Health science careers are not only in high demand, but they offer a diverse range of careers for all types of people interested in helping others. Acquire foundational knowledge required to pursue a career in the healthcare industry, and the education, training, and credentials needed to attain them. Learn basic medical terminology, principles of anatomy and physiology, and legal and ethical responsibilities. Explore communication, teamwork, and leadership techniques – providing a solid basis for those wanting to advance through the health sciences.

Unit 1: Considering a Career in Healthcare? Finding the Right Role

A rewarding career is something every young person would like to look forward to. And while health science careers are secure, as even during economic downturns everyone needs health care, an even more exciting aspect to careers in this field are the various types of work available for all different kinds of people—introverts and extroverts, the mechanically-minded, caregivers, visual thinkers, good organizers, and especially those who work well under high stress. Not only can people with different personality types find a good career in this area, but also many entry-level positions are in demand and that can lead to higher-paying jobs with more experience and further training. Health science is truly an exciting and versatile industry to explore—so let’s start the journey and discover the many career options in healthcare!

What will you learn in this unit?

• Explain the concepts of the five career pathways in health science and provide examples of jobs in each category

• Compare the roles and contributions of different members of a healthcare team

• Research and assess the level of education and training required for specific healthcare jobs

• Develop a logical potential career path in health sciences

Unit 2: Healthcare Today: The Business of Caring

Unique! Uneven! High-cost! Hybrid! Best in the world! These and many other phrases have been used to describe the healthcare system in the United States. There is some truth to all those statements, and with the complexity of our healthcare system, you can say lots more about it. Let’s learn how the many parts of the US system of healthcare fit together to deliver care to a diverse population. From the facilities to the levels of care, we will move on to consider how health insurance and government agencies fit into this complicated system. We’ll also take a dip into the history of medicine, explore the present, and even look at some of the changes that we expect to see in the future of healthcare.

What will you learn in this unit?

• Compare the services of different healthcare settings

• Explain the government’s role in the US healthcare system

• Distinguish between the delivery models of HMOs, PPOs, EPOs, and POSs

• Analyze the economic factors affecting healthcare

• Trace the origins of current health treatments to older practices from many cultures

Unit 3: Anatomy, Physiology, and Medical Terminology in a Nutshell

It’s all Greek to me! That’s a phrase you won’t need to say after you dip your toe into the world of anatomy, physiology, and medical terminology. Learning about the body is fun, but it is also exciting to be able to describe things using the precise terms that are used in the healthcare professions. We’ll learn the basic structure and function of the human body, giving you a foundation for all that you will learn in the future. Then we’ll journey into terminology, breaking words down into their parts to make them easy to understand. Mandibular fossa, anyone? Just a part of the jaw. How about cardiopulmonary resuscitation? You may already know that one is CPR, the lifesaving technique to restart the heart and breathing. Soon, you’ll know how to decipher any medical term you come across, no matter how complicated it looks!

What will you learn in this unit?

• Trace the hierarchy of the structure of the human body, from atoms up to the whole organism

• Distinguish between anatomy and physiology, and discuss the relationship of these two fields of study

• Explain homeostasis and give three examples of this process

• Describe the position and direction of movement in anatomical terminology

• Decipher complex medical terms and build medical terms from prefixes, roots, and suffixes

Unit 4: Growth and Development Throughout the Life Span

The cycle of life—from birth to death—is a process of change and growth. Each stage brings challenges but also accomplishments and joy. Each of us is on this journey of life, and here, we will trace the needs of the tiniest humans up to their great-grandparents, and everyone in between. We will look at what each stage of life needs, physically, psychologically, and socially. We will also learn two of the most prominent theories about growth and psychological motivation: Erikson’s Stages of Psychosocial Development and Maslow’s Hierarchy of Needs. Hop on for the ride and get an overview of the development of a human being through the lifespan.

What will you learn in this unit?

• Explain the physical, emotional, and social needs of babies, toddlers, teenagers, and adults

• Predict healthcare needs throughout the lifespan

• Debate the value of Erikson’s Stages of Psychosocial Development in modern times

• Apply Maslow’s Hierarchy of Needs to understand what motivates human behavior

Unit 5: Health and Wellness

Medical professionals only work with people who are injured and unwell, right? Wrong! Health follows a continuum from optimal wellness to severe illness and everything in between. Today’s health professionals also focus on helping people develop healthy habits to increase their wellness. From eating well and exercising to minimizing exposure, to substances and diseases, allied health workers can improve the health of a whole population with small interventions. Concentrating on physical, emotional, and social health can be an enjoyable part of any health profession as it focuses on planning for health rather than waiting for illness to set in.

What will you learn in this unit?

• Integrate healthy eating and regular exercise into daily habits

• Assess and avoid the risks associated with using substances like alcohol, tobacco, and drugs

• Reflect on the emotional reactions to illness and the stages of grief

• Apply wellness principles to improve health and plan for wellness

• Link the effects of chronic stress to physical health and strategize interventions for stress management

Unit 6: Effective Communication in Healthcare

“What’s up, doc?” We all communicate every day, through the words we speak and write and also through the gestures and expressions of our bodies. In healthcare, communication is key to serving patients—as errors are costly. Medical error is the third leading cause of death in the United States, and up to 30 percent of all malpractice cases report communication error as a factor. So it pays to have every healthcare worker learn the techniques needed to communicate effectively and clearly. In addition, learning to communicate no matter the barriers—whether cultural or physical or as a result of how one communicates—means that important objective and subjective information can be collected and used to treat patients. Once the information is gathered, it will be time to report the data, in both written and oral formats. With that, we will have a great start in learning how to communicate in healthcare settings.

What will you learn in this unit?

