CODES UNLIMITED HEALTHCARE



Enrollment Form Application

CODES UNLIMITED HEALTHCARE ACADEMY (CUHA)



Postsecondary School authorized by

Tennessee Higher Education Commission (THEC)

Presents Professional Medical Coding Curriculum (PMCC)

Sponsored by American Academy of Procedural Coders (AAPC)

Certified Professional Coder- Instructor---Donna M. Martin

MBA, BS-Healthcare Management. Approved Instructor, CPC; COC; CPC-P; MCS-P, CCS-P

ICD-10-CM Trained/Proficient-AHIMA, AAPC

36 yrs. experience: Current Physician Terminology (CPT®), ICD-10-CM Coding & HCPCS Level 2

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2020 Classes: ( January 18th –April 25th ( July 11th–October 17th (Dates subject to change)

15-week Professional Medical Coding Course includes:

1 Business of Medicine: Medical Compliance & Third-Party Reimbursement

2 ICD-10 CM- Principles

3 ICD-10 CM- Applications

4 Intro: Current Procedural Terminology (CPT®) and HCPCS Level 2; Surgical Package & Modifiers

5 Intro to Documentation (operative cases/procedures covered through-out the course) & CPT Anesthesia

6 Surgery: Integumentary & Musculoskeletal Systems

7 Surgery: Respiratory System

8 Surgery: Cardiovascular & Digestive Systems

9 Surgery: Urinary, Male & Female Reproductive Systems

10 Surgery: Endocrine, Nervous, Eye, & Ear Systems

11 Radiology & Pathology

12 Evaluation & Management (E/M) Principles

13 Evaluation & Management (E/M) Applications (Chart Auditing-Documentation

14 ____ Medicine

15 Review session (Study Guide) ( 4/25/19 ( 10/17/19 (Dates are subject to change)

16 Individual Class (workshop/seminar) ( 2020 ( 2020 ( 2020 ( 2020 ( 2020

( Full-time: ( Part-time: ( New ( Returning Student

Time: 9:00-til 1:30 pm or lesson completed (4-6 hrs)

Location: 8 South Dunlap Memphis, TN 38103-Humphreys General Education Bldg. (GEB) Room B134

Total Tuition $: 2025 -15 classes that includes a review session: Other required fees (subject to change): PMCC workbooks ($95), plus National (AAPC) ($90) & Local (MSAPC) membership. Other required current year textbooks are not included: AMA CPT Professional, ICD-10-CM; HCPCS Level 2. Check website for textbook (bundled sets). Examination fee is not included.

Full-Time: Student ID No. (office use only)

Name: Signature:

SSN: (if faxing, only add last four digits: Contact CUHA with remaining numbers)

Home Address City State Zip Code

Home Phone ( ) Employer Name

Employer Address: Employer ( ) Fax ( )

Title: Email:

Payment received: ( Cash (Correct Amount) ( Cash App ( Money order ( Check No. ( )

Credit Card: ( VISA ( MASTERCARD ( American Express ( DISCOVER:

Know that all credit cards are accepted, and additional processing fee is associated. (Processing include 2.9% + .30cents increased fee)

← Paid in Full: $ ( Official Receipt provided

← Self-Pay:

← Employer

← Other Source:

Payment method & terms:

All payments will be processed the Friday before class- An invoice will be submitted as payments are due for credit card and/or a request for cash app

Set up fee $30.00 is due with initial payment. Other payment options are subject for review: Student is required to pay the down-payment of $800 or more during the final enrollment meeting.

.

( Payment plan: check one (Down-payment fee $ Date:

( Monthly: Dates:

( Bi-monthly (half/half): Dates:

( Every two weeks: Dates:

Fee Processed: $ Date:

Only provide last four digits ID#: (contact CUHA to provide all 16 numbers)

Expiration date (month/year) Number of back of card:

Name as appear on card: Zip Code:

Signature:

If using payment plan, please sign below to give CUHA permission to process credit card payment each pay date agreed upon: Know that there is additional processing fee.

( Pay dates/Approval (office use only):

(Payable to Codes Unlimited Healthcare Academy, P. O. Box 753056, Memphis, TN 38175) Contact Donna Martin at (901) 336-3677.

Fax number is (901) 366-3468.

In the event of a cancellation for the 15-weeks Professional Medical Coding Curriculum (PMCC); cancellation fees are based on the stated cost ($2025) on the enrollment application and the cancellation date. Last Day of 100% ($2025) refund period less administration cost $145 (cancellation, application, and workbook fees, last day to withdraw is the first day of class for that enrollment period. Last Day of 75% ($1518) refund period less administration cost $145 (cancellation, application, and workbook fees, last day to withdraw is the second day of class for that enrollment period. Last Day of 25% ($506) refund period less administration cost $145 (cancellation, application, and workbook fees, last day to withdraw is the third day of class for that enrollment period.

The 2019 FY Graduation Placement Data is stated at or along with the pre-enrollment form.

Disclaimer: CUHA does not guarantee passing of American Academy Professional Coders’ (AAPC) national certification exam. Students are responsible for submitting national exam application to the AAPC four weeks in advance of the next scheduled exam date. Please reference catalog for additional disclaimers.

Student has received an exact copy of this agreement: Signature of Student: Date:

(Office use only) Enrollment form Received:

(Office use only) Date: Schedule Date:

Place: Time:

( 3030 Poplar-Benjamin Hooks ( 7200 East Shelby Dr. ( 4120 Millbranch

( Other

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