program review Program Review members Dawn Wheaton program coordinator Kathy Hudson Chair Ambulatory services Solanyi Muñoz academic advising What is Medical Coding and medical billing ID: 1030871
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1. Medical Billing Medical Codingprogram reviewProgram Review members:Dawn Wheaton, program coordinatorKathy Hudson, Chair Ambulatory servicesSolanyi Muñoz, academic advising
2. What is Medical Coding and medical billing? Part of revenue cycle managementMedical coders are responsible for translating physicians’ reports into useful uniform medical codes that facilitate reimbursement.Medical Billers are responsible for taking the coded information prepared by the medical coder and submitting the claim. Medical billers are an integral part of the review cycle management process.
3. Coding systemsICD-10-CM – International Classification of Diseases, 10th revision, Clinical ModificationICD-10-PCS – International Classification of Diseases, Procedure Coding System (used only for inpatient hospital settings)CPT – Current Procedural TerminologyHCPCS – Healthcare Common Procedure Coding Systems
4. Medical billing and medical coding mission statements:Medical Coding The mission of the Medical Coding Program is to graduate competent entry-level Medical Coding Specialists who meet the employment needs of area healthcare providers.Medical BillingThe mission of the Medical Billing Program is to graduate competent entry-level Medical Billing Specialists who meet the employment needs of area healthcare providers.
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9. Program Weaknesses:Low EnrollmentsCompetition with AAPCThe AAPC coding curriculum is offered at a fraction of the cost to complete vs. our medical coding certificate. Their most comprehensive educational package includes practice exams, exam review, free coding manuals, exam, Practicode practicum, and a live online instructor. The cost of this package is $3,095.00. The cost of tuition, not including books, for our program is $8,820.00. Practicum placement – many offices have permanently moved to remote status.
10. What do we plan to do about it:Recognizing that many of our Medical Coding students also graduated from Medical Billing, planning has begun to combine the two programs into one certificate. This will allow students to acquire the knowledge needed to sit for either Medical Billing or Medical Coding certification in one year vs. two.
11. What do we plan to do about it:To address the issues surrounding practicum the curriculum will include a capstone course geared toward certification. The capstone course would include study guide review and access to a virtual Medical Coding/Billing internship via Blackboard as implemented in response to COVID. Students may focus on CPB certification in Medical Billing or CPC/CCA certification in Medical Coding.
12. Move to combine programs continued:Lowell General Hospital, Biller/Certified Coder – Indeed.comAs a Biller/Certified Coder you will report directly to the Professional Billing and Coding Manager and will be responsible for the reconciliation and accurate charge entry relative to the professional services provided within practices identified in the Circle Health Physicians Entities.The Biller/Certified Coder will assist with patient and staff questions regarding billing and coding issues, outstanding balances and payments, weekly and monthly reporting, and daily claim resolution within the practice management system.In this role you must stay updated on CMS regulations and billing/payment guidelines for all in-network payers and maintain professional coding certification.
13. Addressing employer needs and facilitating first time employment: Lawrence General Hospital, Patient Account Representative – Indeed.comResponsible for ensuring accurate and timely billing and collection of assigned patient accounts with the goal of providing patient-focused customer service and achieving the departmental goal of ensuring maximum revenue and cash flow benefit to the hospital. High School graduate or equivalent required with a minimum of 1 year of hospital facility billing experience or graduate of a medical billing program. Knowledge of medical coding and medical terminology preferred.