Medical Billing & Medical Coding Combination Program

MBILLMCODE — Medical Billing and Medical Coding , hours

Description

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

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

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

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

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

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%)

Writing Assignment Grading Rubric

Assignment and Discussion Forum Post Rubrics

Writing Assignment Grading Rubric

Points

Excellent
10-9 pts

Good
8-6 pts

Poor
5-3 pts

Very Poor
2-1 pts

No Response
0 pts

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

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

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

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

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

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

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

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

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

Lessons
Title
Lesson #1
Course Topic

Medical Terminology and NHA Registration 

Readings/Assignments

Medical Terminology

NHA Registration

Due

Complete all activities and tests in lesson

Objectives
Objective 1
Objective 2
Title
Lesson #2
Course Topic

Health Insurance Specialist Career

Readings/Assignments

Reading: Chapter 1 
Assignment #1
Simulation #2
Test 1

Due

Complete all activities and tests in lesson

Objectives
Objective 2
Title
Lesson #3 outcome 3
Course Topic

Introduction to Health Insurance / Managed Health Care

Readings/Assignments

Reading: Chapters 2 and 3
Assignment #2
Simulation #3
Test 2
 

Due

Complete all activities and tests in lesson

Title
Lesson #4 outcome 6
Course Topic
Processing an Insurance Claim    
Readings/Assignments

Reading: Chapter 4 
Assignment #3
Forum - Life Cycle of a Claim
Test 3
Simulated Experiential Learning Exercise 4

Due

Complete all activities and tests in lesson

Title
Lesson #5
Course Topic

Legal and Regulatory Issues 

Readings/Assignments

Reading: Chapter 5
Assignment #4
Forum - Simulation #5
Test 4

Due

Complete all activities and tests in lesson

Objectives
Objective 1
Objective 4
Title
Lesson #6 outcome 1 outcome 4
Course Topic

 

ICD-10-CM Coding

Readings/Assignments

Reading: Chapter 6
Assignment #5
Simulation #6
Test 5

Due

Complete all activities and tests in lesson

Title
Lesson #7
Course Topic
CPT Coding    
Readings/Assignments

Reading: Chapter 7
Assignment #6
Test 6
 

Due

Complete all activities and tests in lesson

Objectives
Objective 1
Objective 4
Title
Lesson #8
Course Topic

 

HCPCS Coding System        
Readings/Assignments

Reading: Chapter 8
Assignment #7
Test 7
 

Due

Complete all activities and tests in lesson

Objectives
Objective 7
Title
Lesson #9
Course Topic
CMs Reimbursement Methodologies       

 

Readings/Assignments

Reading: Chapter 9
Assignment #8
Test 8
 

Due

Complete all activities and tests in lesson

Objectives
Objective 5
Title
Lesson #10
Course Topic
Coding for Medical Necessity           
Readings/Assignments

Reading: Chapter 10 
Assignment #9
Test 9
 

Due

Complete all activities and tests in lesson

Objectives
Objective 7
Title
Lesson #11
Course Topic
Essential CMS-1500 Claim Instructions     
Readings/Assignments

Reading: Chapter 11
Forum - InsureKids 
Assignment #10
Test 10

Due

Complete all activities and tests in lesson

Objectives
Objective 1
Objective 3
Title
Lesson #12
Course Topic
Commercial Insurance      
Readings/Assignments

Reading: Chapter 12
Assignment #11
Test 11
 

Due

Complete all activities and tests in lesson

Objectives
Objective 1
Objective 3
Title
Lesson #13
Course Topic
Blue Cross and Blue Shield Plans
Readings/Assignments

Reading: Chapter 13                                                       Assignment #12                                                              Forum - Blue Cross Blue Shield 
Test 12

Due

Complete all activities and tests in lesson

Objectives
Objective 1
Objective 3
Title
Lesson #14
Course Topic
Medicare and Medicaid
Readings/Assignments

Reading: Chapters 14 and 15
Assignment #13
Forum - CMS Quarterly Medicare Updates
Test 13

Due

Complete all activities and tests in lesson

Objectives
Objective 1
Objective 3
Title
Lesson #15
Course Topic
  • TRICARE and Worker’s Compensation
Readings/Assignments

Reading: Chapters 16 and 17
Discussion Forum—TRICARE 
Assignment #14
Forum - Course Experience
Test 14

Due

Complete all activities and tests in lesson

Objectives
Objective 1
Objective 3
Title
Lesson #16
Course Topic
  • Final Examination
Readings/Assignments

Final Exam
Code of Ethics

Due
Complete all activities and tests in lesson
Title
Lesson #17
Course Topic
Reimbursement, HIPAA, & Compliance                              

 

 
Readings/Assignments

Reading: Chapter 1
Assignment #1 
Forum - Medicare Fraud
Simulation #1
Medical Coding Lesson 1 Test

