Medical Billing & Medical Coding Combination Program
MBILLMCODE — Medical Billing and Medical Coding , hours
Lakewood College’s Medical Billing program is to provide a comprehensive understanding of medical billing and its components. This program will contain many topics regarding medical billing topics such as managed care, insurance claim processing, a brief introduction to ICD-10-CM coding, HCPCS coding, and CPT coding and reimbursement methodologies. It will also cover claim form submission for Medicare, Medicaid, Blue Cross Blue Shield, Workers’ Compensation, and TRICARE. It will also cover the basic office needs, how coding and billing interrelate, and how to maintain and establish the electronic health record.
Professor
Gina Hobert
Gina is the Internal Audit Director at MaineGeneral Health in the Health Information Services Department. Prior to joining MaineGeneral Health, she was a Senior Manager Consultant at BNN’s healthcare management consulting practice, specializing in medical billing and coding education, provider education, chart auditing, billing compliance, provider-based practices and billing, and chargemaster reviews.
Gina has over 25 years of healthcare experience, including managing billing compliance and medical audit functions, and conducted educational sessions for a major New England hospital system. She was also previously employed as the director of the Coding Center, which provided chart auditing services, on-site coding education programs, and coding certification courses.
Online Support (IT) and Moodle Navigation
All members of the Lakewood University community who use the University’s computing, information or communication resources must act responsibly. Support is accessible by calling 1-800-517-0857 option 2 or by emailing info@lakewood.edu
Books and Resources
Medical Billing
Green, Michelle A., and Jo Ann C. Rowell. Understanding Health Insurance: A Guide to Billing and Reimbursement. 14th ed. Clifton Park, NY: Delmar Cengage Learning, 2019
Medical Coding
Buck, Carol J. Step-by-Step Medical Coding. 1st ed. Elsevier, 2018
Buck, Carol J. Workbook for Step-by-Step Medical Coding. 1st ed. Elsevier, 2018
AACP. ICD-10-CM Code Book. AAPC, 2021
AACP. HCPCS Level II Expert 2021. AAPC, 2021
AMA. AMA CPT® Professional. AMA, 2021
Evaluation Method
Graded work will receive a numeric score reflecting the quality of performance.
Course Requirement Summary
- Assignments - Total of 140 Points
- Weekly discussion forums-Total of 70 Points
- Lesson Test - 1400 Points
- Final Exam - 50 Points
- Practical Learning Exercises – 200 Points
Grading Scale
Graded work will receive a numeric score reflecting the quality of performance as given above in evaluation methods. The maximum number of points a student may earn is 1660. To determine the final grade, the student's earned points are divided by 1660.
Your overall course grade will be determined according to the following scale:
A = (90% -100%)
B = (80% - 89%)
C = (70% - 79%)
D = (60% - 69%)
F < (Below 60%)
Assignment and Discussion Forum Post Rubrics
Writing Assignment Grading Rubric
|
Points |
Excellent |
Good |
Poor |
Very Poor |
No Response |
|
Original Posting ____/10 |
Writing assignment was well thought out, coherent, and thoughtfully organized with all parts of the questions addressed along with appropriate grammar and spelling |
Writing was clear and relatively well organized and responded to many/most of the key points with a few mistakes in regard to grammar and spelling |
Writing was somewhat confusing and not well organized and had little or no focus on the subject matter with significant grammar and spelling errors |
Writing is confusing and hard to follow with no organization while missing the point of the assignment entirely |
No Assignment |
|
Total Points ____/10 |
Additional Comments: |
Discussion Question Grading Rubric
|
Points |
Excellent Pass |
Good Pass |
Poor Fail |
No Response Fail |
|
Original Posting PASS/FAIL |
Original post reflected good focus to the discussion with well thought out ideas and appropriate grammar and spelling |
Original post responded to the topic in a general fashion but failed to organize them well and had a few mistakes in regard to grammar and spelling |
Responded with little or no focus to the discussion and contained short, irrelevant and/or confusing commentary with significant grammar and spelling errors |
No posting |
|
Reply to fellow student PASS/FAIL |
Response to fellow student reflected good focus to the post with well thought out ideas and appropriate grammar and spelling |
Response to fellow student in a general fashion but failed to organize them well and had a few mistakes in regard to grammar and spelling |
Little or no focus to the post and contained short, irrelevant and/or confusing commentary with significant grammar and spelling errors |
No posting |
|
Total Points PASS/FAIL |
Additional Comments: |
Academic Integrity/ Plagiarism
Cheating (dishonestly taking the knowledge of another person whether on a test or an assignment and presenting it as your work) and plagiarism (to take and pass off as one's own the ideas or writing of another) are a serious issue. While it is legitimate to talk to others about your assignments and incorporate suggestions, do not let others "write" your assignments in the name of peer review or "borrow" sections or whole assignments written by others. We do get ideas from life experiences and what we read but be careful that you interpret these ideas and make them your own.
