Medical Assisting Administrative Procedures II



Medical Assisting Administrative Procedures II WVEIS Code 0736

Within this course students will focus on policies and procedures necessary for medical reimbursement. Students will gain a working knowledge of the systems theory in health care. Additional components of this course include an introduction to Medical Office Coding, ICD-9-CM, CPT-4 Coding, CPT-4 Sections, and auditing process. Current technology will be utilized to master course standards. Students are provided the opportunity to participate in a Career and Technical Student Organization (CTSO).

Standard 1: Health Care Systems (0736.S.1)

Students will describe and apply the systems theory to health care.

Health Care Systems Objectives

Students will:

0736.1.1 Describe systems theory and its components.

0736.1.2 Construct a general systems model using inputs, throughputs and feed back loops.

0736.1.3 Explain the function of systems theory model.

0736.1.4 Describe how systems theory relates to health care.

0736.1.5 List the factors that affect the health care system and predict their influence.

0736.1.6 Construct a systems model depicting the interdependence of health care professionals.

0736.1.7 Analyze the cause and effect of change in the health care system based on the influence of:

technology, epidemiology, bio-ethics, socio-economics, and various forms of complimentary (non-traditional) medicine.

Standard 2: Medical Terminology (0736.S.2)

Students will understand basic medical terminology necessary to interpret and submit medical insurance claims.

Medical Terminology Objectives

Students will:

0736.2.1 Interpret commonly used medical roots, prefixes and suffixes.

0736.2.2 Interpret commonly used abbreviations.

0736.2.3 Incorporate standard medical terms and abbreviations in written and oral communications to interpret, transcribe, and communicate information, data, and observations.

Standard 3: Introduction to Medical Office Coding (0736.S.3)

Students will discuss knowledge of medical office coding principles.

Medical Office Coding Objectives

Students will:

0736.3.1 Describe the evolution of medical insurance in this country.

0736.3.2 Explain the significance of diagnosis-related groups.

0736.3.3 Define coding and discuss its origin and function.

0736.3.4 Categorize the types of codes used in health care.

0736.3.5 Examine and analyze the documentation tools used in the coding process.

0736.3.6 Demonstrate the proper technique for determining the physician’s diagnosis.

Standard 4: ICD-9-CM Coding (0736.S.4)

Students will interpret and apply basic concepts for ICD-9-CM coding.

ICD-9-CM Coding Objectives

Students will:

0736.4.1 Summarize the ICD-9-CM code book format.

0736.4.2 Describe the symbols, punctuation, and abbreviations used in ICD-9-CM codes.

0736.4.3 Discuss the steps for accurate coding from the ICD-9-CM code book.

0736.4.4 Describe the HCFA guideline for ICD-9-CM coding.

0736.4.5 Explain the purpose for V codes and E codes.

0736.4.6 Use the Drug and Chemical Tables found in the ICD-9-CM code book.

0736.4.7 Demonstrate the procedure for coding special complexities.

Standard 5: CPT-4 Coding (0736.S.5)

Students will interpret and apply basic concepts of CPT-4 coding.

CPT-4 Coding Objectives

Students will:

0736.5.1 Demonstrate the proper technique for determining codeable procedures and services.

0736.5.2 Summarize the CPT-4 code book format.

0736.5.3 Identify and understand the signs and symbols used in the CPT-4 code book.

0736.5.4 Discuss the use of modifiers to CPT-4 codes.

0736.5.5 Compare starred, global, and unlisted CPT-4 codes.

Standard 6: CPT-4 Sections (0736.S.6)

Students will interpret and apply CPT-4 code sections.

CPT-4 Sections Objectives

Students will:

0736.6.1 Apply the concepts of evaluation and management coding.

0736.6.2 Understand and apply the principle elements of anesthesia coding.

0736.6.3 Apply the surgery coding guidelines.

0736.6.4 Identify types of pathology services and explain proper application of coding rules for each category of services.

0736.6.5 Identify the proper coding guidelines for each subsection of the medicine services.

0736.6.6 Discuss the rules and application of modifiers to the coding process.

0736.6.7 Code a sample claim form.

Standard 7: Reimbursement and Auditing (0736.S.7)

Students will describe reimbursement and auditing processes.

Reimbursement and Auditing Objectives

Students will:

0736.7.1 Identify and describe the different reimbursement methods.

0736.7.2 Summarize the purpose of third party contracts and their effect on coding.

0736.7.3 Explain the components for payment calculations and reimbursement calculations.

0736.7.4 Abstract information from the patients’ medical records and complete claim forms.

0736.7.5 Recognize internal and external obstacles to accurate and timely reimbursement.

0736.7.6 Describe the auditing process, including the purpose of audits.

Standard 8: Technology (0736.S.8)

Students will apply knowledge of computers and their use within the health care system.

Technology Objectives

Students will:

0736.8.1 Integrate the use of software, hardware, and the Internet to practice and master standards identified in the course.

0736.8.2 Utilize the Internet as a resource/research tool.

Standard 9: Student Organizations (0736.S.9)

Students will participate in a Career and Technical Student Organization (CTSO).

Student Organizations Objectives

Students will:

0736.9.1 Participate in Health Occupations Students of America (HOSA) or SkillsUSA/Vocational Industrial Clubs of America (SkillsUSA/VICA).

0736.9.2 Apply parliamentary procedure in organizational meetings.

0736.9.3 Demonstrate team membership skills, such as cooperation and leadership.

0736.9.4 Take part in local, state, and national health care and education projects.

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