Medical Billing and Coding School Curriculum
A typical medical billing and coding curriculum covers a range of topics that provide students with the skills and knowledge needed to work in the healthcare industry. Here is a short overview of the curriculum.
The curriculum in a medical billing and coding program may vary depending on the specific program and educational institution. However, most programs cover similar topics that are necessary for a career in medical billing and coding. Here are some of the typical courses and topics that may be included in a medical billing and coding program:
- Medical Terminology: Students learn the language and terminology used in medical documentation, including anatomy, physiology, diseases, and treatments.
- Medical Coding: This course covers the different coding systems used in medical billing and coding, such as Current Procedural Terminology (CPT) and International Classification of Diseases (ICD). Students learn how to assign codes to medical procedures and diagnoses.
- Healthcare Delivery Systems: This course provides an overview of the healthcare system and its various components, including insurance, government programs, and healthcare organizations.
- Healthcare Law and Ethics: Students learn about the legal and ethical issues involved in healthcare, including patient privacy, medical malpractice, and insurance regulations.
- Health Information Management: This course covers the management and organization of medical records and health information, including electronic health records (EHR) and health information exchange (HIE) systems.
- Reimbursement Systems: Students learn about the different types of healthcare reimbursement systems, such as fee-for-service and value-based care, and how they affect medical billing and coding.
- Computer Applications in Healthcare: This course covers the use of technology in healthcare, including electronic billing and coding systems, and the use of specialized software for medical billing and coding.
- Clinical Classification Systems: Students learn about the various classification systems used in medical billing and coding, such as Diagnostic Related Groups (DRG) and Ambulatory Payment Classifications (APC).
- Professional Development: This course may cover topics such as resume writing, job searching, and professional communication.
In addition to these courses, many medical billing and coding programs also include hands-on training or internships to give students practical experience in a real-world setting.
Medical Terminology
Medical terminology is a crucial part of a medical billing and coding program, as it provides students with a foundation for understanding the language used in medical documentation, including diagnoses, treatments, and procedures. Here are some of the topics that may be covered in a medical terminology course:
Anatomy and Physiology: Students learn the structure and function of the human body, including the various systems and organs.
Medical Root Words, Prefixes, and Suffixes: Students learn the meaning of common medical word roots, prefixes, and suffixes, which can be combined to form medical terms.
Diseases and Conditions: This course covers the signs and symptoms, causes, and treatments of various diseases and conditions.
Pharmacology: Students learn the names and classifications of common medications, as well as how to read medication orders and prescriptions.
Diagnostic Tests and Procedures: This course covers the different types of diagnostic tests and procedures, including laboratory tests, imaging studies, and surgical procedures.
Medical Abbreviations and Acronyms: Students learn the meaning of commonly used medical abbreviations and acronyms, as well as how to read and interpret medical documentation that includes them.
Medical Records and Documentation: This course covers the various types of medical documentation, including progress notes, discharge summaries, and operative reports, as well as how to read and interpret medical records.
A course in medical terminology is designed to give students a foundation for understanding the language used in medical documentation, which is essential for a career in medical billing and coding. By mastering medical terminology, students are better equipped to accurately assign codes to medical procedures and diagnoses, and to communicate effectively with healthcare providers and insurance companies.
Medical Coding
Medical coding is a critical component of medical billing and coding, as it involves assigning codes to medical procedures and diagnoses for the purposes of billing and insurance reimbursement. Here are some of the topics that may be covered in a medical coding course
Introduction to Coding
This course provides an overview of the coding process, including the different types of codes used in medical billing and coding, such as Current Procedural Terminology (CPT) codes and International Classification of Diseases (ICD) codes.
Overview of the International Classification of Diseases (ICD)
This section of the course will provide students with an in-depth understanding of the ICD coding system, including its structure and organization.
Application of ICD codes
Students will learn how to properly apply ICD codes to medical diagnoses, including how to select the appropriate codes based on the patient’s condition and medical history.
Overview of the Current Procedural Terminology (CPT)
his section of the course will provide students with an introduction to the CPT coding system, including its structure and organization.
Application of CPT codes
Students will learn how to properly apply CPT codes to medical procedures, including how to select the appropriate codes based on the type and complexity of the procedure.
ICD-10-CM Coding
This course covers the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), which is used to classify diagnoses and conditions. Students learn how to assign codes to specific diagnoses based on medical documentation.
CPT Coding
This course covers Current Procedural Terminology (CPT) coding, which is used to classify medical procedures and services. Students learn how to assign codes to specific medical procedures based on documentation.
Medical coding regulations and compliance
This section of the course will cover the various regulations and compliance requirements that apply to medical coding, including HIPAA and other privacy laws.
Healthcare Reimbursement Systems
This course covers the different types of healthcare reimbursement systems, including fee-for-service and value-based care, and how they impact medical coding and billing.
Medical Coding Guidelines
Students learn about the rules and guidelines that govern medical coding, including documentation requirements and code sequencing.
Electronic Health Records
This course covers the use of electronic health records (EHR) in medical coding and billing, including how to access and interpret EHR data.
