| Instructor Information |
| Instructor |
Tonya Harbert |
| Email |
keithtj@lamarpa.edu |
| Phone |
(409) 984-6501 |
| Office |
Umphrey Industrial Technology Center - Room: 201H |
| Office Hours |
Tuesday 1:00-2:30
Wednesday 9:00-2:30
Thursday 9:00-11:00 & 1:00-2:00
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| Additional Contact Information |
Office visits are by appointment only. Instructor may not be in office, nor on campus, outside of these hours, and the instructor may be on other parts of campus during these hours. It is best to call or email the instructor to set up a time to meet. (Virtual and phone appointments are available.) |
| Course Information |
| Description |
An overview of skills and knowledge in ICD and CPT coding of insurance forms for reimbursement of medical services.
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| Required Textbooks |
Textbook Purchasing Statement: A student attending Lamar State College Port Arthur is not under any obligation to purchase a textbook from the college-affiliated bookstore. The same textbook may also be available from an independent retailer, including an online retailer.
Understanding Health Insurance: A Guide to Billing and Reimbursement, 2024 edition by Michelle Green, 19th ed (Mindtap + E-book Online Learning Platform Bundle) (ISBN: 9780357932094) Cengage
*Students will need the access code.
AAPC’s Facility Coder Bundle 2024 (ISBN: 9781646318339) Bundle Includes: AMA CPT®2024 Professional Edition, HCPCS Level II Expert 2024, ICD-10-CM Expert 2024, ICD-10-PCS Expert 2024 *Printed versions only
* All required materials are covered by the Seahawk Book Bundle and included in the student's tuition unless student opted out.
STUDENTS DO NOT NEED TO PURCHASE ANY ADDITIONAL BOOKS OR MATERIALS - REQUIRED MATERIALS ARE COVERED AND PAID FOR BY THE BOOK BUNDLE.
* Textbooks MUST be returned at the end of the semester, BUT students may write and take notes in textbooks as normally would if they owned the book. (Note: Workbooks and manuals do not have to be returned.)
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| Additional Materials/Resources |
None.
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| Corequisites/Prerequisites |
None.
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| Learning Outcomes |
WECM:
An overview of skills and knowledge in ICD and CPT coding and claims forms for reimbursement of medical services.
CODING:
1.1 Enters or confirms code(s) associated with medical diagnosis(es), procedures, and services
1.2 Ensures medical codes reflect medical record documentation
2.2 Communicates with physicians or other care providers to ensure appropriate documentation
2.3 Applies policies and procedures to comply with changing regulations among various payment systems for healthcare services, such as Medicare, Medicaid, managed care, etc.
2.4 Applies policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery
2.5 Supports accurate billing through coding, charge master, claims management and bill reconciliation processes
2.6 Ensures accuracy of diagnostic/procedural groupings such as DRG and APC
3.1 Compiles patient data and performs data quality reviews to validate code assignment and compliance with reporting requirements
3.3 Verifies consistency between diagnosis and treatment plans, procedures and services
4.2 Validates coding accuracy using clinical information found in the health record
4.3 Adheres to current regulations and establish guidelines in code assignment (focus on assignment of principle diagnosis, principle procedure, and sequencing as well as other clinical coding guidelines)
4.4 Uses established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative and others.
5.4 Uses and maintains applications and process to support other clinical classification and nomenclature as appropriate (e.g. DSM-V-Diagnostic and Statistical manual of Mental Disorders – SNOMED-CT – Systemized Nomenclature of Medicine – Clinical terms, etc.)
MOA:
1.4 Inspect medical records
5.2Conduct chart audits
5.3 Review billing outcomes
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| Program Student Learning Outcomes |
Identify, pronounce, and spell medical terms.
Translate and interpret health abbreviations and symbols.
Utilize medical software applications.
Extract information from health records for appropriate code validation.
Sequence codes according to established guidelines and standards.
Analyze current health care trends.
Utilize computer software for basic office functions.
Uses medical terminology, jargon, and abbreviations correctly.
Define general legal terms as they apply to the practice of medicine in ambulatory care settings. Understand and apply ethics relevant to medical coding and medical office practice.
Apply ICD and CPT rules and guidelines to complete claims forms for submission.
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| Lecture Topics Outline |
Health Insurance Specialist Career
Introduction to Health Insurance and Managed Care
Introduction to Revenue Management
Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections
Legal Aspects of Health Insurance and Reimbursement
ICD-10-CM Coding
CPT Coding
HCPCS Level II Coding
CMS Reimbursement Methodologies
Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical Necessity
CMS-1500 and UB-04 Claims
Commercial Insurance
BlueCross BlueShield
Medicare
Medicaid
TRICARE
Workers' Compensation
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| Major Assignments Schedule |
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Dates
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Course Outline
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Due Date
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Week 1
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Jan 16-19
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Introduction to class; Syllabus; Syllabus Quiz; Introduction Discussion Board (Books are NOT required to complete this week’s assignments.)
