MDR 210 - Ambulatory Care Clinical Coding & Reimbursement Systems

 
Description
This course includes a comprehensive study of the International Classification of Diseases (ICD) and Common Procedural Terminology (CPT) classification systems used in the ambulatory care setting. Payment and reimbursement methods such as the prospective payment system and managed care as well as billing and insurance procedures will be presented. The relationship between coding practice and corporate compliance will be emphasized. This course requires a per credit health career fee; Check the tuition and fee schedule for the current rate.

1. Apply diagnoses and procedure codes using the ICD coding system and procedure codes using the CPT/Healthcare Common Procedure Coding System (HCPCS) coding systems.
2. Utilize current regulations and established guidelines in code assignments.
3. Validate coding and sequencing accuracy using clinical information found in the health record.
4. Determine accuracy of diagnostic and procedural groupings such as Ambulatory Payment Classifications.
5. Resolve discrepancies between coded data and supporting documentation.
6. Use and maintain electronic applications and work processes to support clinical classification and coding.
7. Determine accurate billing through coding, chargemaster, claims management and bill reconciliation processes.
8. Apply policies and procedures to comply with the changing regulations among various payment systems for healthcare services.
9. Perform data quality reviews to validate code assignment and coding compliance with reporting requirements.

1. Ambulatory care clinical coding with the International Classification of Diseases
2. Ambulatory care clinical coding with the Current Procedural Terminology
3. Ambulatory payment classification assignment
4. Healthcare reimbursement systems and methodologies
5. Coding and corporate compliance

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