I am aware that many types of assignments are available on the internet and will check these sources when there is legitimate suspicion.
Penalty is a zero on the assignment. In cases where there is a major or continuous breach of trust, further discipline, such as an "F" in the course, may be necessary.
The major consequence of any form of cheating is damage to your character and the result of trust and respect.
Disability Accommodations
Students who have a disability and wish to request an academic accommodation should contact Jim Gepperth, the Disabilities Services Coordinator and Academic Dean. The student can request an accommodation at any time although it is encouraged to do so early in the enrollment process. The student should complete an accommodation request form which begins a conversation between the school and the student regarding the nature of their disability and an accommodation that would help the student succeed in their program. The school may request documentation regarding the disability to address the accommodation request effectively. The school will communicate to the student the type of accommodation arranged. This process typically follows a team approach, bringing together persons from the academic department (including the instructor) and personnel from other departments as necessary. Additional information on disability accommodations may be found in the Lakewood University Catalog.
Disability Services Email: disabilityservices@lakewood.edu
Supplemental Texts
You can use the following resources to assist you with proper source citation.
American Psychological Association Style Guide- https://www.mylakewoodu.com/pluginfile.php/118179/mod_resource/content/1/APA%20Style%20Guide%207th%20edition.pdf
The Purdue OWL website is also a helpful resource for students. Here is a link to the OWL website: https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html
Library
Mary O'Dell is the Librarian on staff at Lakewood University
She is available by appointment. You can make an appointment with her by emailing her at modell@lakewood.edu or call at 1-800-517-0857 X 730
You may also schedule a meeting at this link: https://my.setmore.com/calendar#monthly/r3a761583354923270/01032020
She can assist you with navigating LIRN, research, citations etc.
Support
Each student at Lakewood University is assigned a Success Coach. Your Success Coach exists to assist you with academic and supportive services as you navigate your program. They will reach out to you, often, to check-in. Please use the resources they offer.
Student Services is available to assist with technical questions regarding Lakewood University and all services available to you.
1-800-517-0857 option 2
info@lakewood.edu
studentservices@lakewood.edu
Career Services
Students are offered Career Services at any point as they journey their academics at Lakewood University.
1-800-517-0857 option 2
careerservices@lakewood.edu
Objectives
1) Apply medical terminology
2) Explain the importance of health insurances and managed health care
3) Process an insurance claim for commercial insurance, Blue Cross/Blue Shield, Medicare, Medicaid, TRICARE, and Workers’ Compensation
4) Demonstrate the basics of medical coding
5) Explain the importance of coding for medical necessity
6) Explain the legalities of medical billing
7) Follow essential CMS-1500 Claim instructions
8) Describe the difference between Medicare Part A, B, C, and D
9) Locate and translate regulatory rules and regulations as they apply to medical billing and coding
10) Describe the structure of an ICD-10-CM code
11) Demonstrate the ability to navigate the layout of the ICD-10-CM, CPT, & HCPCS manuals
12) Describe the layout and guidelines of the ICD-10, CPT, & HCPCS manuals
13) Illustrate ability to abstract diagnostic statements from the medical record and differentiate between main and modifying terms and subterms in the coding manuals
14) Choose diagnoses and procedures using the ICD-10, CPT, & HCPCS manuals, following chapter-specific guidelines
15) Recognize the structure of an ICD-10-CM code
Lessons
Medical Terminology and NHA Registration
Medical Terminology
NHA Registration
Complete all activities and tests in lesson
Health Insurance Specialist Career
Reading: Chapter 1
Assignment #1
Simulation #2
