MEDICAL ASSISTANT Coleman College for Health Sciences

MDCA 1343 Medical Insurance

CRN 126734 - Fall 2014
Coleman Campus - Room TBA | 8:00 a.m. - 12:00 p.m. Lecture
CHSC Room TBA | Lab |CHSC271|3:30p.m. 05:30 p.m. Monday & Thursday (16
weeks FALL hybrid) 2 hour lecture course/ 2 hours lab/
64 hours per semester/ 8 weeks

Instructor: Sheila M Williams, AA, CMA (AAMA), CET,
CCT Instructor Contact Information:
Office: 713) 718-7360
E-mail: Sheila.williams@hccs.edu

Office location and hours
The MDCA Program is located in Suite 434. The instructor assigned to this course can be reached
by phone at (713)-718-7360 or (713)-718-7365 (secretary), Mr. George Kollie. Individual/group
tutoring is available. Schedule the time with your instructor. Students will be seen during the
instructors conference period as walkins or by scheduled appointments. Instructors office hours
will be posted on the outside door of Room 432 and an appointment schedule will be left with the
MDCA secretary.

Course Description MDCA 1343 emphasizes medical office coding procedures for
payments/reimbursement by patient or third party.

Prerequisites None

Course Goal The course goal for MDCA 1343 is to provide allied health students who have
minimum background in medical insurance with the basics of filing and coding medical insurance
claims.

Student Learning Outcomes The student will be able to:
1. Code procedures performed during office visits
2. Bill patients or insurance carriers for visits/procedures
3. Compare and contrast insurance plans
4. Define common terms used to file third party reimbursement forms.

Learning objectives
Students will:
1.1 Perform diagnostic coding accurately by using ICD-9 coding books
1.2 Perform procedural coding accurately using CPT coding books
2.1 Abstract from source document relevant information for completing claim form
2.2 Accurately complete claim form for a third party payer
3.1 Compare and contrast insurance plans
3.2 Using manage care policies and procedures complete a referral form
3.3 Recognize and recall terms used in filing third party reimbursement
SCANS or Core Curriculum Statement and Other Standards
Credit: 3 (3 lecture)
Scans Competencies (C1. C2, C6, C5, C8, C15, C16, C17)
CAAHEP VII. C (Cognitive) Managed Care/ Insurance (1-12)
VII. P (Psychomotor/ Skills) Managed care/ Insurance (1-6)
VII. A (Affective/ Behavior) Managed care / Insurance (1-3)
VIII. C (Cognitive) Procedural and Diagnostic
Coding (1-4)
VIII. P (Psychomotor/ Skills) Procedural and Diagnostic Coding (1-2) VIII. A
(Affective/Behavior) Procedural and Diagnostic Coding (1)


Learning objectives
Students will:
1.1 Perform diagnostic coding accurately by using ICD-9 coding books
1.2 Perform procedural coding accurately using CPT coding books
2.1 Abstract from source document relevant information for completing claim form
2.2 Accurately complete claim form for a third party payer
3.1 Compare and contrast insurance plans
3.2 Using manage care policies and procedures complete a referral form
3.3 Recognize and recall terms used in filing third party reimbursement SCANS or Core


Curriculum Statement and Other Standards Credit: 3 (3 lecture) Scans
Competencies (C1. C2, C6, C5, C8, C15, C16, C17)
CAAHEP VII. C (Cognitive) Managed Care/ Insurance (1-12)
VII. P (Psychomotor/ Skills) Managed care/ Insurance (1-6)
VII. A (Affective/ Behavior) Managed care / Insurance (1-3)
VIII. C (Cognitive) Procedural and Diagnostic Coding (1-4)
VIII. P (Psychomotor/ Skills) Procedural and Diagnostic Coding (1-
2)
VIII. A (Affective/Behavior) Procedural and Diagnostic Coding (1)

MDCA 1343 Sixteen Week Calendar

Date Class To Assignments
08/25/2014 Week One
1
Orientation
Chapter 1: Health
insurance
Specialist Career
Orientation
Peer Introduction
Read Chapter One
Complete chapter
coursemate as
homework
Complete chapter quizzes on