• Deconstruct communication using the sender-receiver model

• Experiment with active listening and using open-ended questions in personal and school life

• Articulate barriers to communication in healthcare settings, including cultural factors

• Adapt your body language to build trust in a professional setting

• Categorize objective and subjective data and report events in the order of occurrence

Unit 7: Health and the Law

What would you do if a patient refused treatment that would save their life? How would you handle it if your best friend asked you questions about a patient at your clinic? Just because someone is a patient does not mean they are passive—patients participate in their care and they have rights. Respecting patient rights and autonomy is an important part of the job. Get the inside scoop on informed consent and that weird beast of a law—HIPAA—that helps keep patient records confidential. Knowledge is power, so learn the laws that apply to the health professions and learn how to protect yourself from criminal or civil liability. Plus, find out what employment laws will keep you safe and happy on the job.

What will you learn in this unit?

• Advocate for your rights as a patient

• Explain the components of HIPAA to keep patient information safe

• Debate the legality of actions a healthcare worker might take

• Role-play situations with legal and ethical implications for health workers

• List workplace rights and responsibilities that apply to healthcare employees

Unit 8: Ethical Responsibilities

Do the right thing! That’s what we should all do all the time, but in healthcare, there are ethical guidelines that help us figure out what that ‘right thing’ is. Complex matters of life and death come up every day in healthcare settings, providing ethical dilemmas that require thought and consideration to sort out. Thankfully, each profession and each healthcare institution has a code of ethics to help workers find the most beneficial and least harmful course of action. Learning how to recognize and deal with ethical dilemmas, from the life-threatening to the daily small decisions, is something that all healthcare professionals can use. These ethical conundrums are some of what make the healthcare field so interesting and challenging, no matter what career you choose. Fasten your seatbelts and come along as we explore ethics in the practice of healthcare.

What will you learn in this unit?

• Apply ethical principles to healthcare decisions

• Compare and contrast the scope of practice and codes of ethics

• Debate the ethics of technological advances in healthcare

• Reflect on how empathy is related to ethical principles in healthcare

Making sure that you, your patients, and your colleagues stay safe, you’ll begin analyzing your responsibilities for ensuring patient and personal safety with special attention paid to emergency procedures. Examine infection control, first-aid, CPR, and measuring a patient’s vitals. Learn about numerical data, such as systems of measurement, medical math, and reading and interpreting charts. And examine effective teamwork and leadership characteristics while building your employment skills.

Unit 1: Health, Safety, Security

Every workplace has dangers, but the risks that occur in healthcare settings are part of the everyday jobs of every player on the healthcare team. From taking care of the safety of vulnerable patients to taking care of your health so you can continue to help people, there are many things to learn about applying safety measures while working to improve the health of those in your community. Implementing standard precautions and following all hazard warnings, including reading SDSs for the chemicals you use, will ensure safer conduct. When there is an emergency, you not only need to respond to protect yourself but to operate as part of the response to any threat. Finally, we look at how to reduce medical errors in healthcare settings, creating a culture of safety on the job.

What will you learn in this unit?

• Identify and manage safety hazards in a healthcare setting

• Implement proper body mechanics while moving patients

• Explain how different government agencies contribute to safety in healthcare

• Prepare for and respond to emergencies

• Analyze a problem using root cause analysis

Unit 2: Infection Control

How do we get sick? Tracing the chain of infection, we will learn how pathogens can invade and cause illness. We will learn how the body defends itself and the steps that each person can take to help stop the spread of infection. Something as simple as handwashing is the strongest weapon against pathogens, helping ordinary people and healthcare workers to keep germs at bay. But healthcare workers have a special duty to fight the spread of disease, being in the center of infection control—and with the power to fight the spread of disease, both to themselves and to the public at large.

What will you learn in this unit?

• Summarize the chain of infection

• Compare levels of cleaning in a healthcare setting

• Recommend when and how to cleanse hands in a healthcare setting

• Differentiate between standard precautions and transmission-based precautions

• Link infection control practices to the fight against drug-resistant infections

Unit 3: Bloodborne Pathogens

Jobs in healthcare are on the front lines of the fight against the spread of pathogens, and none more important than the serious bloodborne diseases caused by HIV, Hepatitis B, and Hepatitis C. We will learn the proper techniques for putting on and taking off PPE to stay safe from bloodborne and other pathogens. Each step done properly can stop a deadly pathogen in its tracks. In addition, we will dig into what community members can do to prevent exposure or access resources if they are exposed to a bloodborne disease.

What will you learn in this unit?

• Assess the risks posed by the most common bloodborne pathogens in the United States

• Describe how bloodborne pathogens can spread in healthcare settings

• Reconstruct the steps for properly putting on PPE

• Explain the reasons for safely disposing of biohazardous waste

• Summarize the most risky behaviors for transmission of bloodborne diseases, both in a healthcare setting and in the community

Unit 4: Signs of Life: Vital Signs and CPR

The signs of life, or what we call vital signs, are the ways we can sense the mysterious quality we call “life” in a body. The right temperature, the beating of the heart, the in and out of respiration, and the pressure with which blood pumps throughout our bodies are the ways we can tell that we are alive. Anytime any one of the vital signs deviates from the normal range, it can signal a serious health problem, so healthcare workers check on these signs of life very frequently, looking for any early sign of an ailment that they can help. Knowing how to properly check these measurements and record them is an integral part of most healthcare jobs. In an emergency, when these signs are not present or are wavering, learning CPR and first aid will mean that you can help keep these vital signs going, keeping a person alive until advanced medical care can take over.

What will you learn in this unit?

• Measure and assess body temperature readings, integrating knowledge about thermoregulation

• Trace the changes in breathing and pulse rates throughout the lifespan

• Appraise the relationship between the oxygen saturation of the blood and other vital signs

• Summarize the difference between systolic and diastolic blood pressure readings

• Describe the effects that CPR can have on a patient in cardiac arrest

Unit 5: Data, Measurement, and Math

It’s as easy as 1, 2, 3 to apply math skills to healthcare calculations that are used every day. Fractions, decimals, and converting measurements are numerical tools that healthcare workers use all the time. Measuring time, temperature, height, weight, distance, angle, and many other parameters provide valuable data for treating patients or analyzing public health problems. Once that important data is collected, turning it into a visually interesting graph, table, diagram, or chart can help healthcare professionals and their patients understand this information quickly and easily.