Due

Complete all activities

Objectives
Objective 4
Objective 8
Objective 9
Title
Lesson #18
Course Topic
An Overview of ICD-10-CM / ICD-10-CM Outpatient Coding & Reporting Guidelines                
Readings/Assignments

Reading: Chapters 2 and 3
Assignment #2
Forum - ICD-10 Excludes Notes
Medical Coding Lesson 2 Test

Due

Complete all activities

Objectives
Objective 10
Objective 11
Title
Lesson #19
Course Topic
Using ICD-10-CM  
Readings/Assignments

Reading: Chapters 4 and 5
Assignment #3
Forum - Assigning Codes
Medical Coding Lesson 3 Test
 

Due

Complete all activities

Objectives
Objective 10
Objective 11
Title
Lesson #20
Course Topic
 Using ICD-10-CM Continued  
Readings/Assignments

Reading: Chapters 6 and 7
Assignment #4
Forum - Circumstances for Coding ICD-10 Signs and Symptoms
Medical Coding Lesson 4 Test

Due

Complete all activities

Objectives
Objective 10
Objective 11
Title
Lesson #21
Course Topic
Introduction to the CPT and Level II National Codes/Modifiers            
Readings/Assignments

Reading: Chapters 8, 9, and 10
Assignment #5
Medical Coding Lesson 5 Test

Due

Complete all activities

Objectives
Objective 11
Objective 12
Objective 13
Objective 14
Objective 15
Title
Lesson #22
Course Topic
Evaluation and Management (E/M) Services, Anesthesia/Surgery Guidelines, and General Surgery        
Readings/Assignments

Reading: Chapters 11, 12, and 13
Assignment #6
Forum - Consider the Statement
Medical Coding Lesson 6 Test

Due

Complete all activities

Objectives
Objective 1
Objective 11
Objective 12
Objective 13
Objective 14
Objective 15
Title
Lesson #23
Course Topic
Integumentary System/Musculoskeletal System
Readings/Assignments

Reading: Chapters 14 and 15
Forum - Coding for Different Practices
Assignment #7
Medical Coding Lesson 7 Test
Simulation #2

Due

Complete all activities

Objectives
Objective 1
Objective 11
Objective 12
Objective 13
Objective 14
Objective 15
Title
Lesson #24
Course Topic

Respiratory Systems/Cardiovascular System

Readings/Assignments

Reading: Chapters 16 and 17
Assignment #8
Simulation #3
Medical Coding Lesson 8 Test

Due

Complete all activities

Objectives
Objective 1
Objective 11
Objective 12
Objective 13
Objective 14
Objective 15
Title
Lesson #25
Course Topic

Hemic, Lymphatic, Mediastinum, and Diaphragm/Digestive

Readings/Assignments

Reading: Chapters 18 and 19
Assignment #9
Medical Coding Lesson 9 Test

Due

Complete all activities

Objectives
Objective 1
Objective 11
Objective 12
Objective 13
Objective 14
Objective 15
Title
Lesson #26
Course Topic

Urinary and Male Genital Systems/Reproductive, Intersex Surgery, Female Genital System, and Maternity Care and Delivery

Readings/Assignments

Reading: Chapters 20 and 21
Assignment #10
Global Pregnancy Period
Medical Coding Lesson 10 Test
 

Due

Complete all activities

Objectives
Objective 1
Objective 11
Objective 12
Objective 13
Objective 14
Objective 15
Title
Lesson #27
Course Topic

Endocrine and Nervous Systems/Eye, Ocular, Adnexa, Auditory, and Operating Microscope

Readings/Assignments

Reading: Chapters 22 and 23
Assignment #11
Medical Coding Lesson 11 Test

Due

Complete all activities

Objectives
Objective 1
Objective 11
Objective 12
Objective 13
Objective 14
Objective 15
Title
Lesson #28
Course Topic

Radiology/Pathology/Laboratory

Readings/Assignments

Reading: Chapters 24 and 25
Assignment #12
Medical Coding Lesson 12 Test

Due

Complete all activities

Objectives
Objective 1
Objective 11
Objective 12
Objective 13
Objective 14
Objective 15
Title
Lesson #29
Course Topic

Medicine

Readings/Assignments

Reading: Chapter 26
Assignment #13
Simulation #4
Medical Coding Lesson 13 Test

Due

Complete all activities 

Objectives
Objective 1
Objective 11
Objective 12
Objective 13
Objective 14
Objective 15
Title
Lesson #30
Course Topic

Impatient Coding

Readings/Assignments

Reading: Chapter 27Assignment #11
Assignment #14
Simulation #5
Course Experience

Due

Complete all activities 

Title
Lesson #31
Course Topic

Career Visioning Assignment 

Title
Lesson #32
Course Topic

Final Exam

Readings/Assignments

Final Exam

Due

Study for Final Exam

Overview

Course

Course

Contact Information

Contact Information

E-mail: ghobert@lakewood.edu
Cell Phone: 800-517-0857 X 747