09/01/2014 Week Two
No Class
Holiday
Labor Day
2
Chapter 2:
Introduction to health
Insurance
Chapter 3: Managed
Health
Care
Lab Day
No Class; chapter
quizzes : Course mate
quiz and Moodle quiz
However Please read
the following chapters
2& 3
09/08/2014 Week Three
Exam 1 Lab A
Chapters 1-3
3
Chapter4: Processing an
Insurance Claim
Read Chapter 4
Complete chapter
review
Complete chapter
Course mate quiz
and chapter quiz on
Moodle
09/15/2014 Week Four
4
Chapter 5: Legal
and Regulatory
Issues
Read chapter 5
Complete chapter
coursemate Complete
chapter quizzes on Moodle
Interview Due
09/22/2014 Week Five
5
Chapter 6: ICD-9-CM
Coding Chapter 6B; ICD-
9-CM Coding
Read chapters 6A and
6B Complete the
Coursemate quiz and
Moodle quiz
Soap Format Due
09/29/2014 Week Six
6
Chapter 7: CPT Coding Read chapter 7
Complete chapter
coursemate Complete
chapter quizzes on Moodle
10/06/2014 Week Seven
7
Chapter8: HCPCS
Level II Coding
Read chapter 8
Complete chapter
coursemate Complete
chapter quizzes on Moodle
10/13/2014 Week Eight
8
Midterm Exam
Chapter 9: CMS
Reimbursement
Methodologies
MidTerm Examination
Chapters 1-8
Read chapter 9
Complete chapter
coursemate
Complete chapter
quizzes on Moodle
10/20/2014 Week Nine
9
Exam 2
chaps 4- 7
Chapter 10: Coding for
Medical Necessity
Chapter 11: Essential
CMS-
1500 Claim Instructions
Read chapters 10-11
Complete chapter
coursemate
Complete chapter quizzes on
Moodle
10/27/2014 Week Ten
10
Chapter 12: Commercial
Insurance
Read chapter 12
Complete chapter
coursemate
Complete chapter
quizzes on Moodle

11/03/2014 Week Eleven Chapter 13: Blue Cross
Blue
Shield
Read chapter 12
Complete chapter
coursemate
Complete chapter
quizzes on Moodle
11/10/2014 Week Twelve
12
Chapter 14: Medicare Read chapters 14
Complete chapter
coursemate
Complete chapter
quizzes on Moodle
11/17/2014 Week Thirteen
13
Chapter 15: Medicaid Read chapters 14
Complete chapter
coursemate
Complete chapter
quizzes on Moodle
11/24/2014 Week Fourteen
14
Final Review
Chapter 16:
TRICARE
Read Chapter 16
Complete chapter
coursemate Complete
chapter quizzes on Moodle
SimCase studies due
MOSS assignment due
12/01/2014 Week Fifteen
15
Chapter 17: Workers
Compensation
Read Chapters 15-17
Complete chapter reviews
Complete chapter quizzes on
Moodle
SimCase studies due
MOSS assignment due
12/08/2014 Week 16
Final
Examination
Final Examinations FINAL EXAMINATION


Major Assignment:
ASSIGNMENTS for MDCA 1343

1. Using the case studies provided in Appendix I, students will create five (5) patient folders with all the
required forms needed(Students may use any of the 20 cases provided). Each folder must have
completed electronic CMS- 1500 form.

2. Following the general instructions and hints for Sim Claim Case Studies in Appendix I, students
will complete claims using the SimClaim software for Case Studies 1-1 through 1-20.
3. Using the Appendix II in the textbook, students will complete five (5) claims using the SimClaim
Software
from Case Studies 2-1 through 2-20. Due date: 12/01/2014

4. Using the Appendix II in the textbook and the claim form from Appendix III in the textbook, students
will also complete five manual CMS-1500 claim forms by typewriter. The manual claims may be the
same Case Studies as in the assignment above. Due Date: 12/01/2014

5. Project is worth 30% for your final grade and is due 12/01/2014. NO late work accepted under
any circumstances.

CLASS SOAP FORMAT : Due date 09/22/ 2014
Instruction: Review the following SOAP notes, then select and code the
Diagnose
S: Patient complains of stomach pain, 3 days duration. She still also stated that her legs still
painful from the knee down.
O: Ht 5 6; Wt 164; BP 122/82; pulse 92 and regular; temp 97.0F, oral;
chest normal; heart normal . The Doppler arteriogram of lower extremity taken last week at the
hospital is reported as within limits bilaterally.
A: Another episode of atrophic gastritis. Leg pain.
P: Carafate 1 g. Take 1 tablet qid before meals and at bedtime. #120 tabs



Moss Assignment
1. Using the case studies in the Appendix C of the workbook Case Studies for Medical Office
Simulation Software 2.0 MOSS you will complete a total of 6 case studies. You completed the first
one in lab all ready.
2. You will print the Insurance prebilling worksheet, the test version transmission screen status
report, a provider payment advice and final print screen of the verification of posting and post.
3. You may place these in a purple folder to be graded. Each document should have your names printed
on
it for when you print screen and/or save it. No name items will be accepted.
4. You will be divided into groups to complete this assignment. The first group A_H will complete
case studies 1, 3, 5, 7, 9, 10 and the last group I-Z will complete case studies 1, 24,6, 8, 10.
5. Case studies will be due on October27, 2014 the day of class. No later.

