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Coding & Reimbursement Specialist
This program is taught online.
Securing accurate and appropriate payment for health care services challenges health care providers, insurance companies, and patients. Today's complex health care insurance and governmental payment systems depend on medical coding to determine proper payment. The coding and reimbursement specialist program incorporates the knowledge and skills needed to assign the correct code for prompt and accurate reimbursement. C&RS professionals analyze patient records, assign ICD (ICD-9-CM, ICD-10-CM/ICD-10-PCS), CPT, and HCPCS codes to diagnoses, procedures, and services provided to patients for timely and accurate healthcare billing, reimbursement, and medical necessity.
Web-based instruction is organized under the health information technology program (HIT program). This means that if you initially select the C&RS program, you can transfer courses into the HIT program and earn your associate in applied science (AAS) degree.
Alfred State's comprehensive coding certificate program offers individuals the opportunity to pursue a business-related career that is an essential part of the health care industry.
Professional Practice Experience
Students complete non-paid professional practice experiences (PPEs) in the health information (coding) program of an acute care hospital (160 hours). PPE arrangements are made in consultation with each student so that a convenient location is selected. Students are not a substitute for paid staff during PPEs, which means they are expected to receive appropriate supervision and mentoring during completion of all tasks.
Joint Commission Hospital Accreditation Standards Manual requires hospitals to implement “a process to ensure that a person’s qualifications are consistent with his/her job responsibilities.” This standard “applies to staff, students, and volunteers,” and it further states that the hospital is responsible for verifying “the following according to law, regulation, or hospital policy: information on criminal background.” As such, Alfred State students who complete PPEs in the C&RS program may be required to undergo a criminal background check prior to placement at the facility. In addition, the facility may require students to undergo a physical examination (on-site at the facility or by the student’s primary care provider) prior to beginning the PPE. The physical examination includes drug screening, a TB test, and/or DTB, hepatitis B, and/or MMRV immunization or status. Students may be required to incur costs associated with the criminal background check and/or physical examination.
Once a PPE placement has been arranged, students are expected to contact the professional practice supervisor to arrange a schedule for attendance. Students may be required to attend an on-site orientation at the professional practice facility, which could be several days in length.
The Coding and Reimbursement Specialist program, an online certificate program, provides career-focused education to produce job-and transfer-ready coding and reimbursement specialist graduates.
Graduates of the Alfred State CRS program will be able to perform the functions of entry-level coder. The program student learning outcomes are as follows:
- PSLO 1- Apply biomedical knowledge (including medical terminology, anatomy & physiology, pathophysiology, and pharmacology) to apply diagnosis/procedure codes (ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, and HCPCS level II according to current nomenclature.
- PSLO 2 - Use established federal guidelines, accreditation standards, and APC and DRG calculator/grouper software to comply with healthcare documentation (review), reimbursement, and reporting requirements.
- PSLO 3 - Apply HIM knowledge as defined by organizational policy and external regulations (e.g., Medicare, Medicaid, and managed care) and standards to maintain the accuracy and completeness of the patient record.
- PSLO 4 - Apply HIM knowledge of policies and procedures for confidentiality and security measures regarding the access and disclosure of protected health information (PHI) to authorized users.
- PSLO 5 – Apply HIM knowledge in the collection, maintenance and reporting of data for clinical indices/databases/registries to meet specific organizational and regulatory needs for the purposes of medical research and education.
- PSLO 6 – Apply HIM knowledge of legal, ethical, accreditation and certification standards as appropriate for the management of health information.
- PSLO 7 - Apply basic methods when calculating descriptive, institutional, and healthcare vital statistics.
- PSLO 8 – Apply the use common software applications (e.g., spreadsheets, databases, word processing, graphics, presentation, email, and so on) and HIM-related software applications (e.g., release of information, electronic health record, patient record abstracting, and so on).
- PSLO 9 - Apply HIM knowledge to promote ethical standards of practice to health information management and coding.
- PSLO 10 – Demonstrate critical thinking to problem solving and reasoning skills to health information management and coding practices.
Required: High School Biology or equivalent
Must be able to visually read computer monitor; must be able to use keyboard and mouse.