Coding accuracy and quality control
This section of the course will cover the importance of coding accuracy and quality control, including strategies for ensuring accurate and reliable coding.
Practice Management Systems
This course covers the use of practice management systems in medical billing and coding, including how to generate reports and manage patient data.
Overall, a course in medical coding is designed to give students a foundation for understanding the coding process and how it impacts medical billing and reimbursement.
Healthcare Delivery Systems
The healthcare delivery systems course in medical billing and coding is designed to provide students with an overview of the healthcare system and its various components, including insurance, government programs, and healthcare organizations. Here are some of the topics that may be covered in a healthcare delivery systems course:
- Healthcare Systems Overview: Students learn about the different components of the healthcare system, including hospitals, clinics, long-term care facilities, and other healthcare organizations.
- Healthcare Finance and Economics: This course covers the financial aspects of healthcare, including insurance, reimbursement, and the costs of healthcare services.
- Healthcare Insurance: Students learn about the different types of health insurance plans, including employer-sponsored plans, government-sponsored plans, and individual plans.
- Healthcare Regulations: This course covers the laws and regulations that govern healthcare, including patient privacy laws, insurance regulations, and healthcare quality measures.
- Healthcare Policy: Students learn about healthcare policy at the national and state level, including healthcare reform efforts and healthcare policy issues.
- Managed Care: This course covers the concept of managed care, including the different types of managed care plans and how they impact healthcare delivery and reimbursement.
- Government Programs: Students learn about government-sponsored healthcare programs, including Medicare and Medicaid, and how they impact healthcare delivery and reimbursement.
A course in healthcare delivery systems is designed to give students a broad understanding of the healthcare system and its various components, including insurance, government programs, and healthcare organizations. This knowledge is essential for medical billing and coding professionals, as it helps them understand the context in which medical coding and billing takes place, and how to navigate the complex healthcare system to ensure accurate and timely reimbursement.
Healthcare Law and Ethics
A healthcare law and ethics course in medical billing and coding is designed to provide students with an understanding of the legal and ethical issues involved in healthcare, including patient privacy, medical malpractice, and insurance regulations. Here are some of the topics that may be covered in a healthcare law and ethics course:
- Legal and Ethical Principles: Students learn about the basic principles of healthcare law and ethics, including the concepts of autonomy, beneficence, non-maleficence, and justice.
- Patient Rights: This course covers the legal and ethical rights of patients, including the right to informed consent, the right to privacy, and the right to confidentiality.
- Medical Malpractice: Students learn about the legal and ethical issues involved in medical malpractice, including the elements of a malpractice claim, and the role of medical malpractice insurance.
- Healthcare Quality and Safety: This course covers the legal and ethical principles involved in maintaining healthcare quality and safety, including the use of patient safety initiatives and healthcare quality measures.
- Healthcare Regulations: Students learn about the various healthcare regulations that govern the healthcare system, including HIPAA, Stark Law, and the Anti-Kickback Statute.
- Insurance Regulations: This course covers the regulations that govern insurance in the healthcare industry, including the Affordable Care Act, and the role of insurance in healthcare delivery and reimbursement.
- Ethical Decision Making: Students learn how to apply ethical principles to real-world situations, including how to make ethical decisions in complex healthcare scenarios.
A course in healthcare law and ethics is designed to give students an understanding of the legal and ethical issues involved in healthcare, and how they impact medical billing and coding. This knowledge is essential for medical billing and coding professionals, as it helps them navigate the complex legal and ethical landscape of healthcare, and ensure compliance with applicable laws and regulations.
Health Information Management
health information management course in medical billing and coding is designed to provide students with an understanding of the management and organization of medical records and health information, including electronic health records (EHR) and health information exchange (HIE) systems. Here are some of the topics that may be covered in a health information management course:
Health Information Management Overview
Students learn about the basics of health information management, including the role of health information professionals and the importance of accurate and secure medical record keeping.
Medical Record Management
This course covers the management and organization of medical records, including the various types of medical records, such as inpatient and outpatient records.
Electronic Health Records
Students learn about the use of electronic health records (EHR) in medical record keeping, including the benefits and challenges of using EHR systems.
Health Information Exchange
This course covers the concept of health information exchange (HIE), including how it works, the benefits of HIE, and the challenges of implementing HIE systems.
Medical Record Security and Privacy
Students learn about the legal and ethical principles involved in maintaining the security and privacy of medical records, including HIPAA regulations.
Medical Record Coding
This course covers the coding of medical records, including the use of medical coding systems, such as ICD-10 and CPT, to assign codes to diagnoses and procedures.
Quality and Performance Improvement
Students learn about the importance of quality and performance improvement in health information management, including how to use data to improve healthcare outcomes.
Reimbursements Systems
A reimbursement systems course in medical billing and coding is designed to provide students with an understanding of the different types of healthcare reimbursement systems, such as fee-for-service and value-based care, and how they impact medical billing and coding. Here are some of the topics that may be covered in a reimbursement systems course:
Reimbursement Overview: Students learn about the basics of healthcare reimbursement, including the different types of reimbursement systems and the factors that impact reimbursement.
