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Course Information
Health Careers Education
HL00516
Medical Insurance & Coding (FY2012)
54.00
"This course covers information necessary to understand medical insurance form preparation and coding as used in a medical clinical office. Students demonstrate an understanding of the legal issues of insurance claims, procedural & diagnostic coding, delinquent claims, problem solving, managed care systems, proper form preparation and several major types of medical forms."
Lara Skaggs
lskag@okcareertech.org
405 743 5106
None
Course Objectives are:
1. Explain the qualifications and skills of a person trained as an insurance billing specialist.
2. Explain the important federal, state, and private health insurance plans.
3. Explain the purpose of medical insurance coding for professional services.
4. Discuss the importance for coding properly the diagnosis of a physician.
5. Identify the specific volumes of the International Classification of Diseases as they apply to medical practices.
6. Apply the five basic steps used to code diagnosis.
7. Explain the guidelines and conventions used in ICD-9-CM.
8. Recognize the various applications of numeric codes, V codes, and E codes.
9. Explain the guidelines and conventions used in CPT-4.
10. Identify CPT-4 codes and explain their application to a medical office.
11. Locate and use the various appendices of CPT-4.
12. Define what is covered in the Medicare benefit program.
13. Define the two parts of the Medicare system.
14. Describe the types of providers in the Medicare system.
15. Compile from a patient chart the proper data to complete a CMS-1500 claim form.
16. Discuss the similarities and differences between manual and electronic claim submission.
17. Explain several claim management techniques that will help eliminate medical insurance claims problems.
18. Explain the purpose and function of prepaid health plans as they apply to the proper insurance form preparation.
19. Discuss the features of Blue Cross and Blue Shield plans as they apply to the proper insurance form preparation.
20. Discuss the benefits of Medicaid as it applies to proper insurance form preparation.
21. Explain the benefits of Medicare as it applies to the proper insurance form preparation.
22. Explain the benefits of Champus, Champa, and Tricare as it applies to the roper insurance form preparation.
23. Explain worker’s compensation as it relates to proper insurance form preparation.
24. Explain the benefits and exclusions for individual and group disability income insurance as it pertains to insurance forms preparation.


Unit exams. Skill Check-offs on insurance form preparation and coding for a physician’s office.
Competencies are aligned and validated by industry (advisory committees) according to job tasks/requirements for MA positions. This course is aligned with CRB-AAMA entry-level competencies for the Medical Assistant.

Previously the coding course and insurance courses were taught as individual courses and the information was redundant and repetitive to students. This course teaches the medical insurance and basic coding components together for processing medical insurance forms common to medical office environments. In the modern physician’s office coding is required for patient billing and patient billing requires coding. Coding and insurance form preparation together is an integrated part of the Electronic Health Record (EHR) used in the modern paperless physicians office.
Textbook: “From Patient to Payment” 6 Ed. Newby, McGrawHill, 2010.
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Career Majors That Sequence This Course
Career Cluster Pathway Career Major
Health Science Therapeutic Services Medical Assisting (FY2011)