Coding & Reimbursement Specialist
Certificate – Code #1671
Tracy Locke MS, RHIA, Program Director
Email address: LockeTF@alfredstate.edu
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 health care billing, reimbursement, and medical necessity.
Online instruction is organized under the health information technology program (HIT program). This means 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 essential to the health care industry.
PROGRAM STUDENT LEARNING OUTCOMES
PSLO 1 (Domain I.C.1.) Use and maintain electronic applications and work processes to support clinical classification and coding.
PSLO 2 (Domain I.C.2.) Apply diagnosis/procedure codes according to current nomenclature.
PSLO 3 (Domain I.C.3.) Ensure accuracy of diagnostic/procedural groupings such as DRG, MSDRG, APC, and so on.
PSLO 4 (Domain 1.B.3.) Maintain the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards.
PSLO 5 (Domain 3.B.2.) Apply policies and procedures for access and disclosure of personal health information.
PSLO 6 (Domain IV.D.1.) Apply confidentiality and security measures to protect electronic health information.
PSLO 7 (Domain II.A.3.) Comprehend basic descriptive, institutional, and healthcare vital statistics.
Info Management (computer & research skills appropriate to degree level and type). (Domain IV.A.2.) Use common software applications such as spreadsheets, databases, word processing, graphics, presentation, e-mail, and so on in the execution of work processes.
Written & Oral Communication (appropriate to degree level and type). (Domain I.C.7.) Resolve discrepancies between coded data and supporting documentation.
Critical Thinking (problem solving, reasoning skills appropriate to degree level and type.) (Domain I.A.2.) Conduct analysis to ensure that documentation in the health record supports the diagnosis and reflects the patient’s progress, clinical findings, and discharge status.
PROFESSIONAL PRACTICE EXPERIENCE
Students complete non-paid professional practice experiences (PPEs) in the health information (coding) department of an acute care hospital (160 hours) in their last semester of study. 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. Although we try to accommodate student's first choice, we can only place students at facilities willing to host a student.
Joint Commission 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 beyond the 160 PPE hours. Students must make appropriate arrangements with their current employer to complete the 160 hours at the PPE host site.
CRS ENTRANCE REQUIREMENTS & RECOMMENDATIONS
High School biology or equivalent
Must be able to visually read computer monitor: must be able to use keyboard and mouse.
Must be able to attend Professional Practice Experience (PPE) course including 160 hours at a health care facility within reasonable driving/travel distance to their home.
Keyboarding, MS Office Professional
Graduates are eligible to continue their education by completing the health information technology (HIT) program. The HIT program is also Internet-based.
Hospitals and other health care facilities
Clinics and physicians’ offices
State and federal agencies
Employment and transfer rate of 100 percent – 100 are employed.
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 students work for a minimum of one year full-time in a coding position before taking the CCS and CPC exams.
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
Health Information Technology
Coding & Reimbursement Specialist - Certificate
TYPICAL FOUR-SEMESTER PROGRAM - Full-time
This program is offered as an internet-based program only
Human A&P I
Essentials of Pharmacology
Intro. to Microcomputers
Intro. to Health Info. Mgt.
Human A&P II
Health Data Management
CPT and HCPCS Level II Coding
ICD-9-CM, ICD-10-CM & ICD-10-PCS Coding
Electronic Health Records
Insurance & Reimbursement Proc.
Advanced Coding & Reimbursement
Intro. to HIM PPE
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.
Should a student fail MEDR or BIOL courses a second time: They 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.
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 for entire program completed in normal time (full-time, in-state):
Tuition and required fees: $14,368.00
Estimated costs of books and supplies: $3,472.00
Room and Board charges for living on campus: $22,320
Additional cost information can be found at www.alfredstate.edu/paying-for-college/tuition-and-costs.
Median Cumulative Loan Debt for students in the program between July 1, 2012 and June 30, 2013:
Median Federal Student Loan debt: $4,543.00
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 50 percent.
The job placement rate for students who completed their program between July 1, 2009 through June 30, 2011 can be found in the following chart.
Employment and Transfer Report
Employment and Transfer Rate: 100%
Responding to Survey
Employed in Field
Unemployed Seeking Employment
Unemployed/Not Seeking Employment
Salary Range Not Available