What will you learn in this unit?

• Distinguish between ratios and percentages

• Name the units of measurement in imperial and metric systems

• Convert between imperial and metric measurements

• Calculate body mass index

• Interpret charts, diagrams, graphs, and tables to use numeric information

Unit 6: Technology in Healthcare

Information technology as well as simple and advanced technologies used in diagnosing and treating patients plays a crucial role in medicine today. From stethoscopes to CT scanners, all this tech requires skilled, observant workers to correctly operate and maintain. But some of the biggest changes that tech brings to healthcare are in the electronic health records (EHRs) that store all types of patient information so medical professionals can help patients to optimize their health. Of course, along with the ease of using EHRs comes the danger of compromising patient privacy—either by posting about your work on social media (a big no-no!) or simply sending a record to the wrong person. Learning how to appropriately handle medical records is therefore of the utmost importance – let’s dive in!

What will you learn in this unit?

• Describe the different types of technology used to diagnose, treat, and track patient health

• Troubleshoot simple computer problems

• Summarize the different parts of an electronic health record (EHR)

• Evaluate the reliability of health resources on the web

• Explain steps to keep protected health information (PHI) safe as an allied health professional

Unit 7: Teamwork and Leadership

Healthcare is a team sport—each person on the team has a job, and if they all work together effectively, the goal of high-quality patient care can be met. Everyone wins when the team pulls together. But just what can each person do to be a great team member? Read on for some great teamwork tips, as well as guidance on how to become a leader. Leadership can be practiced whether you are a member of a team or leading a team. When the team comes into conflict, there are some basic strategies to manage and resolve issues so everyone can continue to work towards the goal of health for the community.

What will you learn in this unit?

• Analyze the roles of different healthcare team members

• List and explain the characteristics of good teams

• Lead or participate effectively in meetings

• Recognize resistance to change in patients and colleagues

• Apply conflict resolution techniques to disagreements

Unit 8: Employability in Healthcare

The healthcare industry has the most jobs of any sector of the US economy. Students who can demonstrate both competent skills and strong “soft” skills will likely become valuable team members. Enthusiasm, integrity, and a strong work ethic will impress potential employers, so improving these qualities in oneself is an important part of preparing for a career. Read on for some tips regarding how to find and successfully apply for job opportunities in the field.

What will you learn in this unit?

• Present a professional image through behavior, appearance, and demeanor

• Demonstrate work-ready characteristics and habits such as punctuality, dependability, discretion, and flexibility

• Analyze your career goals and assess their feasibility

• Evaluate and interpret employment opportunities in healthcare

• Create elements of a career portfolio

Caring for a patient takes more than a medical degree: it takes a team! In this course, you will build your knowledge of medical terminology, medical office processes, the technology that keeps an office humming, and the laws that keep it operating ethically. You’ll also explore different office roles all while building the beginnings of a portfolio. Let’s march through the waiting room and throw open the doors to a career as a Medical Office Admin today!

Unit 1: Working in the Medical Office

You’ve likely been to a medical office to see your physician and you may even have spoken with the receptionist. But do you know how a medical office operates? What are its functions? Who are the people who work there? What are their roles and responsibilities in helping to run the office efficiently for patients, physicians, and other healthcare providers? You’re about to find out! Let’s step inside a medical office and get to know some of its employees and what they do. Who knows, after you get to know them, you might just be intrigued enough to look for a career path in the medical office!

What will you learn in this unit?

• Articulate the functions of the medical office

• Describe the positions and responsibilities of medical office employees

• Identify and describe the career paths available in the medical office setting

• Explain how the medical office fits into the big picture of health care in the United States

Unit 2: Communication and Professionalism

In any job, communication is extremely important. In healthcare facilities, communication is critical because it affects patients’ health, safety, and, at times, their very survival. Imagine what can happen if a medical assistant does not listen closely to crucial medical information provided by a patient or does not communicate the information to the physician. Medical office staff must not only communicate with patients but with each other and other healthcare workers, and they must do so effectively, for the care and safety of every patient.

What will you learn in this unit?

• Define communication and explain its importance in health care

• Describe what it means to communicate with professionalism

• Identify communication skills required for employees in the medical office

• Outline office procedures for verbal communication with patients

Unit 3: Medical Terminology: The Language of Health Care

Parlez vous français? Imagine going on a school trip to France. In addition to getting a passport and packing your bags, you might think about learning the basics of the French language so you can communicate with people while in France. Working in health care is similar to visiting a foreign country. Before working in the medical field, you must understand the language to communicate effectively with the patients, staff, and providers. We call this language medical terminology, and it’s really easier to learn than most people think. Healthcare workers must have a working knowledge of medical terminology and be able to use the language in both verbal and written forms.

What will you learn in this unit?

• Describe the history of medical terminology

• Define the four parts of a medical term

• Demonstrate knowledge of common medical terms and abbreviations

• Summarize guidelines for spelling and pronunciation of medical terms

• Explain how medical terminology is used in written and verbal communications

Unit 4: Procedures in the Medical Office

Most jobs require employees to follow certain procedures. Why? Policies and procedures act as a roadmap for the organization. Patients have high expectations of their physician and the medical office. They expect the staff to be knowledgeable in their jobs and that they follow office policies and procedures consistently. Procedures outline expectations of employees when conducting daily tasks. Following procedures helps internal processes run more efficiently and procedures safeguard the office against legal action, ensuring compliance with law and regulations. Most importantly, the primary reason to know and understand policies and procedures is so that we provide quality patient care in a safe environment.

What will you learn in this unit?

• Provide examples of the importance of policies and procedures

• Summarize the procedures for opening and closing the medical office

• Describe procedures for managing incoming and outgoing communications

• Outline basic procedures for scheduling, preauthorization, and referrals

• Give examples of other required policies

Unit 5: Procedures and Patient Care

Clerical procedures in healthcare facilities are associated with either administrative tasks or clinical/patient care. Clerical procedures associated with clinical services affect patient care and are carried out by employees who possess a basic set of clinical skills, such as medical assistants, nursing assistants, nurses, etc. The focus of this unit is on the clerical procedures associated with direct patient care.

