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Medical Coder/Biller

Published
Competency-Based Apprenticeship
Sponsoring Company:
American Health Information Management Association (AHIMA)
O*Net Code
29-2072.00
Rapids Code
1114CB
Req. Hours
0
State
DC
Created
Jun 02, 2021
Updated
Jun 02, 2021

Competency-Based Skills

5 skill sets | 18 total skills
Receptionist Duties
Handle incoming and outgoing calls/e-mails to and from Physicians, department administrative assistants, the billing office, compliance office and others
Mail, fax, and handle correspondence
Office Procedures
Care and maintain office equipment
Develop and maintain mailing lists and tickler file
Inventory management
Use Query database to retrieve information
Insurance Coding
Use and understand format, conventions, guidelines and rules of ICD-10-CM diagnostic and procedural coding
Coding of insurance forms using ICD-10-CM and CPT
Process and complete all insurance forms
Code diagnoses and procedures
Medical Records
Retrieving and filing of medical records
Keep medical records updated
Locate data in and abstract information from medical records
Health Care Reimbursement
Comply with regulations related to fraud and abuse
Compare non-government payers versus government payers
Compare other prospective payment systems
Understand and comprehend reimbursement cycle
Apply facility based codes (i.e., Diagnostic Related Groups, Ambulatory Payment Classifications, and Resource Utilization Groups)

Technical Instruction

Program orientation with tutorials for Litmos and VLab - 2 req. hrs
Program overview
Medical Terminology - 45 req. hrs
This course covers medical terminology, symbols and abbreviations, and the application of this new language in the field of health care.  While terms are covered as they relate to body structure and function, the main focus is on medical vocabulary and being able to construct terms using word parts such as roots, suffixes, and prefixes.
Anatomy, Physiology & Human Disease - 45 req. hrs
This course provides an overview to the anatomical structures and physiology of the human body. Each body system is discussed in terms of the major anatomical structures and function including how each system participates in homeostasis of the body. In addition, the course discusses selected major pathologies, including disease definitions and causes, signs and symptoms, diagnostic procedures, and possible treatments. Finally, the course discusses common issues and changes that occur in each body system through the life span.
Pathophysiology and Pharmacology - 45 req. hrs
Emphasis is placed on the disease processes affecting the human body via an integrated approach to specific disease entities. Included will be the study of causes, diagnosis and treatment of disease as well as an understanding of the basic principles of pharmacology
Healthcare Delivery Systems - 45 req. hrs
An introduction to the organization, financing and delivery of health care services, this course gives an overview of the organization and activities of hospitals, nursing homes, mental health and ambulatory care centers, home health agencies, and hospices. Apprentices will also learn about the educational preparation and responsibilities of health care professionals and government regulations.
Healthcare Data Content and Structure - 45 req. hrs
This course introduces apprentices to the contents, use and structure of the health record, including data and data sets. It explains how these components relate to primary and secondary record systems and gives an overview of the legal and ethical issues applicable to health information.
Medical Law and Ethics - 45 req. hrs
This course introduces apprentices to legal and ethical issues related to the health care setting. This course provides an overview of the laws and professional requirements that regulate the delivery of health care, including HIPAA, the Patient's Bill of Rights, and standard of care. Apprentices will also gain an understanding of the ethical and moral issues that health care professionals may encounter.
Basic ICD Coding Part 1 - 45 req. hrs
This course provides the apprentice with the basic principles of the ICD-10-CM Coding and Classification System, including the following of guidelines, proper sequencing of codes and the impact on reimbursement.
Basic ICD Coding Part 2 - 45 req. hrs
A continuation of Part 1 of the Basic ICD Coding course, Part 2 focuses on ICD-10-PCS coding. This course emphasizes practice in the assignment of valid ICD-10-PCS procedure codes.
Basic CPT Part 1 - 45 req. hrs
An introduction to basic coding concepts using CPT/HCPCS. Coding/classification systems, this course emphasizes practice in the assignment of valid diagnostic and procedure codes in an ambulatory care setting. The course covers procedural terminology in current use, evaluation and management services, medicine, HCPCS Levels II and III and CPT Category II and III Codes
Basic CPT Part 2 - 45 req. hrs
A continuation of Part 1 of the Basic CPT/HCPCS Coding course, Part 2 utilizes higher level, more complex examples (case studies, records and scenarios). This course covers surgery coding, anesthesia coding, radiology coding, pathology and laboratory coding, and reimbursement in the ambulatory setting. Students are assigned exercises to complete using Nuance Healthcare's Clintegrity 360 encoder.
Reimbursement Methodology - 45 req. hrs
Emphasis is placed on the uses of coded data and health information in reimbursement and payment systems appropriate to all healthcare settings and managed care. Students are exposed to the contemporary prospective payment systems used by the U.S. government and other key health plans that comprise most patients' source of payment for healthcare services.
Professional Coding Practice - 60 req. hrs
This course offers apprentices the ability to practice coding in real-world professional coding scenarios. Apprentices step through more than six different settings to complete 101 online coding exercises using either codebooks or the 3M Encoder. In addition, using official coding guidelines, preparing for a career, keeping code sets current, and applying standards of ethical behavior are covered.
Post-immersion assessment - 4 req. hrs
Retired CCA exam questions.

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