Interview Assignment
Interview of a Professional Due Date: September 15 , 2014
The student will submit a three-page, double-spaced, word-processed report on an interview of a professional; the
paper should be in paragraph form (not written in a question/answer format). Each paragraph should include a
minimum of three complete sentences, containing no typographical or grammatical errors. The last paragraph of the
paper should summarize the students reaction to the interview and whether the student would be interested in
having this professionals position (along with why or why not). Also, the student should predict where she or he will
be in 10 years (in terms of family, employment, and so on).


Classroom Practical Application

1. Discuss and research the web link http://www.irp.com and click on the Medicare DRG calculator link
and summary what you have discovered and learned.

2. Discuss why you feel that coding is a Medical Necessity. October 30, 2014
MOVIE DAY : DAMAGED CARE
Watch the movie and answer the following questions as it relates to the Movie. This is your understanding of
the movie.


1. When is it necessary to ration health care? Who does it? How can it be done ethically and
compassionately? Give two examples from the movie.

2. Where does the money go in the health care system? If health care dollars are "scarce," can we
ethically defend their use for non-health care expenditures, such as the sculpture portrayed in the
movie?

3. How does the organizational culture affect the decision-making and ethics of the individuals within it?
When is a system or organization unethical? Can one be ethical in an unethical system? Give examples from
the movie.

4. Can we expect individuals to make moral decisions when the costs (professional and personal) are too
great? Give examples from the movie.

5. Who was Linda Peeno and what was her role in the movie?

6. List some abuse of the Insurance Industries? Due on October 16 , 2014



Instructional Methods
MDCA 1343 courses involve the uses of lectures, PowerPoint presentation, videos,
virtual simulation, visual aid, and medical computer software.

Student Assignments
Assignments have been developed that will enhance your learning skills. To better understand
a topic, you will be given assignments on key information that you will need to remember for
your success in your career as a Medical Assistant. There are two special assignments for this
course that must be completed for you to achieve success in this course along with two major
exams. The Student SimClaim software CD along with the Encoder Pro is designed to help
students learn how to complete insurance claim forms for a variety of facilities. The Encoder Pro
allows the student to look up ICD-9CM, CPT and HCPCS level II codes quickly and accurately.
Students will be required to successfully complete the following:

Final Exam
The test will consist of one hundred (100) multiple choice questions, which will include all
chapters of the textbook. Questions will include knowledge and comprehension questions
covering medical

billing, coding, reimbursement, definitions and terminology. Questions will also include practical
applications scenarios, coding identifications and completing a CMS-1500 form.

Final Lab Practical Portfolio Students are required to complete the twenty (20) cases studies from
the Sim Claim software CD which accompanies their textbook .They are also to complete chapters
9-14 of the stop and practice exercise, chapter reviews 9- 14 (typed), and manual CMS-1500
forms. Manual CMS forms will be provided by your instructor. Students are to complete five (5) of
the 20 case studies manually using the typewriter. Upon completion of this simulation the student
will create a portfolio dividing their work into three sections Manual CMS-1500, Electronic
CMS-1500, Review Questions and Stop and Practice.

1. Portfolio should be neatly organized using the efolio on the Eagle online
2. All content of the portfolio will be submitted via the efolio except for the manual forms and the
folders
3. No partial work will be accepted nor will any disorganized folio be accepted. You must include a
summary of your work experience in your efolio.
4. Project is worth 30% of your overall grade.
5. Manual forms are due on 12/01/2014 @ 9:00 a.m.
6. Using the case studies provided in Appendix 1 students will create five (5) patient folders with all
the required forms needed. (Students may use any of the 20 cases provided.).
7. Each folder must consist of a completed CMS-1500 form for that particular patient whether the
patient is new or established. Forms needed are located in Appendix 3 of your textbook.
8. Students will complete five manual CMS-1500 forms from Appendix 1 using a typewriter.
9. There will be no specific homework assignment for this course except completion of stop and
practice and review exercises in the textbook.
10. Student will use lab time to help them to complete their assignment; so please use your time
wisely
11. Software can be installed on your personal computers or desktop at home so there are no
excuses for not completing your work on time and none will be accepted.
12. This software also allows you to save your work on a flash drive or to the hard drive you are
working on.