What will you learn in this unit?

• Identify the type of employee positions that assist providers with patient care

• Describe the procedure for a patient exam conducted by the assistant

• Outline the components of a pre-op and post-op order

• Explain the admission process followed by the health unit coordinator

• Compare and contrast the use of electronic medical records and paper records

Unit 6: Information Technology in the Medical Office

The medical office relies on a variety of technology and computer systems to accomplish daily tasks and meet patient expectations. Years ago, a patient would call the office to get an appointment and/or request copies of their medical record. Now, patients can make appointments, request medication refills, and obtain copies of their record through the office’s patient portal. Technology that was once a luxury for large offices and organizations is now a necessity, and even the smallest offices can afford to use it. Examples of advances in technology include the electronic medical record, electronic prescribing, patient portals, email and voicemail reminders, automated patient appointments, and telemedicine. It’s amazing how the practice of medicine has been transformed by a computer.

What will you learn in this unit?

• Describe how technology has affected health care in the past 50 years

• List the basic technology skills needed in the medical office

• Identify the functions of a medical office computer system

• Summarize the responsibilities of information technology (IT) support personnel

Unit 7: Medical Records Management

Medical records are used to gather and document patients’ health and administrative information. Electronic medical records organize information in a manner that is easy to read, easy to search, and easy to use. Most medical offices use electronic medical records, but there are still some that prefer paper records. The offices that use electronic records still may use paper forms for certain services, but later transfer that information to the electronic record. Medical records assist physicians in providing the best care possible to their patients. They are also used to track information for reporting and data collection purposes. Everyone in the medical office should understand how a record is created, the content, organization of content, filing methods, and the legal requirements for working with medical records.

What will you learn in this unit?

• Explain why medical facilities have converted from paper to electronic medical records

• Provide examples of how different office staff use electronic medical records

• Identify processes for using paper medical records

• List the primary responsibilities of the medical records staff

Unit 8: Medical Law and Ethics

What if you were asked by a friend to find out why their daughter came to your medical office last week. Would you do it? Can you do it? No, you cannot—because this is against the law. Anyone working in a healthcare setting must have a working knowledge of medical law and ethics. Whether you are working in the office setting or providing direct patient care, you must understand and abide by the laws and ethics set forth by state and federal governments and organizations such as the American Medical Association. We study law and ethics so that we know these laws and can therefore protect our providers and their employees from unwanted legal situations.

What will you learn in this unit?

• Identify the primary reason to study law and ethics in health care

• Give an example of each of the four HIPAA standards

• Explain workplace laws and how they affect the medical office

• Examine the role of ethics in the medical office

• Describe the advanced directive process

Unit 1: Foundations of Medical Billing and Coding

Participants will embark on a comprehensive exploration of the fundamentals of medical billing and coding, laying the groundwork for a successful career in healthcare administration. This unit covers essential topics such as medical terminology, anatomy, and the basics of healthcare documentation. Students will gain insights into the foundational principles of coding conventions, emphasizing accuracy and precision.

What will you learn in this unit?

• Acquire a solid understanding of medical terminology.

• Explore the basics of human anatomy relevant to medical coding.

• Develop foundational knowledge of healthcare documentation.

• Understand coding conventions and principles for accurate code assignment.

Unit 2: Healthcare Reimbursement Systems

This unit focuses on the intricate landscape of healthcare reimbursement systems, providing students with insights into insurance types, claims processing, and reimbursement methodologies. Participants will delve into the complexities of healthcare coding and billing guidelines, ensuring compliance with industry standards.

What will you learn in this unit?

• Gain an understanding of various healthcare reimbursement systems.

• Explore the intricacies of claims processing and documentation requirements.

• Understand reimbursement methodologies and their impact on medical billing.

• Navigate coding and billing guidelines to ensure compliance.

Unit 3: Anatomy of CPT and ICD-10-CM Coding

Delve into the core of medical coding with a focus on Current Procedural Terminology (CPT) and International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) coding systems. Participants will learn the intricacies of assigning accurate procedure and diagnosis codes, essential for medical billing accuracy.

What will you learn in this unit?

• Master the CPT coding system for procedures.

• Acquire proficiency in assigning ICD-10-CM codes for accurate diagnosis coding.

• Understand the linkage between CPT and ICD-10-CM codes.

• Apply coding guidelines for precise code assignment.

Unit 4: Advanced Medical Coding Techniques

Building on the foundational coding knowledge, this unit explores advanced medical coding techniques and specialties. Participants will delve into the complexities of Hierarchical Condition Category (HCC) coding, Evaluation and Management (E/M) coding, and specialty-specific coding scenarios, honing their skills for diverse coding challenges.

What will you learn in this unit?

• Master advanced coding techniques such as HCC coding.

• Gain proficiency in Evaluation and Management (E/M) coding.

• Navigate specialty-specific coding scenarios.

• Develop skills for accurate and detailed medical code assignments.

Unit 5: Medical Billing Practices and Regulations

This unit delves into the practical aspects of medical billing, covering billing practices, regulations, and compliance. Students will explore the intricacies of billing software, claims submission, and reimbursement management while ensuring adherence to healthcare laws and regulations.

What will you learn in this unit?

• Understand best practices in medical billing.

• Navigate billing software for efficient claims submission.

• Comprehend healthcare regulations and compliance requirements.

• Learn effective reimbursement management strategies.

Unit 6: Health Information Management and Electronic Health Records (EHR)

Explore the integration of health information management and Electronic Health Records (EHR) in the medical billing and coding process. Participants will gain insights into the role of EHR in coding accuracy, data security, and interoperability, enhancing their ability to work with modern healthcare technologies.

What will you learn in this unit?

• Understand the role of health information management in medical billing and coding.

• Explore the impact of Electronic Health Records (EHR) on coding accuracy.

• Navigate EHR systems for efficient data management.

• Ensure data security and interoperability in healthcare technology.

