Introduction to Coding; pre-requisite – MOA102

The main subject of this course is the theoretical aspect of medical record coding. The student will be introduced to ICD-9 and ICD-10 basic coding rules and conventions, sequencing codes and other coding principles. We will cover the CPT-4 Coding System Structure of the three levels of CPT-4, general guidelines for using CPT-4, basic steps to assign CPT-4 and understanding the sequencing and linking requirements. During this course the student will become familiar with the terminology in the procedure and diagnostic coding systems to use them efficiently and provide accurate descriptions of services rendered and maximize payment from insurance companies. (Lec 20 clock hrs/ Lab 20 hrs)

MCB 104 Health Claim Forms; pre-requisite – MCB103

This course is designed to provide the student with the understanding and practical skills necessary to abstract relevant information from the medical records for completing the CMS-1500 claim form, as well as completely expediting the logins and processing of different types of medical forms. Students will study general guidelines for completing forms for different carriers to include: Medicare, Medicaid, and Workers’ Comp. This course will teach the student the knowledge necessary to optimize payment in a timely and cost efficient manner. The students will study the difference between clean, pending, rejected, incomplete and invalid claims and describe the reasons why claims were rejected. This course will also provide the student with the necessary skills to understand and complete the UB-92 claim form and to know when it may or may not minimize their chances of rejection by insurance carriers. (Lec 20 clock hrs/ Lab 20 hrs)

MCB 105 Introduction to Health Claims Examining; pre-requisite – MCB104

This course will introduce the student to the theory and practical skills necessary to process health insurance claims to include CMS-1500 and UB-92 as a health claims examiner. Additionally, the students will learn the difference between insurance companies and third party administrators. Students will be taught the basic concepts of medical billing practices of the areas that will be covered are: verification of eligibility, claims inventory, deductibles, provider billing, claims investigation, coordination of benefits, legislation and insurance riders. Emphasis will be placed on the premise that guidelines presented are generally accepted standards within the industry. (Lec 08 clock hrs/ Lab 32 hrs)

 MCB 106 Health Claims Examining and Processing; pre-requisite – MCB105

This course will give the student the opportunity to simulate the entire claims examination process in a group and individual setting. This course will also provide the student with the skills needed to understand and process the insurance claims for hospitals, physician services, DME, ambulance, x-ray and laboratory services. This phase will also provide the student with the skills necessary to understand the Coordination of Benefits and recognize the difference between primary and secondary payers, organize the order of benefit rules and right of recovery, and compute the correct secondary benefit and benefit reserve. The student will also learn to determine coordination of benefits as they apply to HMO and PPO plans. In addition the student will learn the importance of capturing all aspects of the CPT-4 integumentary system section, and will give the students an understanding of procedures performed on the skin, nails, and breast; including repair of lacerations, removal of lesions, insertion, and removal of subcutaneous contraceptive devices, treatment of decubitus ulcers, breast surgeries and reconstruction. (Lec 08 clock hrs/ Lab 32 hrs)

MCB 107 Dental Claims Examining; pre-requisite – MCB106

This course will provide the student with the information and practical skills necessary to process dental claims. Topics to cover include the structures of the teeth, restorative procedures, oral surgery, and examining the claims billed for these procedures. This course will also introduce the student to an ADA claim form, coding and conversion to CPT-4. This course will provide the student with the knowledge and practical skills necessary in applying the correct guidelines in using CPT-4 In-patient, Out-patient, and confirmatory consultation codes, as well as modifiers commonly used in reporting consultations. (Lec 20 clock hrs/ Lab 20 hrs)

MCB 108 Advanced Coding; pre-requisite – MCB107

Student will study the coding of more complex diagnostic and procedural statements. This subject will cover clinical information regarding specific disease processes, more advanced diagnostic and procedural terminology, detailed instruction exploring the CPT book section by section builds upon previous basic knowledge of payer reimbursement guidelines for optimal reimbursement. Understanding how to use the medical record to provide necessary information essential to the assignment of accurate codes will be covered. Students will recognize when multiple coding is required, when it is recommended and when it should not be used. Class room work will involve coding signs and symptoms, V-codes, infectious disease, neoplasm, endocrine, nutritional and metabolic diseases of the blood and blood-forming organs, mental disorders, diseases of the nervous systems and sense organs, circulatory, respiratory, digestive, and genitourinary system as well as diseases of the musculoskeletal system and connective tissue injuries, complications of surgical and medical care, and external causes of injury will be covered. (Lec 16 clock hrs/ Lab 24 hrs)

MCB 109 Medical Record Coder Clinical Practice; pre-requisite – MCB108

In this subject students will learn managed care systems, and special plans, collection policies, tracing delinquent claims, insurance problem solving, and the appeal process of Medicare and Medicaid. Students will learn coding and billing compliance for medical practices. Review current practices with respect to ICD-9-CM diagnosis and CPT-4 procedure coding and modifier knowledge for the generation of medical visit APCs. Practical work will also include the coding and more complex diagnostic and procedural statements in complication of pregnancy, childbirth, congenital abnormalities, and certain condition arising on the prenatal period. (Lec 08 clock hrs/ Lab 32 clock hrs)