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Jan 23
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Week 2
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Jan 22-26
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Chapter 1: Health Insurance Specialist Career
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Jan 30
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Week 3
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Jan 29-Feb 2
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Chapter 2: Introduction to Health Insurance and Managed Care
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Feb 6
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Week 4
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Feb 5-9
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Chapter 3: Introduction to Revenue Management; Chapter 4: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections
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Feb 13
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Week 5
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Feb 12-16
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EXAM 1 (Chps.1-4); Chapter 5: Legal Aspects of Health Insurance and Reimbursement
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Feb 20
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Week 6
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Feb 19-23
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Chapter 6: ICD-10-CM Coding
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Feb 27
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Week 7
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Feb 26-Mar1
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Chapter 7: CPT Coding
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Mar 5
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Week 8
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Mar 4-8
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Chapter 8: HCPCS Level II Coding
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Mar 19
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** SPRING BREAK ** MARCH 11-15 ** SPRING BREAK **
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Week 9
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Mar 18-22
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EXAM 2 (Chps.5-8); Chapter 9: CMS Reimbursement Methodologies
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Mar 26
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Week 10
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Mar 25-29
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Chapter 10: Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical Necessity
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Apr 2
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Week 11
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Apr 1-5
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Chapter 11: CMS-1500 and UB-04 Claims
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Apr 9
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Week 12
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Apr 8-12
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EXAM 3 (Chps. 9-11); Chapter 12: Commercial Insurance; Chapter 13: BlueCross BlueShield
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Apr 16
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Week 13
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Apr15-19
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Chapter 14: Medicare; Chapter 15: Medicaid
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Apr 23
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Week 14
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Apr 22-26
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Chapter 16: TRICARE; Chapter 17: Workers' Compensation
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Apr 30
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Week 15 & 16
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Apr 29-May 7
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EXAM 3 (Chapters. 12-17); FINAL EXAM (Comprehensive)
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May 7
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*** ASSIGNMENTS DUE TUESDAYS @ 9 a.m. ***
OTHER IMPORTANT DATES:
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Jan 23
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Apply for May 23 graduation BEGINS
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Jan 31
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Census date
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Feb 26
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Last day to drop/withdraw WITHOUT penalty
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Mar 29
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Good Friday
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Apr 1
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Summer & Fall registration BEGINS
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Apr 12
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FINAL day to drop/withdraw WITH penalty
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Apr 19
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FINAL day to Apply for May 23 graduation
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* Students are required to monitor announcements, emails, and course content multiple times throughout the week.
* Assignments and due dates are posted in the course. Check the calendar; check the announcements; check email; and check the To-Do List.
* If course work is available, students can complete work ahead of scheduled weeks/due dates.
* Changes may be made to course work, due dates, etc.
Instructor reserves the right to add or change assignments during semester. It is the student's responsibility to be active within the course and stay current with due dates as posted within the course.
ALWAYS USE LINKS PROVIDED IN BLACKBOARD TO COMPLETE ASSIGNMENTS.
DO NOT GO DIRECTLY TO THE PUBLISHER SITE TO COMPLETE WORK UNLESS OTHERWISE DIRECTED BY INSTRUCTOR.
TURN WORK IN ON TIME AS POSTED IN THE COURSE OR AS OUTLINED BY INSTRUCTOR'S VERBAL OR WRITTEN INSTRUCTIONS.
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|
| Final Exam Date |
April 29, 2024 - 8:0 AM
Through May 7, 2024 - 9:0 AM
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| Grading Scale |
A= 90-100
B= 80-89
C= 70-79
D= 60-69
F= 59 or below
*Only the letters are input into the main system at the end of the semester. If one student makes a 90, and another makes a 100, they will both have the same grade at the end of the semester. They both have an "A".
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Determination of
Final Grade |
Assignments/Quizzes/Participation 50%
Exams 50%
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| Course Policies |
| Instructor Policies |
ASSESSMENT METHODS & GRADING POLICY
* Students should keep a record of their grades/average. It is not the instructor's responsibility to average grades for students to review. (Students can see grades in the blackboard gradebook when an assignment has been completed and graded.)
*Instructor reserves the right to add or change assignments during semester.
*The instructor will not drop grades.
* Each module focuses on specific learning outcomes; however, some activities in the course may be used to enhance learning and may not be graded. Student learning will be assessed throughout the course using assignments, quizzes, discussions, labs, participation, exams, or any other means of assessment.
