Medical Coding and Billing (Certificate) Curriculum

This course introduces students to different types of healthcare delivery systems and how to analyze the organization, financing, regulatory issues, and delivery of different healthcare services. Topics covered include the "continuum of care" concept, and methods and theories in healthcare delivery systems and computer applications in healthcare. Focus is placed on evolution and trends in managed healthcare, including research, statistics, quality management, and integrating information technologies into medical office practices. Other processes such as staffing, productivity, and improving quality are also discussed.

This course teaches the foundation of the language of healthcare. Students will learn how to pronounce medical terms and communicate medical information to both health professionals and patients. Students will also learn the principles of word-building needed for the extensive medical vocabulary used in healthcare. Students will utilize interactive technology to assist with learning, pronunciation and application in Anatomy and Physiology.

This course examines medical billing and coding in medical practice. All basic medical billing and coding issues are discussed, including coding diagnosis, the International Classification of Diseases Manual (ICD-10-CM), coding compliance and legal and ethical compliance. Students extrapolate coding information from the ICD-10-CM manual and examine usage guidelines for Volumes I, II and III.

This course provides the student with in-depth coverage of procedural coding utilizing the HCPCS coding system composed of Current Procedure Terminology (CPT) and national codes. The course includes detailed application of the CPT classification system for outpatient services. Emphasis includes Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology, and Laboratory and Medicine codes, as well as the use of modifiers. Students will apply coding and billing principles through the use of coding exercises and coding simulation software.

This course provides students with a working knowledge of medical insurance and its applications. Emphasis is on understanding insurance essentials, including the role of the medical insurance billing specialist and legal and ethical requirements. Medical documents and coding diagnoses and procedures are discussed. Students comprehend the claims process, focusing on charges, methods of payments, billing and reimbursement. Other topics covered are private payers, Blue Cross and Blue Shield, Medicaid and Medicare, TRICARE and worker's compensation. Patient billing software is also explored.

Students in this course will gain practical experience applying advanced ICD-10-CM and CPT coding skills. Students will come from a variety of healthcare settings including hospital, physicians’ offices, and/or other healthcare settings. Intensive coding application will be achieved through the use of real medical records, case studies and scenarios. The training in this course integrates coding and the classification of diseases and treatment in preparation for certification and employment as a clinical coding specialist.