Simi Institute for Careers & Education | Evaluated Learning Experience
Medical Insurance Billing and Coding Technician AH 207
100 hours (20 weeks).
May 1989 - Present.
Upon successful completion of the learning experience, students will be able to apply CPT, ICD-10, and HCPCS coding guidelines to identify diagnoses, procedures, and patient medical records; identify the procedures for patient record retrieval and reimbursement; explain the role of a medical coder as a liaison between the health clinician and billing offices; apply computer and information literacy skills using electronic health records software; identify terms, facts, methods, procedures, concepts, theories, principles, and processes within medical billing and coding scenarios; classify relationships among data and items within medical billing and coding scenarios; recognize laws and theories, including issues relating to ethics and confidentiality; calculate solutions to mathematical problems related to reimbursement and medical mathematics; interpret information to make proper coding decisions; and review basic written and workplace communication skills.
This course covers patient advocacy, HIPAA and confidentiality, collecting and protecting patient information and medical records, completion of the CMS 1500 insurance claim form, accurate use of diagnostic and procedural coding systems (ICD-10-CM and CPT/HCPCS), insurance regulation and benefit structures such as Indemnity, PPO, EPO, and HMO in major third-party-payers including Medicare, Medi-Cal, Tricare, Commercial Group Health, exchange plans under the Affordable Care Act, and Worker's Compensation and Disability, basic bookkeeping for medical billing, including patient ledger, patient statements, reading the insurance explanation of benefits/remittance advice, applying contract discounts, applying insurance and patient payments and provisions of coordination of benefits, and the appeal of denied or underpaid claims and the biller's rights under California AB1455. Prerequisites: Basic computer skills and completion of Medical Terminology course are recommended; High School diploma or equivalent is also recommended.
In the lower division baccalaureate/associate degree category, 7 semester hours in Allied Health (4/22).