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Medical Reimbursement Program

The Medical Reimbursement and Medical Coding certificate programs at Good Samaritan College of Nursing and Health Science (GSC) are designed to prepare students for a career in the medical revenue cycle industry as outpatient billers and coders. Each program may be completed within one semester to quickly give students the knowledge and skills necessary for employment in the fast-growing and high demand field of medical billing and coding.

Medical Reimbursement Program

The Medical Reimbursement program prepares students for an entry-level position in an outpatient medical billing office by providing a foundation to the revenue cycle. Courses include medical terminology and human biology and a basic introduction to medical coding as well as the preparation of claim forms to third-party payers. This is a 12-credit-hour program that may be completed in one semester and allows interested students to continue to a second semester to complete the Medical Coding certificate program.

Upon successful completion of the Medical Reimbursement program, students may test for the national Certified Medical Reimbursement Specialist (CMRS) credential offered through the American Medical Billing Association.

Program Learning Outcomes:

  • Demonstrate a basic knowledge of human biology necessary for correct assignment of medical codes
  • Interpret medical documentation for completion of medical claims
  • Describe the importance of documentation on code number assignment and its impact on reimbursement
  • Interpret coding guidelines for assigning codes
MEDICAL REIMBURSEMENT 1-SEMESTER CURRICULUM:
Medical TerminologyALH 1103 Credit Hours3 Lecture
0 Lab
None
Medical Insurance and
Billing
MRC 1013 credit hours1 Lecture, 2
Lab
Medical Coding I
Human BiologyBIO 1013 credit hours2 Lecture, 1
lab
None
Medical Coding I MRC 102 3 credit hours1 Lecture
2 Lab
ALH 110 and
BIO 107
(May be taken
concurrently with ALH
110 & BIO 107)

Medical Reimbursement Program and New Course Descriptions/ SLO’s

MRC 101 Medical Insurance and Billing (3 credit hours: 1 lecture, 2 lab; 6 contact hours)
*Must be taken concurrently with Medical Coding I (MRC 102)

This emphasis of this course is to introduce the student to the practice of medical billing within the outpatient medical office. Students will explore reimbursement and payment methodologies and concepts in insurance and managed care organizations. This course also covers abstracting and classifying medical data to ensure data quality and integrity in written form on the CMS-1500 and in the electronic format. Students will also be introduced to the principles of bookkeeping and financial accounting, collection techniques, and banking procedures.

Learning Outcomes:

  1. Describe the medical billing process including verification of eligibility for services and preauthorization of procedures.
  2. Identify types of third-party payers and explain the steps for filing a third-party medical claim.
  3. Discuss revenue cycle management related to reimbursement in the healthcare industry
  4. Explain patient financial obligations for medical services and bookkeeping terms required to accurately post transactions on patient accounts including collections.
  5. Describe banking procedures as related to the ambulatory care setting.

MRC 102 Medical Coding I (3 credit hours: 1 lecture, 2 lab; 6 contact hours)
Prerequisites: ALH 110 and BIO 107 (May be taken concurrently)

This course is an introduction to the fundamentals of medical coding including coding terminology, nomenclature, and medical documentation. Students will apply guidelines for using the Current Procedural Terminology system for reporting physician and other healthcare services and guidelines for using the International Classification of Diseases to report conditions that require healthcare encounters.

  1. Identify ethical, legal, and compliance issues as they relate to coding and reimbursement
  2. Explain the importance for applying CPT and ICD-10-CM guidelines and conventions for coding and reporting.
  3. Locate main terms for diagnostic statements using ICD-10-CM Index to Diseases and Injuries
  4. Describe CPT conventions to identify main terms, sub-terms, qualifiers, cross-references, code ranges, and modifiers
  5. Apply steps for accurately selecting CPT procedure codes and modifiers and ICD-10-CM codes for documented patient care in the outpatient setting.

Medical Coding Program

The Medical Coding Program may be completed with a second semester that is structured with a focus on the health care knowledge and skills necessary to analyze and accurately code outpatient patient data. It is a 24-credit-hour program with curriculum that includes the legal and ethical implications in the medical billing and coding environment as well as the application of diagnostic and procedural codes. There is also a 105-hour unpaid practicum component in an outpatient medical billing office.

