Advanced Hospital Coding and CCS Prep

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Description

Facility coding (hospital coding) is one of the best-paying sectors of the coding profession. If you're already performing some aspect of facility coding, the Advanced Hospital Coding (AHC) Program will fill in the gaps, making you a more marketable employee. These skills are essential to your successful completion of the American Health Information Management Association's (AHIMA) mastery-level credentialing exam, the Certified Coding Specialist (CCS).

If you're currently working in a physician’s office or billing service, this program will give you the edge you need to advance in the workplace. Most hospitals will only hire coders with previous exposure to facility coding or who are already certified. Training on-the-job is a luxury most hospitals are unable to offer. Coders of all levels must undergo continuing education to stay current with the constantly changing regulations.

The AHC program covers advanced, hospital-specific coding and billing procedures and is designed to help students meet the challenge of today's changing standards. This program will utilize your existing knowledge of medical terminology and healthcare sciences. Your coding skills will be heightened and focused, preparing you for employment testing and successful completion of the CCS exam.

Upon registering, you are given an initial six months to complete the program. Should you need more time, you may request a six-month extension at no additional charge.

When you've successfully completed this program, you'll:

  • Understand how health information travels within departments of a facility
  • Be able to define the roles and responsibilities of a coder in both in- and out-patient facilities
  • Know how to interpret health-record documentation using your knowledge of anatomy, physiology, clinical disease processes, and medical terminology
  • Accurately assign codes for diagnoses, conditions, problems, or other reasons for patient encounters
  • Select codes according to Uniform Hospital Discharge Data Sets (UHDDS) definitions and official coding guidelines
  • Evaluate the effect of code selection on Diagnosis Related Group (DRG) assignment, and verify DRG assignment based on Prospective Payment System (PPS) definitions
  • Determine proper use of Modifiers, CPT vs. HCPCS Level II codes, and Medical Necessity (linking diagnosis to procedure or service)
  • Understand reimbursement methodologies and documentation rules and regulations
  • Identify the Charge Master and its components
  • Understand the CPT guidelines, with special emphasis on Evaluation and Management (E & M) and surgery coding

This program will help you become competent in these hospital-based coding areas:

Data Identification

  • Read and interpret health-record documentation to identify diagnoses and procedures
  • Apply your knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes
  • Apply knowledge of disease processes and surgical procedures to assign non-indexed medical terms to the appropriate class

Coding Guidelines

  • Use current approved coding guidelines to assign and sequence the correct diagnosis and procedure codes for hospital inpatient services
  • Apply knowledge of CPT format, guidelines, and notes to locate the correct codes or correctly use an unlisted procedure code for a patient encounter, and sequence the codes correctly

Regulatory Guidelines

  • Apply Uniform Hospital Discharge Data Set (UHDDS) definitions to select accurate codes
  • Determine the appropriate principal diagnosis for patients who have more than one ailment
  • Use the Prospective Payment System to confirm a DRG assignment
  • Prevent fraud by maintaining approved coding principles and guidelines, including the National Correct Coding Initiative (CCI)
  • Use the Ambulatory Surgery Center (ASC) Payment Groups to confirm ASC assignment and ensure appropriate reimbursement
  • Use the HCFA Common Procedural Coding System (HCPCS) to appropriately assign HCPCS codes for outpatient Medicare reimbursement

Coding

  • Understand which diagnoses, conditions, and procedures to exclude from coding
  • Apply your knowledge of ICD-9-CM instructional notations and conventions to locate, assign, and correctly sequence codes
  • Facilitate data retrieval by recognizing when more than one code is required to adequately classify a given condition

Data Quality

  • Clarify conflicting, ambiguous, or nonspecific information appearing in a health record by consulting the appropriate physician
  • Participate in quality assessment to ensure continuous improvement in ICD-9-CM and CPT coding and collection of accurate health data
  • Demonstrate ability to recognize potential coding-quality issues from an array of data
  • Apply policies and procedures on health-record documentation and coding that are consistent with official coding guidelines
  • Contribute to the development of facility-specific coding policies and procedures

