MDA 2030 - Administrative Procedures II

1. Identify the structure and format of the ICD-10
2. Describe how to use the Alphabetic index to select main terms, essential modifiers and the appropriate code ranges
3. Explain how to use the tabular index
4. Describe how to use the most current diagnostic codes and perform diagnostic coding
5. Summarize coding conventions

UNIT #2 BASICS OF PROCEDURAL CODING

1. Distinguish between the alphabetic index and the tabular index
2. Classify the six different sections of the CPT code set
3. Review various conventions in the CPT code set
4. Identify the required medical documentation for accurate procedural coding
5. Identify common CPT coding guidelines for (E/M) procedures
6. Identify procedures and services that require HCPS codes
7. Describe how to use the most current HCPS level II coding system

UNIT #3 BASICS OF HEALTH INSURANCE

1. Identify types of third party plans
2. Explain the importance of verifying eligibility and be able to verify eligibility services, including documentation
3. Explain how insurance reimbursements are determined 
4. Describe privately sponsored health insurance plans
5. Differentiate among the different types of managed care models
6. Review the process for preauthorization and how to obtain preauthorization including documentation
7. List and discuss various government-sponsored insurance plans
8. Review employer-established self-funded plans

UNIT #4 MEDICAL BILLING REIMBURSEMENT

1. Identify steps for filing third-party claims
2. Identify the types of information contained in the patient’s billing record
3. Demonstrate how to submit health insurance claims, including electronic claims
4. Complete a CMS 1500 claim form
5. Review and explain Explanation of Benefits
6. Define medical necessity guidelines
7. Explain a patient’s financial obligation for services rendered

UNIT #5 PATIENT ACCOUNTS, COLLECTIONS AND PRACTICE MANAGEMENT

1. Perform accounts receivable procedures for patient accounts:  Charges
2. Perform accounts receivable procedures in patient accounts:  Payments and Adjustments
3. Describe the patient Truth in Lending Act when offering credit options for payment
4. Describe professional courtesy
5. Describe collection procedures

UNIT #6 BANKING SERVICES AND PROCEDURES

1. Describe banking procedures as related to the ambulatory care setting
2. Explain the importance of depositing checks daily
3. Prepare a bank statement
4. Understand the purpose of bank account reconciliation for auditing purposes