Upon successful completion of the Medical Coding program, students will sit for the national Certified Professional Coder examination by the American Academy of Professional Coders to earn the CPC credential as an apprentice (CPC-A). The AAPC requires individuals with the CPC-A credential to demonstrate on-the-job coding experience in order to remove the apprentice designation and use the credential CPC without the “A.”.

Program Learning Outcomes:

  • Identify ethical, legal, and compliance issues as they relate to coding and reimbursement, and describe the consequences of noncompliance
  • Accurately analyze medical documentation to code diagnoses for reimbursement and billing with ICD-10-CM
  • Accurately analyze medical documentation to code procedures for reimbursement and billing with CPT and HCPCS
  • Complete 105 practicum hours in an outpatient medical billing setting

Medical Coding Certificate New Course Descriptions/ SLO’s

MRC 103 Medical Coding II (3 credit hours: 1 lecture, 2 lab)
Prerequisites: MRC 101; MRC 102; ALH 110; BIO 107

MEDICAL CODING 2-SEMESTER CURRICULUM
First SemesterSuccessful completion of the 12-credit hour Medical Reimbursement Certificate
courses
Second SemesterGSC CourseCredit HoursLecture/LabPre-requisites
Human DiseaseALH 1113 credit hours3 Lecture
0 Lab
Revised to 3
lecture 0 lab
ALH 110, BIO 107
(May be taken
concurrently with
ALH 110 & BIO 107)
Medical Law and
Ethics
ALH 1013 credit hours3 Lecture
0 Lab
None
Medical Coding IIMRC 1034 credit hours2 Lecture
2 Lab
Medical Coding I
Medical Coding
and Billing
Practicum
MRC 1102 credit hours1 Lecture
105 Practicum
Hours
Medical Coding I
and Medical Coding
II
(May be taken
concurrently with
Medical Coding II)

This course continues with the application of the fundamentals of medical coding described in Medical Coding I and includes an introduction to the HCPCS Level II code set. Students will continue to apply guidelines for using the Current Procedural Terminology system for reporting physician and other healthcare services and guidelines for using the International Classification of Diseases to report conditions that require healthcare encounters.

  1. Explain proper code sequencing in choosing principal diagnosis and procedure determination and secondary/additional diagnosis and procedure determination
  2. Discuss the purpose of the HCPCS Level II code set and its modifiers
  3. Apply steps for accurately selecting CPT procedure codes and modifiers, ICD-10-CM codes, and HCPCS Level II codes for documented patient care in the outpatient setting.

ALH 101 Medical Law and Ethics (3 credit hours: 3 lecture, 0 lab)
Prerequisites: None

This course covers the concepts and principles of law found in the healthcare field. The focus is on legal issues regarding health information including confidentiality, consent forms, and release of health information. There is also an emphasis on the liability of healthcare providers, concepts and methods of risk management in the healthcare industry, and other current medical/legal issues.

  1. Identify the roles and responsibilities of health care professionals in legal healthcare compliance
  2. Explain policies for the control, use, and release of health information including identifying public duties relating to reportable information
  3. Explain the difference between civil law and criminal law and civil and criminal actions that relate to the healthcare professional
  4. Discuss the legal principles impacting health information technology

MRC 110 Medical Coding and Billing Practicum (2 credit hours: 1 lecture, 105 Practicum Hours)
Prerequisites: MRC 101; MRC 102; ALH 110; BIO 107
Corequisites: ALH 111; ALH 101; MRC 103

This course integrates classroom instruction with applied technical experience by placing students in an approved outpatient medical billing setting for 105 hours. The practicum hours include any orientation to the office, health system, or electronic health record or medical billing system. These hours are generally completed during the day and regular work week.

  1. Participate in an introductory interview with the practice manager at the approved office for placement before beginning the practicum experience.
  2. Communicate the arranged days and hours of the practicum experience with the practicum instructor and/or Dean.
  3. Complete 105 hours as scheduled and maintain accurate documentation of the hours.
  4. Obtain all survey evaluations as required including an evaluation of performances from the office staff and an evaluation of the practicum site.
  5. Perform all duties as directed by the policies and procedures of the medical office or health system.

Hospital

The Good Samaritan College campus is located in Good Samaritan Hospital, part of the TriHealth medical system.

Student

Our students practice their medical skills in our nationally-recognized Simulation and Skills Lab.

Faculty

Study under faculty with doctorate degrees in their field.