Unit 7: Compliance and Ethics in Medical Billing and Coding

This unit focuses on the critical aspects of compliance and ethics in medical billing and coding. Students will explore ethical considerations, patient privacy, and compliance with healthcare regulations, emphasizing the importance of maintaining integrity in healthcare administration.

What will you learn in this unit?

• Understand ethical considerations in medical billing and coding.

• Navigate patient privacy and confidentiality requirements.

• Comprehend compliance with healthcare laws and regulations.

• Develop a strong foundation for maintaining integrity in healthcare practices.

Unit 8: Emerging Trends and Career Development in Medical Billing and Coding

Stay ahead of the curve with insights into the latest trends and innovations in medical billing and coding. Participants will explore emerging technologies, career development opportunities, and strategies for staying current in this dynamic field, ensuring a successful and evolving career path.

What will you learn in this unit?

• Stay abreast of emerging trends in medical billing and coding.

• Explore career development opportunities in the healthcare industry.

• Understand the impact of technology on the future of medical billing and coding.

• Develop strategies for continuous learning and professional growth.

Unit 1: Overview of Coding Guidelines

Embark on an exploration of comprehensive coding guidelines that govern medical billing and coding practices. Participants will delve into the fundamental principles guiding accurate code assignment, laying the foundation for more advanced coding concepts. This unit provides an overview of coding guidelines, emphasizing the importance of adherence to precision in healthcare coding.

What will you learn in this unit?

• Understand the foundational principles of coding guidelines.

• Explore the importance of adherence to coding guidelines in medical billing.

• Recognize the impact of accurate coding on healthcare reimbursement.

• Gain insights into the role of coding guidelines in maintaining data integrity.

Unit 2: ICD-10-CM Coding Guidelines

Delve into the intricate world of the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) coding guidelines. Participants will gain a comprehensive understanding of the principles guiding the assignment of accurate diagnosis codes, covering conventions, sequencing, and documentation requirements.

What will you learn in this unit?

• Master the ICD-10-CM coding guidelines for precise diagnosis coding.

• Understand conventions and sequencing principles in ICD-10-CM coding.

• Explore documentation requirements to support accurate code assignment.

• Apply ICD-10-CM guidelines to various medical scenarios.

Unit 3: CPT-10 Evaluation and Management (E/M) Coding Guidelines

This unit focuses on the Evaluation and Management (E/M) coding guidelines within the Current Procedural Terminology, 10th Edition (CPT-10). Participants will explore the intricacies of E/M code assignment, covering key components, documentation requirements, and the decision-making process.

What will you learn in this unit?

• Master the guidelines for assigning Evaluation and Management (E/M) codes in CPT-10.

• Understand key components and documentation requirements for E/M coding.

• Explore the decision-making process in E/M code assignment.

• Apply E/M coding guidelines to diverse patient encounters.

Unit 4: Surgical Coding Guidelines in CPT-10

Gain expertise in the surgical coding guidelines within CPT-10, covering a wide array of procedures. Participants will explore the principles guiding accurate code assignment for surgical interventions, including modifiers, bundling, and global periods.

What will you learn in this unit?

• Understand the surgical coding guidelines in CPT-10.

• Explore the use of modifiers in surgical code assignment.

• Navigate bundling principles and global periods in surgical coding.

• Apply surgical coding guidelines to various operative scenarios.

Unit 5: Radiology and Imaging Coding Guidelines

Navigate the specific guidelines governing radiology and imaging coding within the CPT-10 system. Participants will learn to accurately code diagnostic and interventional radiological procedures, including guidelines for contrast administration and multiple imaging studies.

What will you learn in this unit?

• Master the coding guidelines for diagnostic and interventional radiology.

• Understand guidelines for contrast administration in radiology coding.

• Explore coding principles for multiple imaging studies.

• Apply radiology and imaging coding guidelines to diverse scenarios.

Unit 6: Pathology and Laboratory Coding Guidelines

This unit focuses on the coding guidelines for pathology and laboratory services, covering a variety of diagnostic procedures. Participants will gain insights into code assignment for laboratory tests, specimen handling, and pathology services.

What will you learn in this unit?

• Understand coding guidelines for pathology and laboratory services.

• Explore the principles governing code assignment for laboratory tests.

• Navigate guidelines for specimen handling and pathology services.

• Apply pathology and laboratory coding guidelines to diverse diagnostic scenarios.

Unit 7: Medicine Coding Guidelines in CPT-10

Explore the diverse guidelines governing medicine coding within CPT-10, encompassing a range of medical services. Participants will delve into the coding principles for vaccinations, injections, and non-surgical interventions, ensuring accuracy in code assignment.

What will you learn in this unit?

• Master the guidelines for coding medical services in CPT-10.

• Explore principles governing medicine code assignment.

• Understand guidelines for coding vaccinations and injections.

• Apply medicine coding guidelines to various non-surgical interventions.

Unit 8: Modifiers and Compliance in Coding

Conclude the course by focusing on modifiers and compliance within coding practices. Participants will gain insights into the purpose and application of modifiers, ensuring accurate code assignment. This unit also covers compliance with coding regulations, emphasizing ethical considerations in healthcare coding.

What will you learn in this unit?

• Understand the purpose and application of modifiers in coding.

• Explore common modifiers and their impact on code assignment.

• Learn guidelines for appropriate modifier usage.

• Understand the importance of compliance and ethical considerations in coding practices.

Unit 1: In-Depth Exploration of ICD-10 Coding System

Begin your journey into advanced coding with an in-depth exploration of the International Classification of Diseases, 10th Edition (ICD-10) coding system. Participants will delve into the structure and hierarchy of ICD-10 codes, understanding their role in documenting diseases, conditions, and related health issues. This unit provides a foundation for advanced coding practices in medical billing and coding.

What will you learn in this unit?

• Understand the structure and organization of the ICD-10 coding system.

• Explore the hierarchy and specificity of ICD-10 codes.

• Learn the purpose and application of ICD-10 codes in healthcare documentation.

• Gain familiarity with the terminology used in ICD-10 coding.

