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

Required:

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.

Recommended:

Keyboarding, MS Office Professional

TRANSFER OPPORTUNITIES

Graduates are eligible to continue their education by completing the health information technology (HIT) program. The HIT program is also Internet-based.

OCCUPATIONAL OPPORTUNITIES

Hospitals and other health care facilities

Clinics and physicians’ offices

Insurance companies

State and federal agencies

Legal firms

Software companies

Consulting firms

EMPLOYMENT STATISTICS

Employment and transfer rate of 100 percent – 100 are employed.

CERTIFICATION

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.

ENTRANCE REQUIREMENTS/RECOMMENDATIONS

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

RELATED PROGRAMS

Health Information Technology

Coding & Reimbursement Specialist - Certificate

TYPICAL FOUR-SEMESTER PROGRAM - Full-time

This program is offered as an internet-based program only

First

BIOL

1114

Human A&P I

4

MEDR

1132

Essentials of Pharmacology

2

MEDR

1133

Medical Terminology

3

CISY

1003

Intro. to Microcomputers

3

12

Second

MEDR

1114

Intro. to Health Info. Mgt.

4

BIOL

2214

Human A&P II

4

BIOL

4403

Pathophysiology

3

MEDR

1223

Health Data Management

3

14

Third

MEDR

1244

CPT and HCPCS Level II Coding

4

MEDR

1234

ICD-9-CM, ICD-10-CM & ICD-10-PCS Coding

4

MEDR

3114

Electronic Health Records

4

12

Fourth

MEDR

4214

Insurance & Reimbursement Proc.

4

MEDR

2614

Advanced Coding & Reimbursement

4

MEDR

4312

Intro. to HIM PPE

2

MEDR

4322

Coding PPE

2

12

GRADUATION REQUIREMENTS

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%

Survey Details

2009

2010

2011

2012

Receiving Degrees

3

5

2

2

Responding to Survey

2 (67%)

5 (100%)

1 (50%)

2 (100%)

Employed

2 (100%)

4 (80%)

-

2 (100%)

Employed in Field

2 (100%)

4 (100%)

-

2 (100%)

Transferred

-

1 (20%)

1 (100%)

-

Unemployed Seeking Employment

-

-

-

-

Unemployed/Not Seeking Employment

-

-

-

-

Salary Range Not Available