ICTQual Level 3 Award in Medical Coding and Billing

Learning Outcomes for the Study Units:

Medical Terminology:

• Understand and interpret medical terms, including prefixes, suffixes, and root words.
• Demonstrate proficiency in medical terminology used in various healthcare settings.
• Accurately decode and analyze complex medical terms to support effective communication and documentation.

Anatomy and Physiology:

• Identify and describe the structure and function of major human body systems.
• Explain how anatomical structures relate to physiological functions.
• Apply knowledge of anatomy and physiology to understand medical conditions and procedures.

Healthcare Law and Ethics:

• Describe legal and ethical principles relevant to healthcare settings.
• Analyze ethical dilemmas and apply ethical decision-making frameworks.
• Demonstrate understanding of patient confidentiality, informed consent, and professional codes of conduct.

Medical Coding Systems:

• Explain the purpose and structure of coding systems such as ICD (International Classification of Diseases) and CPT (Current Procedural Terminology).
• Assign appropriate codes to diagnoses, procedures, and services based on medical documentation.
• Interpret official coding guidelines and conventions to ensure accurate coding.

Health Information Management:

• Implement techniques for managing health information, including data collection, storage, and retrieval.
• Ensure data accuracy, accessibility, and security in compliance with healthcare regulations.
• Utilize health information systems to support clinical and administrative decision-making.

Healthcare Reimbursement:

• Describe reimbursement methodologies used in healthcare, including fee-for-service and prospective payment systems.
• Identify the roles of insurance providers, government programs, and patients in healthcare reimbursement.
• Process insurance claims and patient bills accurately and efficiently.

Medical Billing Software:

• Navigate and utilize medical billing software effectively for tasks such as data entry, claim submission, and payment processing.
• Generate accurate bills and invoices for healthcare services rendered.
• Troubleshoot common issues and errors in medical billing software.

Professional Communication:

• Communicate effectively with healthcare professionals, patients, and insurance providers in verbal and written formats.
• Write clear and concise documentation related to medical coding, billing, and patient records.
• Demonstrate professionalism and empathy in interactions with diverse stakeholders.

Quality Assurance in Medical Coding:

• Apply quality assurance principles to review and audit coded data for accuracy and compliance.
• Identify and resolve discrepancies in medical coding practices.
• Implement strategies to maintain coding accuracy and integrity in healthcare documentation.