* Due dates are posted each week for course work.
* Instructions and grading information will be posted for each assignment.
CLASS PARTICIPATION
* Class participation is required (and has a direct impact on your course average). It is important to be active within the course- not just login and click around on Blackboard. Students are required to be active within the course. The instructor may use attendance (activity within the course) as a weekly participation grade.
* Additional (new) assignments may be added to the course during the week if instructor feels it is necessary.
* Students are required to check announcements and emails 3 or more times throughout the week.
ASSIGNMENTS
* NO MAKE-UP ASSIGNMENTS. The assignment will receive a grade of zero (0) if not completed by the due date & time. Instructor will not go back and grade assignments that were not completed on time.
QUIZZES
* NO MAKE-UP QUIZZES. Quizzes may be given weekly. If a student misses a quiz, the grade is recorded as a zero (0). After quizzes are closed, you cannot make-up a quiz.
EXAMS
* NO MAKE-UP EXAMS. If a student should miss an exam, at the end of the semester, the instructor will average all exam grades [including the zero(s)] to replace the zero for the missed exam.
EXAMPLE: 4 test grades: 100, 100, 0, 80 = 280; 280/4= 70; 70 will go in the place of the zero.; Test grades are now 100, 100, 70, 80
* FINAL EXAM EXEMPTION OPPORTUNITY: If a student has completed and passed ALL other exams & have a grade of 80 or better for the course, the student will have the option to be exempt from the FINAL EXAM. (An AVERAGE of ALL other exam grades will be the grade for the final exam.)
* Academic dishonesty will result in a zero on any academic work or exam in question; a second incidence of academic dishonesty on any academic work or exam in question will result in the student being given an "F" for the course.
* If course work is available, students can complete work ahead of scheduled due dates.
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| Attendance Policy |
* Research has shown a cause-and-effect relationship between attendance and college success. With this factor in mind, the instructor monitors student course activity weekly.
* Students are expected to login to Blackboard, check email and announcements a minimum of 3 times per week - even if they think all work is complete.
* Class participation is required (and has a direct impact on your course average). It is important to be active within the course, not just login and click around on Blackboard. Additional (new) assignments may be added during the week if instructor feels it is necessary. The instructor may use attendance (activity within the course) as a weekly participation grade.
* It is responsibility of the student to contact their instructors by email regarding their absence. An absence from the course does not allow students to have extensions on coursework or due dates.
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| Additional Information |
MYLSCPA USERNAME & PASSWORD ISSUES:
Call Kenneth Lisby @ (409) 984-6150
BLACKBOARD HELP AVAILABLE 24/7:
(936) 496-5379
bbhelp@lamarpa.edu
THIS COURSE WAS DESIGNED TO COMPLETE ON A LAPTOP OR DESKTOP COMPUTER.
Students consistently overlook vital information and assignments when trying to use a mobile device.
Students may use the computers in the LSCPA computer lab if needed. They will need to see your student ID. LSCPA also has a laptop loan program available to students who need to borrow a computer for the semester.
METHODS OF PRESENTATION:
Several methods of presentation may be used and may include any of the following:
Lecture (through PowerPoint slides, interactive notes, video, or audio sources)
Computer Assisted Learning (blackboard, publisher websites, etc.)
Lab Exercises, Discussion Boards, etc.
Internet
LAPTOP LOAN PROGRAM:
LSCPA has a laptop loan program available on a first come, first served basis. Fill out the online application on the LSCPA website. Search "Laptop loan program" in the search bar.
SOFTWARE REQUIREMENTS:
The student is required to have all required course materials including but not limited to any software, e-books, key codes, etc. needed for class to complete required readings, work, etc.
Reliable Internet access is required for all online courses. Students may use the LSCPA open computer lab provided.
COMPUTER FAILURE AND LACK OF INTERNET ACCESS ARE NOT ACCEPTABLE EXCUSES FOR MISSED ASSIGNMENTS, PROJECTS, QUIZZES, EXAMS, ETC.
Students may use the computer lab on LSCPA campus if they do not have reliable internet access.
DROP/WITHDRAWAL POLICY
* If a student decides to drop/withdraw, the student should also verify that the drop/withdrawal is submitted before the final withdrawal date.
* It is the responsibility of each student to ensure that their name is removed from the roll should they decide to drop/withdraw from the class.
* The student is strongly encouraged to retain their copy of the drop/withdrawal form for their records.
* The student is required to turn in any books, equipment or items that belong to the department. Failure to do so may compromise their standing with LSCPA.