Unit 2: Advanced Diagnosis Coding Techniques

Build on your foundational diagnosis coding skills by delving into advanced techniques within the ICD-10 system. Participants will explore intricate coding scenarios, such as coding for chronic conditions, complications, and manifestations. This unit equips students with the knowledge to accurately code complex diagnoses encountered in medical billing and coding.

What will you learn in this unit?

• Master advanced diagnosis coding techniques in ICD-10.

• Gain proficiency in coding for chronic conditions and related complications.

• Explore coding scenarios involving disease manifestations.

• Understand the guidelines for coding multiple diagnoses.

Unit 3: Procedure Coding with ICD-10-PCS

Shift focus to procedure coding with the ICD-10-Procedure Coding System (ICD-10-PCS). Participants will explore the structure and principles of ICD-10-PCS codes, learning to accurately code for medical interventions and procedures. This unit provides essential skills for coding detailed procedural information in medical billing.

What will you learn in this unit?

• Understand the structure and organization of ICD-10-PCS codes.

• Gain proficiency in coding for medical interventions and procedures.

• Explore the guidelines for accurate procedure code assignment.

• Apply ICD-10-PCS codes to diverse procedural scenarios.

Unit 4: Application of ICD-10 Codes in Specialty Areas

Explore the application of ICD-10 codes in various specialty areas of healthcare. Participants will delve into specialty-specific coding scenarios, including coding for obstetrics, orthopedics, cardiology, and more. This unit equips students with the skills needed to navigate the nuances of coding in specialized medical fields.

What will you learn in this unit?

• Master ICD-10 coding for specialty areas in healthcare.

• Explore coding scenarios in obstetrics, orthopedics, cardiology, and other specialties.

• Understand the specific guidelines for coding in diverse medical fields.

• Apply ICD-10 codes to complex cases within specialty areas.

Unit 5: Advanced Modifiers and ICD-10 Coding

Enhance your coding proficiency by delving into the advanced use of modifiers in conjunction with ICD-10 codes. Participants will explore complex coding scenarios requiring modifiers for additional information and specificity. This unit equips students with the skills to accurately convey details in coding through the strategic use of modifiers.

What will you learn in this unit?

• Understand the advanced use of modifiers in conjunction with ICD-10 codes.

• Explore scenarios requiring modifiers for additional specificity.

• Learn guidelines for appropriate modifier usage in complex coding cases.

• Apply modifiers strategically to convey specific details in coding scenarios.

Unit 6: Coding for Chronic Conditions and Long-Term Care

This unit focuses on advanced coding for chronic conditions and long-term care within the ICD-10 system. Participants will explore coding guidelines for chronic diseases, including coding complications and manifestations over extended periods. The unit provides essential skills for accurately coding in the context of long-term care scenarios.

What will you learn in this unit?

• Master advanced coding for chronic conditions in the ICD-10 system.

• Explore coding complications and manifestations over extended periods.

• Understand guidelines for accurate coding in long-term care scenarios.

• Apply coding principles to chronic conditions encountered in medical billing.

Unit 7: Advanced Reporting and Documentation Requirements

Navigate advanced reporting and documentation requirements associated with ICD-10 coding. Participants will explore the documentation criteria necessary for accurate code assignment, focusing on detailed and comprehensive reporting. This unit equips students with the knowledge to ensure compliance with coding and reporting standards.

What will you learn in this unit?

• Understand advanced reporting and documentation requirements in ICD-10 coding.

• Explore criteria for detailed and comprehensive reporting.

• Learn the importance of accurate documentation for code assignment.

• Ensure compliance with coding and reporting standards in advanced scenarios.

Unit 8: Auditing and Quality Assurance in Advanced Coding

Conclude the course by delving into auditing and quality assurance processes in advanced coding scenarios. Participants will explore techniques for assessing the accuracy and completeness of coded data, ensuring adherence to coding guidelines and standards. This unit prepares students for roles involving auditing and quality assurance in medical billing and coding.

What will you learn in this unit?

• Gain proficiency in auditing and quality assurance processes for advanced coding.

• Explore techniques for assessing the accuracy and completeness of coded data.

• Understand the importance of adherence to coding guidelines and standards in auditing.

• Apply quality assurance principles to advanced coding scenarios encountered in medical billing.

Unit 1: Introduction to Medical Insurance Basics

Begin your exploration of Medical Insurance in the context of billing and coding with a comprehensive introduction to the fundamental concepts. Participants will delve into the essential terminology, principles, and regulations governing medical insurance. This unit provides the foundational knowledge required for understanding the intricate world of medical insurance in healthcare administration.

What will you learn in this unit?

• Acquire a comprehensive understanding of medical insurance basics.

• Explore key terminology and principles associated with medical insurance.

• Understand the regulatory landscape influencing medical insurance practices.

• Develop foundational knowledge for navigating the complexities of medical insurance in billing and coding.

Unit 2: Health Insurance Plans and Types

This unit delves into the diverse landscape of health insurance plans, providing participants with insights into various types, structures, and coverage options. Students will explore the nuances of employer-sponsored plans, Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and government-sponsored plans such as Medicare and Medicaid.

What will you learn in this unit?

• Gain insights into the different types of health insurance plans.

• Understand the structures and coverage options of employer-sponsored plans.

• Navigate the distinctions between HMO, PPO, Medicare, and Medicaid.

• Explore the impact of health insurance plan types on medical billing and coding.

Unit 3: Insurance Eligibility and Verification Processes

This unit focuses on the critical process of determining insurance eligibility and verification. Participants will learn effective strategies for verifying patient insurance information, including demographic details, policy benefits, and applicable copayments or deductibles. Emphasis will be placed on accurate and thorough verification to streamline the billing process.

What will you learn in this unit?

• Develop skills for verifying patient insurance information.

• Understand the intricacies of insurance eligibility and benefits verification.

• Differentiate between primary, secondary, and tertiary insurance plans.

• Update Coordination of Benefits (COB) information accurately.