Recommended: Keyboarding, MS Office Professional
Must be able to attend Professional Practice Experience (PPE) courses including 160 hours at a health care facility within reasonable driving/travel distance to the student's home.
The coding and reimbursement specialist program is approved by the American Health Information Management Association (AHIMA). This designation acknowledges the coding program as having been evaluated by a peer review process against a national minimum set of standards for entry-level coding professionals. This process allows academic institutions, healthcare organizations, and private companies to be acknowledged as offering an AHIMA Approved Coding Certificate Program.
Graduates are eligible to take national certification examinations offered by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). AHIMA offers Certified Coding Specialist (CCS) exams, and the AAPC offers Certified Professional Coder (CPC) exams. It is strongly recommended that students work for a minimum of one year full-time as a coder before taking the CCS and CPC exams.
- Prepares graduates for certification as a certified coding specialist or certified professional coder.
- Internet-based courses and on-site professional practice experiences.
C&RS students are required to earn a grade of a least a "C" or better in each BIOL and MEDR prefix course prior to placement in the PPEs. Students must also earn a grade of at "C" in the MEDR courses to graduate from the C&RS program. Additionally, students must be able to complete the on-site PPE hours at a health care facility.
Should a student fail MEDR or BIOL courses a second time: Students may re-take MEDR and/or BIOL courses as a continuing education student. Then, upon successful completion with a "C" or better, apply for readmission to the C&RS program. Or, students may retake the BIOL/MEDR equivalent courses on-campus at Alfred State or at another college, and transfer the credit back to Alfred State after having obtained pre-approval of the course for transfer credit and earning a grade of "C" or better.
- Clinics and Physicians' Offices
- Insurance Companies
- State and Federal Agencies
- Legal Firms
- Software Companies
- Consulting Firms
Graduates are eligible to continue their education by completing the health information technology (HIT) program. The HIT program is also Internet-based.
C&RS is a relatively small program; approximately 27 students are enrolled in each class. Students take courses with those in other programs, including health information technology, court and realtime reporting, and nursing, which simulates a team approach to health care delivery. Upon acceptance into the program, each student is assigned an adviser who assists the student in scheduling courses and provides academic guidance.
|BIOL||1114||Human A&P I||4|
|CISY||1003||Intro to Microcomputer Applications||3|
|MEDR||1132||Essentials of Pharmacology||2|
|BIOL||2214||Human A&P II||4|
|MEDR||1114||Intro to Health Info Mgt||4|
|MEDR||1223||Health Data Management||3|
|MEDR||1244||CPT & HCPCS Level II Coding||4|
|MEDR||1234||ICD-9-CM& ICD-10-CM/PCS Coding||4|
|MEDR||3114||Electronic Health Record Mgmt||4|
|MEDR||4214||Insurance & Reimbursement Proc||4|
|MEDR||2614||Advanced Coding & Reimbursement||4|
|MEDR||4312||Intro to HIM PPE||2|
|MEDR||4322||Coding Professional Practice Experience||2|
522 Coding & Reimbursement Specialist
SOC Occupation Listings:
- 29-2052.00 Pharmacy Technicians
- 43-3051.00 Payroll and Timekeeping Clerks
- 43-3061.00 Procurement Clerks
- 43-4021.00 Correspondence Clerks
- 43-9041.01 Insurance Claims Clerks
- 43-9041.02 Insurance Policy Processing Clerks
- 43-9061.00 Office Clerks, General
Costs information can be found on the tuition and costs page.
Median Cumulative Loan Debt for students in the program between July 1, 2011, and June 30, 2012:
Median Federal Student Loan debt: $3,250.
Median Private Loan debt: $0.00
Median Institutional financing plan debt: $0.00
The on-time completion rate for student’s completing the program between July 1, 2011, and June 30, 2012 within the normal time using the typical semester recommendations as listed is 67 percent.
|Responding to Survey||2 (67%)||5 (100%)||1 (50%)|
|Employed||2 (100%)||4 (80%)||--|
|Employed in Field||2 (100%)||4 (100%)||--|
|Transferred||--||1 (20%)||1 (100%)|
|Unemployed & Seeking Employment||--||--||--|
|Unemployed & Not Seeking Employment||--||--||--|