competency in skills and knowledge through assessment tests,
but are not required to complete a specific number of hours.
Medical Coder/Biller
USDOL
![organization logo](https://flowbite.com/docs/images/examples/image-1@2x.jpg)
Work Process Content
On the Job Training
![organization logo](https://flowbite.com/docs/images/examples/image-1@2x.jpg)
Receptionist Duties
2
- Handle incoming and outgoing calls/e-mails to and from Physicians, department administrative assistants, the billing office, compliance office and others
- Mail, fax, and handle correspondence.
Office Procedures
4
- Care and maintain office equipment
- Develop and maintain mailing lists and tickler file
- Inventory Management
- Use Query database to retrieve information
Insurance Coding
4
- Use and understand format, conventions, guidelines and rules of ICD-10-CM diagnostic and procedural coding
- Coding of insurance forms using ICD-10-CM and CPT
- Process and complete all insurance forms
- Code diagnoses and procedures
Medical Records
1
- Retrieving and filing of medical records; keep medical records updated; locate data in and abstract information from medical records
Health Care Reimbursement
5
- Comply with regulations related to fraud and abuse
- Compare non-government payers versus government payers
- Compare other prospective payment systems
- Understand and comprehend reimbursement cycle
- Apply facility based codes (i.e., Diagnostic Related Groups, Ambulatory Payment Classifications, and Resource Utilization Groups)
Miscellaneous
6
- Investigate health plan payment denials and write claims appeal
- Understand and follow claim rejection and resolution process
- Use coded data in strategic planning/reporting
- Perform qualitative and quantitative analysis of health records to evaluate compliance with regulations and standards
- Research coding updates
- Examine review systems
Interpret healthcare data for code assignment
1
- Audits indicate accuracy of diagnostic and procedural coding
Incorporate clinical vocabularies and terminologies used in health information systems
1
- Demonstrates understanding of clinical vocabularies
Abstract pertinent information from medical records and consults reference materials to facilitate code assignment
1
- Audits indicate compliance with abstracting policies
Apply inpatient coding guidelines appropriately
1
- Audits indicate appropriate code and sequencing following regulations and guidelines
Ensure accuracy of diagnostic/procedural groupings such as DRG (Diagnostic Related Group); MSDRG (Medicare Severity); APC (Ambulatory Payment Classification) system, etc.
1
- Audits indicate accuracy of MSDRG/APC assignment
Sequence codes for optimal reimbursement
1
- Audits indicate appropriate code sequencing
Evaluates and reconciles National Correct Coding Initiative edits
1
- Follows coding edits for compliance with NCCI
Apply outpatient coding guidelines appropriately
1
- Audits indicate appropriate code and sequencing following regulations and guidelines
Validate medical necessity using LCD and NCD
1
- Audits indicate appropriate use of LCD and NCD in coding
Submit claim forms in a timely manner. Evaluate and respond to claim denials.
1
- Compliant with claim submission and claim denials policy
Retrieve, assemble and analyze medical records quantitatively and qualitatively for deficiencies
1
- Meets timeliness and accuracy of record analysis
Retrieve patient-specific information from other sources (ancillary departments, physician offices, master patient index, etc.)
1
- Follows policy on information and data collection
Identify discrepancies between coded data and supporting documentation. Clarify documentation through proper physician query
1
- Creates compliant physician queries
Related Instruction Content
Training Provider(s):
![organization logo](https://flowbite.com/docs/images/examples/image-1@2x.jpg)
Program orientation with tutorials for Litmos and VLab
2
Program Overview
Medical Terminology
45
This course covers medical terminology, symbols and abbreviations, and the application of this new language in the field of health care. While terms are covered as they relate to body structure and function, the main focus is on medical vocabulary and being able to construct terms using word parts such as roots, suffixes, and prefixes.
Anatomy, Physiology & Human Disease
45
This course provides an overview to the anatomical structures and physiology of the human body. Each body system is discussed in terms of the major anatomical structures and function including how each system participates in homeostasis of the body. In addition, the course discusses selected major pathologies, including disease definitions and causes, signs and symptoms, diagnostic procedures, and possible treatments. Finally, the course discusses common issues and changes that occur in each body system through the life span.
Pathophysiology and Pharmacology
45
Emphasis is placed on the disease processes affecting the human body via an integrated approach to specific disease entities. Included will be the study of causes, diagnosis and treatment of disease as well as an understanding of the basic principles of pharmacology
Healthcare Delivery Systems
45
An introduction to the organization, financing and delivery of health care services, this course gives an overview of the organization and activities of hospitals, nursing homes, mental health and ambulatory care centers, home health agencies, and hospices. Apprentices will also learn about the educational preparation and responsibilities of health care professionals and government regulations.
Healthcare Data Content and Structure
45
This course introduces apprentices to the contents, use and structure of the health record, including data and data sets. It explains how these components relate to primary and secondary record systems and gives an overview of the legal and ethical issues applicable to health information.
Medical Law and Ethics
45
This course introduces apprentices to legal and ethical issues related to the health care setting. This course provides an overview of the laws and professional requirements that regulate the delivery of health care, including HIPAA, the Patient's Bill of Rights, and standard of care. Apprentices will also gain an understanding of the ethical and moral issues that health care professionals may encounter.
Basic ICD Coding Part 1
45
This course provides the apprentice with the basic principles of the ICD-10-CM Coding and Classification System, including the following of guidelines, proper sequencing of codes and theimpact on reimbursement.
Basic ICD Coding Part 2
45
A continuation of Part 1 of the Basic ICD Coding course, Part 2 focuses on ICD-10-PCS coding. This course emphasizes practice in the assignment of valid ICD-10-PCS procedure codes.
Basic CPT Part 1
45
An introduction to basic coding concepts using CPT/HCPCS. Coding/classification systems, this course emphasizes practice in the assignment of valid diagnostic and procedure codes in an ambulatory care setting. The course covers procedural terminology in current use, evaluation and management services, medicine, HCPCS Levels II and III and CPT Category II and III Codes
Basic CPT Part 2
45
A continuation of Part 1 of the Basic CPT/HCPCS Coding course, Part 2 utilizes higher level, more complex examples (case studies, records and scenarios). This course covers surgery coding, anesthesia coding, radiology coding, pathology and laboratory coding, and reimbursement in the ambulatory setting. Students are assigned exercises to complete using Nuance Healthcare's Clintegrity 360 encoder.
Reimbursement Methodology
45
Emphasis is placed on the uses of coded data and health information in reimbursement and payment systems appropriate to all healthcare settings and managed care. Students are exposed to the contemporary prospective payment systems used by the U.S. government and other key health plans that comprise most patients' source of payment for healthcare services.
Professional Coding Practice
60
This course offers apprentices the ability to practice coding in real-world professional coding scenarios. Apprentices step through more than six different settings to complete 101 online coding exercises using either codebooks or the 3M Encoder. In addition, using official coding guidelines, preparing for a career, keeping code sets current, and applying standards of ethical behavior are covered.
Post-immersion assessment
4
Retired CCA exam questions.
Meetings with Coding Trainers
4
Review activities, provide feedback and instruction.