Unit 4: Medical Coding and Billing Guidelines for Insurance

Explore the specific coding and billing guidelines associated with medical insurance processes. Participants will gain insights into the unique requirements for submitting clean and accurate claims, adhering to coding rules, and preventing fraud and abuse. This unit will provide a comprehensive understanding of the guidelines essential for successful medical billing and coding.

What will you learn in this unit?

• Master coding and billing guidelines for insurance claims.

• Understand the importance of accurate code assignment for clean claims.

• Adhere to coding rules and conventions in medical billing processes.

• Develop strategies to prevent fraud and abuse in billing practices.

Unit 5: Claims Submission and Reimbursement Processes

Delve into the practical aspects of claims submission and reimbursement in the medical insurance landscape. Participants will gain insights into completing claim forms, transmitting claims electronically, and navigating the reimbursement process. This unit equips students with the knowledge and skills required for efficient and effective claims management.

What will you learn in this unit?

• Understand the process of completing CMS-1500 and other claim forms.

• Gain proficiency in electronic claims submission processes.

• Determine the financial responsibility of patients and third-party payers.

• Analyze and interpret remittance advice (RA) for accurate reimbursement.

Unit 6: Denials Management and Appeals

This unit focuses on denials management and appeals processes in medical insurance billing. Participants will explore the interpretation of denial codes, determine reasons for denials, and develop appropriate resolutions. The unit also covers the submission of reconsiderations or appeals, ensuring effective dispute resolution and claims adjudication.

What will you learn in this unit?

• Analyze and interpret denial codes in medical insurance claims.

• Understand the reasons behind claim denials.

• Navigate the proper procedures for submitting reconsiderations or appeals.

• Develop effective strategies for claims dispute resolution.

Unit 7: Medical Insurance Fraud Detection and Prevention

Explore the critical area of medical insurance fraud detection and prevention. Participants will gain insights into identifying fraudulent activities, understanding red flags, and implementing preventive measures. This unit emphasizes adherence to ethical standards and regulatory guidelines to maintain the integrity of medical insurance practices.

What will you learn in this unit?

• Recognize red flags and indicators of medical insurance fraud.

• Develop skills for detecting and preventing fraudulent activities.

• Understand the importance of ethical standards in medical insurance practices.

• Adhere to regulatory guidelines to maintain integrity in billing and coding.

Unit 8: Emerging Trends in Medical Insurance

Stay informed about the latest trends and innovations shaping the future of medical insurance. This unit explores advancements in technology, changes in regulatory frameworks, and the impact of emerging trends on medical billing and coding. Participants will develop a forward-looking perspective on the evolving landscape of medical insurance.

What will you learn in this unit?

• Stay abreast of emerging trends in medical insurance.

• Explore the impact of technology on insurance processes.

• Understand changes in regulatory frameworks affecting medical billing and coding.

• Develop strategies for adapting to and leveraging emerging trends in the field.

Unit 1: Fundamentals of Billing and Reimbursement

Participants will delve into the foundational principles of billing and reimbursement in the healthcare industry. This unit provides a comprehensive understanding of the billing process, reimbursement methodologies, and the importance of accurate documentation in medical coding.

What will you learn in this unit?

• Understand the fundamentals of the billing and reimbursement process.

• Explore various reimbursement methodologies in healthcare.

• Gain insights into the role of accurate documentation in medical coding.

• Navigate the intricacies of claim submission and processing.

Unit 2: Healthcare Payer Systems and Policies

This unit focuses on the diverse landscape of healthcare payer systems and their policies. Participants will explore the intricacies of commercial insurance plans, government-sponsored programs, and other third-party payers. Understanding payer policies and guidelines is crucial for successful reimbursement.

What will you learn in this unit?

• Explore the policies and practices of commercial insurance plans.

• Understand government-sponsored healthcare programs.

• Navigate the intricacies of third-party payer systems.

• Analyze and interpret various payer policies affecting reimbursement.

Unit 3: Coding and Documentation for Maximum Reimbursement

Building on foundational coding knowledge, this unit emphasizes coding and documentation strategies that maximize reimbursement. Participants will learn techniques to ensure accurate code assignment, reduce claim denials, and optimize revenue for healthcare providers.

What will you learn in this unit?

• Master coding techniques for maximum reimbursement.

• Develop strategies for accurate documentation to support reimbursement.

• Understand the impact of coding on claim reimbursement.

• Learn to mitigate claim denials through precise coding and documentation.

Unit 4: Medicare Billing and Reimbursement

This unit provides a comprehensive understanding of Medicare billing and reimbursement, covering different parts of the program. Participants will navigate the specific requirements, coding guidelines, and reimbursement methodologies associated with Medicare, ensuring compliance with government regulations.

What will you learn in this unit?

• Understand the structure and components of Medicare.

• Navigate Medicare coding guidelines for accurate reimbursement.

• Explore the reimbursement methodologies specific to Medicare.

• Comprehend compliance requirements for billing under Medicare.

Unit 5: Medicaid and State Programs

Delve into the complexities of Medicaid and other state-specific healthcare programs. Participants will explore the eligibility criteria, billing guidelines, and reimbursement methodologies associated with Medicaid, ensuring a comprehensive understanding of state-specific programs.

What will you learn in this unit?

• Understand the structure and components of Medicaid.

• Explore state-specific healthcare programs and their billing requirements.

• Navigate the intricacies of Medicaid coding guidelines.

• Gain insights into reimbursement methodologies for state programs.

Unit 6: Denials Management and Appeals Process

This unit focuses on denials management and the appeals process, crucial aspects of effective revenue cycle management. Participants will learn strategies for identifying, resolving, and preventing claim denials, as well as navigating the appeals process for denied claims.

What will you learn in this unit?

• Develop strategies for effective denials management.

• Understand the appeals process for denied claims.

• Learn to identify and resolve common causes of claim denials.

• Explore preventive measures to minimize claim denials.

Unit 7: Fraud and Abuse in Billing and Reimbursement

Participants will explore the ethical considerations and legal implications surrounding fraud and abuse in billing and reimbursement. This unit covers the detection, prevention, and reporting of fraudulent activities, ensuring compliance with healthcare laws.

