Medical Coding and Reimbursement Specialist

Degree offered

Certificate of Achievement in Coding and Reimbursement Specialist

Credits required 29

Dean

Lynne Brodeur, lynne.brodeur@bristolcc.edu

Program contact

Kelly Doyle, RHIA, Program Chair and Assistant Professor, kelly.doyle2@bristolcc.edu

Program Code: MC

Concentration Code: HCI

Program Goal Statement

The Coding and Reimbursement Specialist program is designed to prepare the student to take an active, professional role in the coding and reimbursement process for services performed by hospitals, physician and non-physician practices, and other health care entities such as skilled nursing facilities, home health agencies, and acute rehabilitation hospitals. The Coding and Reimbursement Specialist Certificate builds upon a sequence of medical reimbursement and coding related courses to satisfy a specific set for employment and career advancement.  This certificate is intended to provide a strong foundation in healthcare reimbursement and coding. The graduate will be prepared to ensure that medical services and diagnoses are correctly identified and coded in the patient's medical record, and that the necessary clinical documentation is present for billing and claims completion. The Coding and Reimbursement Specialist will attain the skills needed to interact with physicians, clinical staff, third-party payers, and patients. Satisfactory completion of the program qualifies the graduate to seek credentials from the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC). 

Program Information 

  • The field of medical coding has expanded and a coder is now responsible for more managing coded data, understanding the revenue cycle, compliance monitoring, and reimbursement issues rather than just assigning codes within healthcare than ever before. Students are required to obtain a "C" or better in all program specific (HCI) courses, HLT 106 and BIO 115.
  • The program specific courses (HCI) other than the professional practice experience (PPE) are primarily offered online.
  • This certificate prepares students to potentially earn any of the following Professional Coding Credentials offered by AHIMA; Certified Coding Associate (CCA), Certified Coding Specialists (CCS), and Certified Coding Specialist – Physician-Based (CCS-P®) by successfully completing the certification examination(s), and/or any of the following Professional Coding Credentials offered by the American Academy of Professional Coders (AAPC), which includes the following Professional Credentials; Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or Certified Inpatient Coder (CIC) by successfully completing the certification examination(s).

    • AHIMA credentials: The CCS credential is generally for professionals who are skilled in coding inpatient and outpatient medical information generally in a hospital setting. The CCA is an entry level coding certificate. The CCS-P specialize in more physician-based settings such as physicians’ offices, clinics, etc. The CCA, the CCS and the CCS-P are the only coding credentials (worldwide) that are currently accredited by the National Commission for Certifying Agencies (NCCA). For further details:
    • AAPC credentials: The CPC credentials are common in physician’s office settings The COC is the only standalone credential for outpatient coding recognized in the healthcare industry and the CIC credential is exclusive to only inpatient hospital/facility coding. For further details:
  • Two program options: Fall River day or New Bedford evening (hybrid model with online classroom learning). Fall admission only.
  • Once credentialed by AHIMA, HIM coders may be able to work remotely more frequently as the industry transitions from paper to electronic medical records



Program Requirements

General Courses

BIO 115Survey of Human Anatomy and Physiology

4 credits

HLT 106Medical Language

3 credits

ENG 101Composition I: College Writing

3 credits

Total Credit Hours:10

 

Program Courses

HCI 111Introduction to Healthcare Information Management

3 credits

HCI 122Medical Law and Ethics

3 credits

HCI 140International Classifications of Disease CM/PCS

2 credits

HCI 211Healthcare Delivery Systems and Reimbursement

2 credits

HCI 213Current Procedural Terminology (CPT) and Healthcare Common Procedural Coding System (HCPCS)

2 credits

HCI 237Human Disease Processes and Procedures

3 credits

HCI 249Advanced Medical Coding

3 credits

HCI 145Coding & Reimbursement Specialist PPE

1 credit

Total Credit Hours:19

Recommendations

To be eligible for consideration to enroll in the Health Information Management degree program, substitute BIO 233 and BIO 234 for BIO 115.

Related Programs

Health Information Management AS degree (Medical Records)

The Coding and Reimbursement Specialist Certificate is aligned with the Health Information Management AS and BS degree opportunities. It is a stand-alone certificate to prepare students to be medical coders and reimbursement specialists in the healthcare industry, but many graduates also chose to continue to complete the HIM degree while working in the field as coders and reimbursement specialists.

Special Requirements for the Program

Admission Requirements

Applicants must have a high school diploma or a state-approved high school equivalency.  Prerequisites for high school graduates include:

  • Completion of high school or college English with a minimum grade of "B" or better.
  • Completion of Algebra II (high school or college) with a minimum grade of of "B" or better.
  • Completion of Chemistry or Biology with laboratory component (high school or college) with a minimum grade of "B" or better. 

Applicants must have a grade point average (GPA) of 3.0 or higher in the aforementioned pre-admission courses.

Accepted applicants must have a physical exam, proof of immunizations or titres.  A TB test is required each year.  Health insurance is required.  Students are responsible for associated costs.  Students should plan on scheduling for a twenty-five hour professional practice experience (PPE). Students must provide their own transportation to professional practice sites. 

Individual healthcare facilities may have additional requirements for professional PPE.

Criminal Offender Record Information and Sex Offender Registry Information Checks

Upon admission to the program, all students must undergo a Criminal Offender Record Information (CORI) check and a Sex Offender Registry Information (SORI) check.  These checks are required due to potential unsupervised contact with children, the disabled, or the elderly during a clinical experience.  Students found to have certain criminal convictions or pending criminal actions will be presumed ineligible for clinical placement.  The College is authorized by the Commonwealth's Department of Criminal Justice to access CORI records.  Sex Offender checks shall be performed pursuant to Massachusetts General Laws, Chapter 6, Sections 178C-178P.

For more information regarding the College's CORI/SORI check process, please contact the Human Resource Department at (508) 678-2811, ext. 2194.

A positive CORI/SORI check may prevent individuals from working in contracted health facilities which could prevent students from completing the program objectives.

Grade Requirements

Students must receive a minimum grade of “C” (73) in all required Medical Coding courses (HCI), HLT 106, and BIO 115. Failure to earn a “C” (73) or better in required courses requires a repeat of that course, which may affect the time to complete the certificate.

Required Course Sequence

HLT 106Medical Language

3 credits

BIO 115Survey of Human Anatomy and Physiology

4 credits

HCI 111Introduction to Healthcare Information Management

3 credits

HCI 213Current Procedural Terminology (CPT) and Healthcare Common Procedural Coding System (HCPCS)

2 credits

HCI 140International Classifications of Disease CM/PCS

2 credits

HCI 211Healthcare Delivery Systems and Reimbursement

2 credits

Contact your program director or your advisor for required course sequence if attending on a part-time basis.

Required Course Sequence

ENG 101Composition I: College Writing

3 credits

HCI 237Human Disease Processes and Procedures

3 credits

HCI 122Medical Law and Ethics

3 credits

HCI 249Advanced Medical Coding

3 credits

HCI 145Coding & Reimbursement Specialist PPE

1 credit

Contact your program director or your advisor for required course sequence if attending on a part-time basis.

Gainful Employment Program Disclosure

In accordance with Federal regulations published in the Federal Register on October 29, 2010, Bristol Community College discloses information about student costs, tuitions, fees and employment statistics to various governing bodies to ensure certification and oversight.

See: Gainful Employment Information


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