HIM 260 - Medical Record Auditing

4 Credit(s)

This is a hands-on, interactive course where students will learn how medical record auditing plays an important role in the financial well-being of every healthcare business. This course is designed to emphasize the principles of medical record documentation and chart auditing. This course will detail the processes of documentation, coding guidelines and regulatory information as it pertains to auditing. This course covers both outpatient physician and inpatient / outpatient hospital records.

Prerequisite: HIM 270 and HIM 273 with a grade of C or better.
Learning Outcomes
Upon successful completion of this course, students will be able to:

Identify a new versus established patient, obtain patient demographic information, insuranceverification, and authorizations and collect time-of- service payments
Understand and explain the importance of accurate documentation when working with electronic health records
Describe the different types of medical insurance, their characteristics and eligibility requirements
Determine Coordination of Benefits for patients with more than one insurance plan
Code diagnoses using the basic steps and principles of the ICD-10-CM coding system
Code procedures/services using the basic steps and principles of the CPT/HCPCS coding system
Complete HIPAA-compliant health care claims for Medicare, Medicaid, and TRICARE/CHAMPVA; Workers’ Compensation; and private payers, including BlueCross and BlueShield Plans,commercial carriers, and managed care organizations
Understand and complete the hospital billing cycle following the guidelines previously learned
Discuss HIPAA/HITECH, legal, and ethical considerations with emphasis on confidentiality, protected health information and fraud related to insurance
Discuss the processing of payers’ remittance advices (RAs) and patient billing/collections

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