What will you learn in this unit?

• Understand the legal implications of fraud and abuse in healthcare billing.

• Explore techniques for detecting and preventing fraudulent activities.

• Comprehend reporting requirements for suspected fraud and abuse.

• Develop a strong ethical foundation for billing and reimbursement practices.

Unit 8: Emerging Trends in Billing and Reimbursement

Stay abreast of the latest trends and innovations in billing and reimbursement. Participants will explore the impact of technology, evolving healthcare policies, and emerging trends on the billing and reimbursement landscape, ensuring adaptability in this dynamic field.

What will you learn in this unit?

• Stay informed about emerging technologies in billing and reimbursement.

• Explore the impact of evolving healthcare policies on reimbursement.

• Understand the role of data analytics in optimizing billing processes.

• Develop strategies for adapting to emerging trends in the healthcare industry.

Unit 1: Introduction to EHR Systems

In this foundational unit, participants will embark on an exploration of Electronic Health Records (EHR) systems, gaining a comprehensive understanding of their evolution, significance, and profound impact on modern healthcare delivery. Participants will delve into the core components and functionalities of EHR systems, with a focus on patient demographics, clinical documentation, and decision support features. Throughout this unit, students will not only grasp the fundamental concepts of EHR but also develop insights into how these systems shape and revolutionize the healthcare landscape. By the end of this unit, participants will have acquired essential knowledge about the origins, importance, and operational aspects of EHR systems.

What will you learn in this unit?

• Understand the evolution of Electronic Health Records (EHR) systems.

• Recognize the significance of EHR in contemporary healthcare delivery.

• Explore the key components of EHR, including patient demographics.

• Gain insights into the functionalities of EHR systems, such as clinical documentation and decision support features.

Unit 2: EHR Implementation and Adoption

In this unit, participants will immerse themselves in the intricate process of implementing Electronic Health Records (EHR) systems within healthcare settings. The exploration will encompass addressing challenges associated with EHR implementation and ensuring a seamless transition. Strategies for fostering successful EHR adoption among healthcare professionals will be examined, emphasizing the crucial aspects of training and change management.

What will you learn in this unit?

• Navigate the implementation process of EHR systems in healthcare settings.

• Address challenges associated with EHR implementation.

• Foster successful EHR adoption among healthcare professionals.

• Emphasize the importance of training and change management in EHR adoption.

Unit 3: EHR Data Security and Privacy

This unit delves into the critical aspects of data security and privacy within Electronic Health Records (EHR) systems. Participants will explore encryption techniques, user authentication, and audit trails to safeguard patient information. Additionally, the unit will cover compliance with healthcare regulations, including the Health Insurance Portability and Accountability Act (HIPAA) and other relevant standards.

What will you learn in this unit?

• Understand the critical aspects of data security and privacy in EHR systems.

• Explore encryption techniques and user authentication for safeguarding patient information.

• Navigate audit trails within EHR systems.

• Ensure compliance with healthcare regulations, including HIPAA.

Unit 4: Interoperability and Health Information Exchange (HIE)

This unit introduces the concept of interoperability and emphasizes the importance of Health Information Exchange (HIE) in facilitating seamless communication between different healthcare entities. Participants will gain an understanding of the standards and protocols supporting interoperability and their impact on coordinated patient care.

What will you learn in this unit?

• Explore the concept of interoperability in healthcare.

• Understand the role of Health Information Exchange (HIE) in facilitating communication.

• Familiarize with standards and protocols supporting interoperability.

• Recognize the impact of interoperability on coordinated patient care.

Unit 5: Clinical Decision Support Systems (CDSS) in EHR

Participants will dive into the realm of Clinical Decision Support Systems (CDSS) integrated within Electronic Health Records (EHR). The unit examines the crucial role of CDSS in enhancing healthcare outcomes and promoting evidence-based practices. Further, participants will explore the design, implementation, and evaluation of CDSS to support healthcare professionals in clinical decision-making.

What will you learn in this unit?

• Understand the role of Clinical Decision Support Systems (CDSS) in EHR.

• Explore how CDSS enhances healthcare outcomes.

• Learn the design, implementation, and evaluation of CDSS.

• Support healthcare professionals in clinical decision-making using CDSS.

Unit 6: EHR Customization and Optimization

In this unit, participants will learn strategies for customizing Electronic Health Records (EHR) systems to meet the specific needs of healthcare organizations. The focus is on ensuring efficiency and user satisfaction through tailored adaptations. The exploration extends to optimization techniques aimed at enhancing the overall functionality, usability, and performance of EHR systems.

What will you learn in this unit?

• Learn strategies for customizing EHR systems to meet organizational needs.

• Ensure efficiency and user satisfaction through tailored adaptations.

• Explore optimization techniques for enhancing EHR functionality.

• Understand the significance of optimizing usability and performance.

Unit 7: Patient Engagement through EHR

Explore the pivotal role of Electronic Health Records (EHR) in promoting patient engagement and empowerment. Participants will delve into features like patient portals and secure communication tools. The unit also encompasses understanding how EHR systems contribute to shared decision-making, improved communication, and enhanced patient satisfaction.

What will you learn in this unit?

• Explore the role of EHR in promoting patient engagement and empowerment.

• Understand features like patient portals and secure communication tools.

• Recognize the contribution of EHR systems to shared decision-making.

• Enhance patient satisfaction through improved communication.

Unit 8: Emerging Trends in EHR Technology

Stay ahead in the dynamic landscape of healthcare technology with this unit on emerging trends in Electronic Health Records (EHR) technology. Participants will explore the latest innovations, including advancements in artificial intelligence, telehealth integration, and the impact of mobile health applications. Engage in discussions about the future direction of EHR systems and their evolving role in shaping modern healthcare.

What will you learn in this unit?

• Stay abreast of the latest trends and innovations in EHR technology.

• Explore advancements in artificial intelligence within EHR systems.

• Understand the integration of telehealth in EHR technology.

• Discuss the evolving role of EHR systems in shaping the future of healthcare.