HIM1272 - Medical Insurance and Billing Fundamentals

Academic Dean’s Contact Information

LAKELAND DEAN’S OFFICE: LLC 2255              PHONE: (863) 297-1024
WINTER HAVEN DEAN’S OFFICE: WSC 101      PHONE: (863) 297-1020

Polk State College Mission and Program Outcomes

Polk State College, a quality driven institution, transforms lives through the power of education by providing access to affordable associate and baccalaureate degree programs, career certificates and workforce employment programs, delivered by diverse, qualified faculty and staff. In line with this purpose, Polk State’s Associate in Science and baccalaureate degree programs develop competence in career areas. This course focuses on the development of competencies related to the following program outcomes:

1. Demonstrate the essential application principles required of the Health Information Technologist.
2. Utilize concepts, applications, and reimbursement guidelines of the following clinical classification systems: International Classification of Diseases, 10th Revision: Clinical Modification Diagnosis Coding System (ICD-10-CM) and the International Classification of Diseases, 10th Revision: Procedure Coding System (ICD-10-PCS).
3. Utilize concepts, applications, and reimbursement guidelines of clinical classification used in Current Procedural Terminology (CPT).

 
Course Objectives:
At the end of this course, the student will be able to:

1. Explain the role of insurance claims in the medical office.
2. Demonstrate application of aspects unique to the different types of insurance plans.
3. Identify potential responsibilities for a medical coder with regard to billing practices.
4. List and describe the privacy, security, and national identifier requirements.
5. Demonstrate application of principal, primary, and concurrent diagnoses related to billing.
6. Demonstrate application of coding rules and guidelines for the use of the International Classification of Diseases, 10th Revision: Clinical Modification Diagnosis Coding System (ICD-10-CM), International Classification of Diseases, 10th Revision: Procedure Coding System (ICD-10-PCS), and Current Procedural Terminology (CPT) code sets.
7. Demonstrate appropriate application and use of the Healthcare Common Procedure Coding System (HCPCS) codes and modifiers.
8. Demonstrate appropriate application of of Medicare, Medicaid, and other third-party payers.

 

Course Content:

• Medical Billing and Coding Overview
• Medical Coding Careers
• Legal Aspects of Coding and Billing
• The Health Insurance Portability and Accountability Act (HIPAA)
• Insurance Providers: Medicare, Medicaid, Managed Care Plans, TRICARE/CHAMPVA and Worker Compensation
• Insurance Payments and Follow-up Procedures

Textbook and Other Requirements

Textbook information is provided in the course syllabus, at the campus bookstore, on the campus bookstore website (www.polk.bncollege.com), or via the “Shop Textbook” button on the PASSPORT schedule of classes.

The Gordon Rule

This is not a Gordon Rule course.

Student Help

The professor is available for help during posted hours and by appointment during other non-class hours. Students are encouraged to seek assistance from the professor. To further the educational process, the campus Learning Resources Centers, comprised of the Teaching/Learning and Computing Center (TLCC) JDA Student Success Center, and library, are available for student use. Each resource provides qualified staff and up-to-date equipment and facilities to promote students’ academic success. The TLCCs and JDA Student Success Center provide tutoring services, computing resources, and other instructional support. The library provides information resources, individual and group study space, research assistance, information literacy instruction, and computing resources. Each facility provides free wireless access to the Internet. Polk State College Library, Student Success Center, and TLCC hours of operation and tutoring schedules are posted at each facility and on the College website.

Withdrawing From a Course

Students may officially withdraw from course(s) during any given term, provided they follow the appropriate policy and procedure. Following the conclusion of the Drop/Add Period, a student may officially withdraw without academic penalty from any credit course, provided he or she has submitted the appropriate forms to the Student Services Office no later than the published deadline. The published deadline reflects approximately (but no more than) 70% of the term, based upon the course’s scheduled duration. It is the student’s responsibility to submit these withdrawal forms; failure to do so may result in a grade of F in the course. Under the Forgiveness Policy, a student is allowed only three attempts in any one course: one initial enrollment and two repeats. A student is not allowed to withdraw from a third course attempt. Limited admission programs may have specific guidelines regarding course withdrawal that vary from this policy. Individuals should refer to the student handbook for that program for more information. If a student stops attending class, the grade earned, usually an F, is assigned and posted. Prior to withdrawing from a course, the student should consult with the Financial Aid Office to determine what impact, if any, withdrawal from the course will have on his or her financial aid status. A student cannot use course withdrawal to avoid academic dishonesty penalties. A student who has been penalized for academic dishonesty in a course is not eligible to withdraw from the course.

Repeating a Course

Under the Forgiveness Policy, a student is allowed only three attempts in any one college credit course: one initial enrollment and two repeats. Under certain circumstances, a student may petition to repeat a credit course beyond the three attempts. Limited admission programs may have specific guidelines regarding repeating a course that vary from this policy. Individuals should refer to the student handbook for that program for more information. The student should be aware that repeating a course may result in a higher course cost. A course cannot be repeated unless the previously earned grade is a D, F, or W (the Polk State College Catalog provides further details regarding this process). Prior to repeating a course, the student should consult with the Financial Aid Office to determine what impact, if any, repeating the course will have on his or her financial aid status.

Academic Dishonesty

Each student is responsible for his or her work. It is assumed that each student is honest and will abide by this standard; however, in the event that there is an indication or suspicion of cheating/plagiarism, the situation shall be dealt with in accordance with the published College policy. Copies of this policy are available in the Student Services Office. Students should also refer to the course syllabus for more specific information.

Information Technology Access/Use Policy

All individuals who employ the information technology resources provided by Polk State College (this includes, but is not limited to, telephones, computers, the Polk State College Local Area and Wide Area Networks, and the Internet) must use these resources for academic purposes only. Use of these resources is a privilege, not a right. Inappropriate use can result in revocation or suspension of this privilege.

Equal Access/Opportunity

Polk State College is an equal access/equal opportunity institution committed to excellence through diversity in education and employment. The College complies with all state and federal laws granting rights to students, employees, and applicants for employment or admission to the College. Polk State College does not discriminate on the basis of race, color, national origin, ethnicity, sex, age, religion, sexual orientation, marital status, veteran status, genetic information, disability, or pregnancy in its programs, activities, or employment.

The following person has been designated to handle inquiries regarding the non-discrimination policies:
Valparisa Baker
Director, Equity & Diversity (Title IX Coordinator)
999 Avenue H NE
Winter Haven, FL 33881-4299
Office: WAD 227, 863.292.3602 Ext. 5378, vbaker@polk.edu.

Equal Opportunity For Students With Disabilities

The College complies with The Americans with Disabilities Act and provides equal educational opportunity for qualified individuals. A student with a disability who requires special accommodations or auxiliary aids under The Americans with Disabilities Act (ADA) should contact the Student Services Office on either campus and speak with a Disability Services Advisor or the Coordinator of Disability Services. Note: Limited admission programs may have performance restrictions that apply. Restrictions (where applicable) are outlined in each program’s student handbook.

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