* State law permits students to withdraw from no more than 6 courses during their entire undergraduate career at Texas public colleges or universities. With certain exceptions, all course withdrawals automatically count towards this limit. Details regarding this policy can be found in the LSCPA college catalog. Students may drop/withdraw on or before the last day to drop/withdraw WITHOUT penalty, and it will not count towards the 6 drops. Drop/withdrawals after that date will count towards the 6 allowed drops. (See important dates.)
E-Mail/Voice Mail Etiquette:
* Students must use appropriate e-mail etiquette when corresponding with instructor; for example, complete sentences and a full subject line with your name/course name/section number.
* Voice mail messages should be clearly spoken identifying student's name, course, and a return phone number.
Dress for Success:
As future professionals, it is important to utilize this time to practice dressing appropriately. Learning to dress for success may set the stage for your greatest achievements. Keeping this in mind, remember to dress appropriately when coming campus and when attending class (virtual and face-to-face). Students may wear clothing to express their individuality, but they should dress in a way of expressing respect for the situation and those around them. One's attire and grooming habits should not be off-putting to your environment or those in the surrounding area. Your look may change depending on the circumstances.
Students attending a face-to-face class may wear casual attire, but if dressed inappropriately, or if attire is inappropriate or distracting, they may be instructed to leave class. This will be considered an absence.
The following attire should not be worn to campus or when coming to class: Clothing that exposes intimate parts of the body, only underclothing without outerwear (such as sports bras or men's boxers), sleepwear such as pajamas, robes, and house slippers, clothing that is too tight or too loose, clothing with inappropriate logos or text, etc.
*Exceptions and/or changes may be made to information in this syllabus at the instructor's discretion.
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| Institutional Policies |
| MyLSCPA |
Be sure to check your campus email and Course Homepage using MyLSCPA campus web portal. You can also access your grades, transcripts, academic advisors, degree progress, and other services through
MyLSCPA.
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| Academic Honesty |
Academic honesty is expected from all students, and dishonesty in any form will not be tolerated. Please consult the LSCPA policies (Academic Dishonesty section in the Student Handbook) for consequences of academic dishonesty.
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| ADA Considerations |
The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides comprehensive
civil rights for persons with disabilities. Among other things, this legislation requires that all students
with disabilities be guaranteed a learning environment that provides for reasonable accommodation of their
disabilities. If you believe you have a disability requiring an accommodation, please contact the
the Office for Disability Services Coordinator, Room 231, in the Madison Monroe Building. The phone number is (409) 984-6241.
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| COVID 19 Information |
The Lamar State College Port Arthur (LSCPA) Student Code of Conduct COVID 19 Policy requires students who have been diagnosed with COVID 19 to report their condition directly to their local health department. Students should also contact their course faculty to report their quarantine status. In addition, this policy requires all students to wear face coverings when directly exposed to COVID 19 in compliance with the criteria included in the policy. For more information please refer to the COVID 19 link on the LSCPA website.
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| Facility Policies |
No food or tobacco products are allowed in the classroom. Only students enrolled in the course are allowed in the classroom, except by special instructor permission. Use of electronic devices is prohibited.
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| HB 2504 |
This syllabus is part of LSCPA's efforts to comply with Texas House Bill 2504.
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| Mandatory Reporting of Child Abuse and Neglect |
As per Texas law and LSCPA policy, all LSCPA employees, including faculty, are required to report allegations or disclosures of child abuse or neglect to the designated authorities, which may include a local or state law enforcement agency or the Texas Department of Family Protective Services. For more information about mandatory reporting requirements, see
LSCPA's Policy and Procedure Manual.
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| Title IX and Sexual Misconduct |
LSCPA is committed to establishing and maintaining an environment that is free from all forms of sex discrimination, including sexual harassment, sexual violence, and other forms of sexual misconduct. All LSCPA employees, including faculty, have the responsibility to report disclosures of sexual misconduct, including sexual harassment, sexual assault (including rape and acquaintance rape), domestic violence, dating violence, relationship violence, or stalking, to LSCPA's Title IX Coordinator, whose role is to coordinate the college's response to sexual misconduct. For more information about Title IX protections, faculty reporting responsibilities, options for confidential reporting, and the resources available for support visit LSCPA's Title IX website.
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| Clery Act Crime Reporting |
For more information about the Clery Act and crime reporting, see the Annual Security & Fire Safety Report and the Campus Security website.
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| Grievance / Complaint / Concern |
If you have a grievance, complaint, or concern about this course that has not been resolved through discussion with the Instructor, please consult the Department Chair.
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| Department Information |
| Business and Industrial Technology |
| Chair: | Sheila Guillot |
| Email: | guillsr@lamarpa.edu |
| Phone: | (409) 984-6381 |
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