Medical Billing Practices

I.     Course Prefix/Number: HIT 125

       Course Name: Medical Billing Practices

       Credits: 2 (2 lecture; 0 lab)

II.    Prerequisite

HIT 115, HIT 116, and HIT 120, all with minimum grades of C, or consent of the instructor.

III.   Course (Catalog) Description

Course concentrates on mastery of guidelines and requirements for efficient and compliant healthcare claims filing. Content includes advanced coding scenarios that incorporate proper diagnosis and procedure code selection, correct modifier usage, appropriate HCPCS code utilization, surgical package billing concepts, and accurate analysis of claims. Current issues and new guidelines also incorporated.

IV.   Learning Objectives

Upon successful completion of this course, the student will be able to:

  1. Assign ICD  and CPT codes to a variety of challenging inpatient and outpatient scenarios:
  2. Use correct HCPCS modifiers to communicate additional information concerning physician services and procedures to third party payers.
  3. Describe the format and content of the Level II (HCPCS) coding system.
  4. Demonstrate knowledge of the surgical package concept, and how it applies to filing claims during the post-operative period.
  5. Indicate knowledge of the guidelines and regulations concerning the ambulatory health care record
  6. Identify  the confidentiality and security issues that are related to the HIPAA legislation.
  7. Describe data quality management and improvement initiatives
  8. Demonstrate knowledge of the Office of Inspector General (OIG) model compliance plan for physician practices.

V.    Academic Integrity and Student Conduct

Students and employees at Oakton Community College are required to demonstrate academic integrity and follow Oakton's Code of Academic Conduct. This code prohibits:

• cheating,
• plagiarism (turning in work not written by you, or lacking proper citation),
• falsification and fabrication (lying or distorting the truth),
• helping others to cheat,
• unauthorized changes on official documents,
• pretending to be someone else or having someone else pretend to be you,
• making or accepting bribes, special favors, or threats, and
• any other behavior that violates academic integrity.

There are serious consequences to violations of the academic integrity policy. Oakton's policies and procedures provide students a fair hearing if a complaint is made against you. If you are found to have violated the policy, the minimum penalty is failure on the assignment and, a disciplinary record will be established and kept on file in the office of the Vice President for Student Affairs for a period of 3 years.

Please review the Code of Academic Conduct and the Code of Student Conduct, both located online at
www.oakton.edu/studentlife/student-handbook.pdf

VI.   Sequence of Topics

  1. Ambulatory health record regulations and guidelines
    1. Regulatory and accrediting organizations
    2. Health record content, forms, and
    3. Documentation guidelines
  2. Review ICD coding guidelines
  3. Inpatient coding guidelines
  4. Review CPT coding guidelines
  5. HCPCS modifier review
  6. Level II (HCPCS) coding system
    HIPPA legislation
  7. Data quality initiatives
    1. Evaluation of code selections
    2. Reporting quality data review results
    3. Monitoring identified problems
  8. Auditing
    1. Office of Inspector General models compliance plan.
    2. Auditing physician documentation and billing practices.
    3. Implement written policies and procedures and standards of conduct.
    4. Monitoring compliance efforts.

VII.  Methods of Instruction

Coding guidelines and instructions will be presented in lecture format for each of the topics in the course.  In-class exercises will be utilized to practice and build coding skills.  Class discussions of various assignments will help develop confidence and demonstrate correct application of topics addressed in the class.  Coding software and internet sites will be incorporated into classroom lab activities, as appropriate.


Course may be taught as face-to-face, hybrid or online course.

VIII. Course Practices Required

Students will be expected to prepare for each class by completing assigned readings and homework assignments.  Participation in class discussions will help both student and professor to assess understanding of course material.  All assignments must be submitted on due dates provided by the instructor, and should be neat and legible.

Course may be taught as face-to-face, hybrid or online course.

IX.   Instructional Materials

Note: Current textbook information for each course and section is available on Oakton's Schedule of Classes.

Current editions of ICD and CPT code books.

X.    Methods of Evaluating Student Progress

Students will be evaluated on homework assignments, and exams. Grades will be determined on a cumulative point basis, which will be averaged. Grade distribution is as follows:

Grade distribution is as follows:
A = 94%
B = 88%
C = 82%
D = 76%
F = Below 76%

XI.   Other Course Information

Attendance:  Class attendance is expected.  If an absence becomes necessary, it should be reported to the professor before the start of class, or as soon as possible in the case of an emergency.  It is the student's responsibility to arrange to make up the work and to find out what assignments were given.

Code of Student Conduct:  Refer to college catalog.

Make-up of Exams - Make-up of exams will be allowed when students contact the instructor prior to the exam being given.  Students will have one week from the date of the exam.  Exams will be made up in the testing center unless other arrangements are made with the instructor.

Incomplete grades - It is the student's responsibility to initiate requests for an “incomplete” and to follow through with the procedure to remove the incomplete grade.

Late assignments - Late assignments will be accepted if the student has made arrangements with the instructor prior to the due date.

If you have a documented learning, psychological, or physical disability you may be entitled to reasonable academic accommodations or services. To request accommodations or services, contact the Access and Disability Resource Center at the Des Plaines or Skokie campus. All students are expected to fulfill essential course requirements. The College will not waive any essential skill or requirement of a course or degree program.

Oakton Community College is committed to maintaining a campus environment emphasizing the dignity and worth of all members of the community, and complies with all federal and state Title IX requirements.

Resources and support for
  • pregnancy-related and parenting accommodations; and
  • victims of sexual misconduct
can be found at www.oakton.edu/title9/.

Resources and support for LGBTQ+ students can be found at www.oakton.edu/lgbtq.