Fee-for-Service Reimbursement: This course covers the fee-for-service reimbursement system, including how it works, the challenges of using fee-for-service reimbursement, and how it affects medical billing and coding.
Value-Based Reimbursement: Students learn about the value-based reimbursement system, including how it works, the benefits and challenges of value-based reimbursement, and how it affects medical billing and coding.
Healthcare Payment Models: This course covers the different healthcare payment models, including capitation, bundled payments, and shared savings.
Healthcare Billing Systems: Students learn about the different healthcare billing systems, including the billing process, claims submission, and denials management.
Healthcare Contracting: This course covers the contracting process in healthcare, including how to negotiate contracts with payers and how to manage relationships with payers.
Revenue Cycle Management: Students learn about the revenue cycle management process, including the various steps involved in managing the revenue cycle, such as patient registration, charge capture, and claims processing.
This knowledge gain in this course is essential for medical billing and coding professionals, as it helps them accurately bill for medical services and ensure that healthcare providers are reimbursed for the services they provide.
Computer Applications in Healthcare
A computer applications in healthcare course in medical billing and coding is designed to provide students with an understanding of the use of technology in healthcare, including electronic billing and coding systems, and the use of specialized software for medical billing and coding. Here are some of the topics that may be covered in a computer applications in healthcare course:
Introduction to Healthcare Technology
Students learn about the use of technology in healthcare, including the different types of healthcare software, and the benefits and challenges of using technology in healthcare.
Electronic Health Records
This course covers the use of electronic health records (EHR) in medical billing and coding, including the features and benefits of EHR systems, as well as the challenges of implementing EHR systems.
Medical Billing and Coding Software
Students learn about the different types of medical billing and coding software, including how to use these software systems to assign codes to medical procedures and diagnoses.
Practice Management Software
This course covers the use of practice management software in medical billing and coding, including how to use these software systems to manage patient data, generate reports, and track billing and coding.
Claims Processing Software
Students learn about the use of claims processing software in medical billing and coding, including how to submit claims electronically and how to track claim status.
Telehealth Technology
This course covers the use of telehealth technology, including the different types of telehealth software and the benefits of using telehealth technology in healthcare.
Health Information Exchange
Students learn about the use of health information exchange (HIE) systems, including how to use these systems to share patient data across different healthcare providers and organizations.
The knowledge gained in this course helps medical billing and coding professionals navigate the complex technological landscape of healthcare, and ensures that they are using the most up-to-date software systems and tools to accurately assign codes and manage medical records.
Clinical Classification Systems
A clinical classification systems course in medical billing and coding is designed to provide students with an understanding of the different clinical classification systems used in medical billing and coding, such as the International Classification of Diseases (ICD) system, and how to use these systems to assign codes to medical procedures and diagnoses. Here are some of the topics that may be covered in a clinical classification systems course:
Introduction to Clinical Classification Systems: Students learn about the different types of clinical classification systems, including the International Classification of Diseases (ICD) system, and how to use these systems to assign codes to medical procedures and diagnoses.
ICD-10-CM Coding: This course covers the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM),which is used to classify diagnoses and conditions. Students learn how to assign codes to specific diagnoses based on medical documentation.
ICD-10-PCS Coding: This course covers the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), which is used to classify medical procedures and services. Students learn how to assign codes to specific medical procedures based on documentation.
Hierarchical Condition Categories: Students learn about the Hierarchical Condition Categories (HCC) system, which is used to predict healthcare costs and reimbursement for Medicare Advantage plans.
Clinical Documentation Improvement: This course covers the concept of clinical documentation improvement (CDI), including how to use CDI to improve the accuracy of medical coding and billing.
Electronic Health Records: Students learn about the use of electronic health records (EHR) in medical coding and billing, including how to access and interpret EHR data for clinical classification.
Case Studies and Practice Exercises: This course may include case studies and practice exercises that allow students to apply their knowledge of clinical classification systems to real-world scenarios.
How is the Medical Billing and Coding Curriculum Evaluated?
The medical billing and coding curriculum is typically evaluated through a variety of methods, including:
Student Assessments
Students are regularly assessed to determine their understanding of the course material. Assessments may include quizzes, exams, assignments, and projects.
Course Evaluations
At the end of each course, students may be asked to complete an evaluation of the course and the instructor. This feedback can be used to improve the curriculum and instructional methods.
Program Reviews
Accreditation agencies and regulatory bodies may conduct periodic reviews of the medical billing and coding program to ensure that it meets the standards for education and training in the field.
Employer Feedback
Employers of medical billing and coding professionals may provide feedback on the effectiveness of the program and the quality of graduates.
Industry Standards
The curriculum is evaluated based on whether it meets the industry standards for medical billing and coding. Industry standards may be established by organizations such as the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).
Student Outcomes
The success of the program is evaluated based on the outcomes of graduates. This may include job placement rates, passing rates on certification exams, and feedback from employers on the quality of graduates.
The evaluation of the medical billing and coding curriculum is a comprehensive process that involves assessing the effectiveness of the curriculum, the quality of instruction, and the outcomes of graduates. This evaluation is critical for ensuring that the program meets the needs of the healthcare industry and provides graduates with the skills and knowledge they need to succeed in their careers.