Portland Community College | Portland, Oregon

Students who successfully complete this course will be able to:

1. Support accurate billing through coding, chargemaster, and bill reconciliation processes.
2. Apply privacy, confidentiality, and security requirements.
3. Monitor health records for compliance with state and federal regulations.
4. Apply state and federal compliance requirements.
5. Explain the concept of managed care and the different types of managed care.
6. Understand the purpose of fee schedules, chargemasters, and auditing.
7. Monitor health records for documentation to support medical necessity as required by Medicare and other payers.
8. Participate in facility education programs on health information management compliance issues.
9. Understand OIG fraud and abuse reporting and investigation.
10. Follow the AHIMA standards of ethical coding .
11. Explain the purpose of case mix.

Students will demonstrate these learning outcomes by these tasks conducted individually and in cooperation with other students:  

1. Answer theoretical and application questions on information covered in the lecture, graded assignments and reading assignments.
2. Complete a billing audit of documentation against charges.

To complete the outcomes the student must have skills and knowledge in:  

• communication techniques
• information technologies
• health record content
• state, federal, and accreditation documentation requirements
• healthcare facility organization
• critical thinking
• classification systems
• data quality attributes
• abstracting
• data security
• health record analysis
• medical vocabularies
• data collection tools