Assessments
Major exams (4) 15% of your final grade
Weekly quizzes (9) 15% of your final grade
Homework 10% of your final grade
Final Exam 30% of your final grade
Final Exam Portfolio 30% of your final grade



HCC Policy Statement - ADA
Services to Students with Disabilities Students who require reasonable accommodations for
disabilities are encouraged to report to Dr. Raj Gupta at 713-718-7631 to make necessary
arrangements. Faculty is only authorized to provide accommodations by the Disability Support
Service Office
Students who are requesting special testing accommodations must first contact the appropriate
(most convenient) DSS office for assistance: Disability Support Services Offices: System:
713.718.5165 Central: 713.718.6164 also for Deaf and Hard of Hearing Services and Students
Outside of the HCC District service areas. Northwest: 713.718.5422 Northeast: 713.718.8420

Southeast: 713.718.7218
Southwest: 713.718.7909

After student accommodation letters have been approved by the DSS office and submitted to DE
Counseling for processing, students will receive an email confirmation informing them of the
Instructional Support Specialist assigned to their professor


HCC Policy Statement: Academic Honesty
Students are responsible for conducting themselves with honor and integrity in fulfilling course
requirements. Penalties and or/ disciplinary proceedings may be initiated by College System
officials against a student accused of scholastic dishonesty. The following statement is an excerpt
from the Student Conduct section of the College System catalog: Scholastic dishonesty includes,
but is not limited to, cheating on test, plagiarism, and collusion. Cheating on a test includes:
Copying from another students test paper;
Using, during a test, materials not authorized by the person giving the test;
Collaborating with another student during a test without authority;
Knowingly using, buying, selling, stealing, transporting, or soliciting in whole or part the contents
of an unadministered test;
Bribing another person to obtain a test that is to be administered.

Plagiarism means the appropriation of anothers work and the unacknowledged incorporation of
that work in ones own written work for credit. Collusion means the unauthorized collaboration with
another person in preparing written work offered for credit.

HCC Policy Statements
Class Attendance Students are responsible for attending 90% of the class including lecture/lab.
Class attendance equals class success.

HCC Course Withdrawal Policy It is the responsibility of the student to officially drop or withdraw
from a course. Failure to officially withdraw may result in the student receiving a grade of F in the
course. The final day for withdrawal is October 31, 2014 at 4:30 p.m. If you feel that you cannot
complete this course, you will need to withdraw from the course prior to the final date of withdrawal.
Before, you withdraw from your course; please take the time to meet with the instructor to
discuss why you feel it is necessary to do so. The instructor may be able to provide you with
suggestions that would enable you to complete the course. Your success is very important.
Beginning in fall 2007, the Texas Legislature passed a law limiting first time entering freshmen to
no more than SIX total course withdrawals throughout their educational career in obtaining a
certificate and/or degree.

To help students avoid having to drop/withdraw from any class, HCC has instituted an Early Alert
process by which your professor may alert you and HCC counselors that you might fail a class
because of excessive absences and/or poor academic performance. It is your responsibility to visit
with your professor or a counselor to learn about what, if any, HCC interventions might be available
to assist you online tutoring, child care, financial aid, job placement, etc. to stay in class and
improve your academic performance.


If you plan on withdrawing from your class, you MUST contact a HCC counselor or your professor
prior to withdrawing (dropping) the class for approval and this must be done PRIOR to the
withdrawal deadline to receive a W on your transcript. **Final withdrawal deadlines vary each
semester and/or depending on class length, please visit the online registration calendars, HCC
schedule of classes and catalog, any HCC Registration Office, or any HCC counselor to determine
class withdrawal deadlines on October 31, 2014 @ 4:30 p.m. Remember to allow a 24-hour
response time when communicating via email and/or telephone with a professor and/or
counselor. Do not submit a request to discuss withdrawal options less than a day before
the deadline. If you do not withdraw before the deadline, you will receive the grade that you are
making in the class as your final grade.

Repeat Course Fee The State of Texas encourages students to complete college without having to
repeat failed classes. To increase student success, students who repeat the same course more
than twice, are required to pay extra tuition. The purpose of this extra tuition fee is to encourage
students to pass their courses and to graduate. Effective fall 2006, HCC will charge a higher tuition
rate to students registering the third or subsequent time for a course. If you are considering course
withdrawal because you are not earning passing grades, confer with your instructor/counselor as
early as possible about your study habits, reading and writing homework, test taking skills,
attendance, course participation, and opportunities for tutoring or other assistance that might be
available.