Outline

  1. Module I: Introduction
    1. The Hospital Revenue Cycle
    2. Understanding the Patient Billing Process
    3. Services Provided in the Facility Setting
    4. Career Opportunities in the Hospital Setting
  2. Module II: Hospital Coding and Billing Overview
    1. ICD-9-CM Coding Guidelines
    2. ICD-9-CM Procedural Guidelines
    3. CPT/HCPCS Procedure Coding Guidelines
    4. Review of Appropriate Coding Assignment
  3. Module III: Hospital Billing Process
    1. General Overview of the Billing Process
    2. Admission/Preadmission Process
    3. Insurance Carriers
    4. Capturing Patient Services
    5. Coding and Health Information Department
    6. Billing Department
    7. Collection and Payment Policies
  4. Module IV: UB-04 Overview
    1. General Overview of the Hospital Billing Form
    2. Field-by-field Description of UB-04 With Code Values
  5. Module V: Inpatient Coding
    1. ICD-9-CM Diagnostic Coding Tools
    2. Inpatient ICD-9-CM Diagnostic Coding
    3. Additional ICD-9-CM Diagnostic Coding Guidelines
    4. Special Inpatient ICD-9-CM Considerations
    5. Injuries and Poisonings
  6. Module VI: Inpatient Billing
    1. Methodologies for Inpatient Services
    2. Concepts of Inpatient Prospective Payment System (IPPS)
    3. Diagnosis Related Groups
  7. Module VII: Outpatient Coding
    1. Documentation Review for Key Elements
    2. General ICD-9-CM Diagnostic Coding Guidelines
    3. ICD-9-CM Procedure Coding
    4. General Procedure Coding Guidelines (CPT/HCPCS)
    5. CPT Specific Section Guidelines
    6. Outpatient CPT Surgery Coding Guidelines
    7. CPT Surgical Modifier Codes
    8. Guidelines by all Body Systems
    9. Outpatient Radiology Coding
    10. HCPCS Codes
  8. Module VIII: Outpatient Billing
    1. General Concepts of the Outpatient Prospective Payment System (OPPS)
    2. Ambulatory Payment Classifications (APC)
    3. Outpatient Revenue Codes
    4. Outpatient Code Editor
    5. The Outpatient Billing Process (UB-04)
  9. Module IX: Completion and Certification Preparation
    1. AHC Program Completion Steps
    2. Overview of the Certification Process
    3. Introduction to the Certified Coding Specialist (CCS) Certification
    4. Introduction to the American Health Information Management Association (AHIMA)
    5. Skills Competency Review and Practice
    6. Study Schedule for Certification Preparation

Demo

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Additional Info

Languages
English
Course Length
80.00 hours
Duration of Access
Duration: 80 hours

All of our programs are self-paced and open enrollment, so you can start them when you want and finish them at your own pace. Most programs allow you 180 days after you register to complete them. If you need more time, extensions are available.
Instructor

Carline Dalgleish has been employed in the business office management profession since 1970. She began in the medical records department of the Army/Air Force Hospital in Nuremberg, Germany, and over the years has performed accounts receivable and business office management services for physicians, clinics, and hospitals, as well as the Healthcare Financing Administration (now CMS). She has real-time experience in administrative and financial departments, as well as management experience in business office administration, regulatory compliance, information technology, and services. In addition, she has created the curriculum for and instructed programs in administrative medical billing, diagnostic and procedural coding, and accounts receivable and accounts payable, as well as other allied health, business, and professional development courses.

In the early 90's, Carline moved full-time into curriculum development, teaching, and management of business and allied health education programs, with special emphasis on business office administration and management.

Carline is a Certified Medical Assistant-Administrative (CMAA) and a formerly licensed vocational/practical nurse, and she holds a Bachelor's degree in business information systems and a Master's degree in leadership and healthcare administration.

She is a member of AAHAM, AHIMA, PAHCOM, AAMA, AAPC, CCST, AAMT, and AMTIE, as well as the National Dean's Scholars List. She currently owns and operates COUGAR-Ed.net, which specializes in curriculum development and delivery of continuing education products, seminars, and services.

In addition to her work with Gatlin Education Services, Carline is adjunct faculty at University of Phoenix and is a contributing author to several allied health textbooks.

Bunny Reeves is the senior ambulatory surgery coder at Maimonides Medical Center in Brooklyn, NY. She ensures that all charges are captured using appropriate CPT, ICD-9 codes, and modifiers.

Bunny has trained and supervised entry-level coders at St. Vincent Medical Center in Staten Island and currently trains student coders at Maimonides Medical Center. She has many years of experience in inpatient and professional coding.

In 2007, Ms. Reeves became a Certified Coding Specialist (CCS) through the nationally known organization, American Health Information Management Association (AHIMA).

Bunny is married with two children.

Prerequisites/Audience

The Advanced Hospital Coding program is not an entry-level program. This program is designed specifically for students with previous coding experience or education, and for students who have completed the Gatlin International Administrative Medical Specialist program.

Advanced Hospital Coding students should have:

  • High school diploma/GED
  • Minimum two years of experience with medical terminology, anatomy, physiology, pathology
  • ICD-9-CM coding experience
  • CPT-4 coding experience

 

This program is for you if you're seeking preparation for national certification, or if you want to enhance your coding skills and become more marketable in the workplace.

Requirements/Materials Included

This program is compatible with the Windows Vista operating system.
This program can be taken on either a Mac or a PC; however, most medical offices currently use PCs.

Adobe Flash Player and Adobe Acrobat Reader are required for this program.

Click here to download the Acrobat Reader.
Click here to download the Flash Player.

The following textbooks and CD will be provided by Gatlin International:

  • Understanding Hospital Coding and Billing: A Worktext
  • In- and Outpatient Case and Insurance Claim Billing Practice CD
  • Professional Review Guide for the CCS Certification Examination

Student must provide:

  • Current-year ICD-9-CM, Volumes 1, ,2 and 3 (any publisher)
  • Current-year Current Procedural Terminology (CPT)
  • Optional: current-year HealthCare Procedural Coding System (HCPCS)