Test 1
Complete all activities and tests in lesson
Introduction to Health Insurance / Managed Health Care
Reading: Chapters 2 and 3
Assignment #2
Simulation #3
Test 2
Complete all activities and tests in lesson
| Processing an Insurance Claim |
Reading: Chapter 4
Assignment #3
Forum - Life Cycle of a Claim
Test 3
Simulated Experiential Learning Exercise 4
Complete all activities and tests in lesson
Legal and Regulatory Issues
Reading: Chapter 5
Assignment #4
Forum - Simulation #5
Test 4
Complete all activities and tests in lesson
ICD-10-CM Coding
Reading: Chapter 6
Assignment #5
Simulation #6
Test 5
Complete all activities and tests in lesson
| CPT Coding |
Reading: Chapter 7
Assignment #6
Test 6
Complete all activities and tests in lesson
| HCPCS Coding System |
Reading: Chapter 8
Assignment #7
Test 7
Complete all activities and tests in lesson
| CMs Reimbursement Methodologies |
Reading: Chapter 9
Assignment #8
Test 8
Complete all activities and tests in lesson
| Coding for Medical Necessity |
Reading: Chapter 10
Assignment #9
Test 9
Complete all activities and tests in lesson
| Essential CMS-1500 Claim Instructions |
Reading: Chapter 11
Forum - InsureKids
Assignment #10
Test 10
Complete all activities and tests in lesson
| Commercial Insurance |
Reading: Chapter 12
Assignment #11
Test 11
Complete all activities and tests in lesson
| Blue Cross and Blue Shield Plans |
Reading: Chapter 13 Assignment #12 Forum - Blue Cross Blue Shield
Test 12
Complete all activities and tests in lesson
| Medicare and Medicaid |
Reading: Chapters 14 and 15
Assignment #13
Forum - CMS Quarterly Medicare Updates
Test 13
Complete all activities and tests in lesson
- TRICARE and Worker’s Compensation
Reading: Chapters 16 and 17
Discussion Forum—TRICARE
Assignment #14
Forum - Course Experience
Test 14
Complete all activities and tests in lesson
- Final Examination
Final Exam
Code of Ethics
| Reimbursement, HIPAA, & Compliance |
Reading: Chapter 1
Assignment #1
Forum - Medicare Fraud
Simulation #1
Medical Coding Lesson 1 Test
Complete all activities
| An Overview of ICD-10-CM / ICD-10-CM Outpatient Coding & Reporting Guidelines |
Reading: Chapters 2 and 3
Assignment #2
Forum - ICD-10 Excludes Notes
Medical Coding Lesson 2 Test
Complete all activities
| Using ICD-10-CM |
Reading: Chapters 4 and 5
Assignment #3
Forum - Assigning Codes
Medical Coding Lesson 3 Test
Complete all activities
| Using ICD-10-CM Continued |
Reading: Chapters 6 and 7
Assignment #4
Forum - Circumstances for Coding ICD-10 Signs and Symptoms
Medical Coding Lesson 4 Test
Complete all activities
| Introduction to the CPT and Level II National Codes/Modifiers |
Reading: Chapters 8, 9, and 10
Assignment #5
Medical Coding Lesson 5 Test
Complete all activities
| Evaluation and Management (E/M) Services, Anesthesia/Surgery Guidelines, and General Surgery |
Reading: Chapters 11, 12, and 13
Assignment #6
Forum - Consider the Statement
Medical Coding Lesson 6 Test
Complete all activities
| Integumentary System/Musculoskeletal System |
Reading: Chapters 14 and 15
Forum - Coding for Different Practices
Assignment #7
Medical Coding Lesson 7 Test
Simulation #2
Complete all activities
Respiratory Systems/Cardiovascular System
Reading: Chapters 16 and 17
Assignment #8
Simulation #3
Medical Coding Lesson 8 Test
Complete all activities
Hemic, Lymphatic, Mediastinum, and Diaphragm/Digestive
Reading: Chapters 18 and 19
Assignment #9
Medical Coding Lesson 9 Test
Complete all activities
Urinary and Male Genital Systems/Reproductive, Intersex Surgery, Female Genital System, and Maternity Care and Delivery
Reading: Chapters 20 and 21
Assignment #10
Global Pregnancy Period
Medical Coding Lesson 10 Test
Complete all activities
Endocrine and Nervous Systems/Eye, Ocular, Adnexa, Auditory, and Operating Microscope
Reading: Chapters 22 and 23
Assignment #11
Medical Coding Lesson 11 Test
Complete all activities
Radiology/Pathology/Laboratory
Reading: Chapters 24 and 25
Assignment #12
Medical Coding Lesson 12 Test
Complete all activities
Medicine
Reading: Chapter 26
Assignment #13
Simulation #4
Medical Coding Lesson 13 Test
Complete all activities
Impatient Coding
Reading: Chapter 27Assignment #11
Assignment #14
Simulation #5
Course Experience
Complete all activities
Final Exam
Final Exam
Study for Final Exam