HCC Student Service Information

Earl y Alert: HCC has instituted an Early Alert process by which your professor will alert you
through counselors of concerns that you might fail a class because of excessive absences and/or
poor academic performance.

For DE students: Much information can be found on the DE Student Services website:
de.hccs.edu. Advising or counseling can be accomplished through our online request form
AskDECounseling. Counselors and Student Services Associates (SSA) can assist students with
admissions, registration, entrance testing requirements, degree planning, transfer issues, and
career counseling. In-person, confidential sessions, can also be scheduled to provide brief
counseling and community referrals to address personal concerns impacting academic success.

Virtual Classroom Conduct
As with on-campus classes, all students in HCC Distance Education courses are required to follow
all HCC Policies & Procedures, the Student Code of Conduct, the Student Handbook, and relevant
sections of the Texas Education Code when interacting and communicating in a virtual classroom
with faculty and fellow students. Students who violate these policies and guidelines will be subject to
disciplinary action that could include denial of access to course-related email, discussion groups,
and chat rooms or being removed from the class.


Classroom Behavior As your instructor and as a student in this class, it is our shared responsibility
to develop and maintain a positive learning environment for everyone. Your instructor takes this
responsibility very seriously and will inform members of the class if their behavior makes it difficult
for him/her to carry out this task. As a fellow learner, you are asked to respect the learning needs
of your classmates and assist your instructor achieve this critical goal.

Use of Camera and/or Recording Devices As a student active in the learning community of this
course, it is your responsibility to be respectful of the learning atmosphere in your classroom. To
show respect of your fellow students and instructor, you will turn off your phone and other electronic
devices, and will not use these devices in the classroom unless you receive permission from the
instructor.
Use of recording devices, including camera phones and tape recorders, is prohibited in classrooms,
laboratories, faculty offices, and other locations where instruction, tutoring, or testing occurs.
Students with disabilities who need to use a recording device as a reasonable accommodation
should contact the Office for Students with Disabilities for information regarding reasonable
accommodations

Instructor Requirements
As your Instructor, it is my responsibility to:
Provide the grading scale and detailed grading formula explaining how student grades are to be
derived
Facilitate an effective learning environment through class activities, discussions, and lectures
Description of any special projects or assignments
Inform students of policies such as attendance, withdrawal, tardiness and make up
Provide the course outline and class calendar which will include a description of any special
projects or assignments
Arrange to meet with individual students before and after class as required


To be successful in this class, it is the students responsibility to:
Attend class and participate in class discussions and activities
Read and comprehend the textbook
Complete the required assignments and exams:
Ask for help when there is a question or problem
Keep copies of all paperwork, including this syllabus, handouts and all assignments
Passing all written examinations, quizzes and assignments with a minimum grade average of
75%
Pass all skill competencies with 90% proficiency
Be in class attendance 90% of the time


Program/Discipline Requirements
Using the experience from the textbook in medical reimbursement and coding field the students will
practice skills learned during the course at the midterm and submit a Midterm Lab Practical Skill
portfolio (manual/ computer) worth 25% This project will also include creating five (5) patient folder
with the completed forms required for a new patient or an established patient. Patients will be
assigned by your instructor. The students will also submit a Final Lab Practice (portfolio) which will
include manual and computer skills used from the SimClaim software case studies (20 cases) worth
30%.

Grading
Your instructor will conduct quizzes, exams, and assessments that you can use to determine how
successful you are at achieving the course learning outcomes (mastery of course content and skills)
outlined in the syllabus. If you find you are not mastering the material and skills, you are encouraged
to reflect on how you study and prepare for each class. Your instructor welcomes a dialogue on
what you discover and may be able to assist you in finding resources on campus that will improve
your performance.

Grading Scale
90 - 100 =A 80 - 89 =B 75 - 79 =C 60 - 69 =D below 60 =F

Assessments
Major exams (4) 15% of your final grade
Weekly quizzes (9) 15% of your final grade
Homework 10% of your final grade
Final Exam 30% of your final grade
Final Exam Portfolio 30% of your final grade


EGLS3 -- Evaluation for Greater Learning Student Survey System
At Houston Community College, professors believe that thoughtful student feedback is necessary to
improve teaching and learning. During a designated time, you will be asked to answer a short online
survey of research-based questions related to instruction. The anonymous results of the survey will be
made available to your professors and division chairs for continual improvement of instruction. Look
for the survey as part of the Houston Community College Student System online near the end of the
term.