Florida Department of Education
Curriculum Framework 

Program Title:	Medical Coder/ Biller 
Program Type:	Career Preparatory
Career Cluster:	Health Science

Career Certificate Program	
Program Number	H170529	
CIP Number	0351071403	
Grade Level	30, 31	
Standard Length	1110 hours	
Teacher Certification	Refer to the Program Structure section.	
CTSO	HOSA	
SOC Codes (all applicable) 	Assignment pending.	
CTE Program Resources 	http://www.fldoe.org/academics/career-adult-edu/career-tech-edu/program-resources.stml	
Basic Skills Level	Computation (Mathematics):	9	Communications (Reading and Language Arts):	11	

Purpose

This program offers a sequence of courses that provides coherent and rigorous content aligned with challenging academic standards and relevant technical knowledge and skills needed to prepare for further education and careers in the Health Science career cluster; provides technical skill proficiency, and includes competency-based applied learning that contributes to the academic knowledge, higher-order reasoning and problem-solving skills, work attitudes, general employability skills, technical skills, and occupation-specific skills, and knowledge of all aspects of Health Science career cluster. 

The program is designed to prepare students for employment in a variety of health care settings as entry level coder, medical record coder, coding technician, or coding clerks, or medical coder/biller (Medical Records and Health Information Technicians). 

The content includes but is not limited to medical terminology, anatomy and physiology, coding systems, fundamentals of disease process including pharmacology, health care delivery systems, basics of medical records services, ethical and legal responsibilities, safety/security procedures, basic data processing, and employability skills.

Additional Information relevant to this Career and Technical Education (CTE) program is provided at the end of this document.

Program Structure

This program is a planned sequence of instruction consisting of 2 occupational completion points.

This program is comprised of courses which have been assigned course numbers in the SCNS (Statewide Course Numbering System) in accordance with Section 1007.24 (1), F.S.  Career and Technical credit shall be awarded to the student on a transcript in accordance with Section 1001.44(3) (b), F.S.

To teach the courses listed below, instructors must hold at least one of the teacher certifications indicated for that course.

The following table illustrates the postsecondary program structure:

OCP	Course Number	Course Title	Teacher Certification	Length	SOC Code	
A	HIM0009	Introduction to Health Information Technology	CER COD SP 7 G
MED RECTEC 7G 
MED ASST 7G 
MED TRANS 7G	90 hours		
B	HIM0091	Medical Coder/Biller I		350 hours		
	HIM0092	Medical Coder/Biller II		350 hours		
	HIM0093	Medical Coder/Biller III		320 hours		

Common Career Technical Core – Career Ready Practices

Career Ready Practices describe the career-ready skills that educators should seek to develop in their students.  These practices are not exclusive to a Career Pathway, program of study, discipline or level of education.  Career Ready Practices should be taught and reinforced in all career exploration and preparation programs with increasingly higher levels of complexity and expectation as a student advances through a program of study. 

1. Act as a responsible and contributing citizen and employee. 

2. Apply appropriate academic and technical skills. 

3. Attend to personal health and financial well-being. 

4. Communicate clearly, effectively and with reason. 

5. Consider the environmental, social and economic impacts of decisions. 

6. Demonstrate creativity and innovation. 

7. Employ valid and reliable research strategies. 

8. Utilize critical thinking to make sense of problems and persevere in solving them. 

9. Model integrity, ethical leadership and effective management. 

10. Plan education and career path aligned to personal goals. 

11. Use technology to enhance productivity. 

12. Work productively in teams while using cultural/global competence. 

Standards

After successfully completing this program, the student will be able to perform the following:

01.0	Demonstrate an understanding of healthcare organizations and health occupations.
02.0	Demonstrate the ability to communicate and use interpersonal skills effectively.
03.0	Explore health informatics as an allied health profession.
04.0	Demonstrate an understanding of health data concepts.
05.0	Identify the functions of a health record.
06.0	Demonstrate an understanding of Health Information Technology.
07.0	Discuss classification systems, clinical vocabularies and terminologies.
08.0	Evaluate ethical issues in Health Information Professions.
09.0	Demonstrate compliance with laws, regulations, and standards that impact healthcare.
10.0	Apply policies, regulations, and standards to the management of information associated with treatment, payment, and operations (TPO). 
11.0	Demonstrate computer knowledge and skills.
12.0	Demonstrate employability skills.
13.0	Describe the anatomy and physiology of the human body.
14.0	Demonstrate proficiency in the application of medical terminology.
15.0	Demonstrate an understanding of the fundamentals of disease process in relationship to the human body, including pharmacology.
16.0	Demonstrate proficiency in the use of ICD and HCPCS/CPT coding systems, both manual and automated.
17.0	Perform coding complexities proficiently.
18.0	Explain the significance of health information services as it relates to the medical coder/biller.
19.0	Demonstrate professional and ethical behavior of a medical coder/biller.
20.0	Perform healthcare revenue cycle management processes.
21.0	

Florida Department of Education
Student Performance Standards

Program Title:	Medical Coder/Biller
Career Certificate Program Number:	H170529

Course Number: HIM0009
Occupational Completion Point: A
Introduction to Health Information Technology – 90 Hours	
01.0	Demonstrate an understanding of the healthcare organizations and health occupations. – The student will be able to:	
01.01	Discuss the evolution of healthcare.	
01.02	Demonstrate an understanding of the infrastructure of healthcare in the United States.	
01.03	Discuss healthcare regulatory agencies and organizations.	
01.04	Recognize levels of education, credentialing requirements, employment opportunities, workplace environments, and career growth potential.	
01.05	Differentiate the roles of various providers and disciplines throughout the continuum of healthcare and respond to their information needs. 	
02.0	Demonstrate the ability to communicate and use interpersonal skills effectively. – The student will be able to:	
02.01	Develop basic speaking and active listening skills with meaningful feedback. 	
02.02	Develop basic observational skills and related documentation strategies in written and oral form.	
02.03	Identify characteristics of successful and unsuccessful communication including barriers. 	
02.04	Respond to verbal and non-verbal cues. 	
02.05	Compose written communication including emails using correct spelling, grammar, formatting and confidentiality. 	
02.06	Demonstrate ability to create professional correspondence using appropriate email practices and etiquette. 	
02.07	Use appropriate medical terminology and abbreviations. 	
02.08	Model the importance of courtesy and respect for patients and other healthcare workers and maintain good interpersonal relationships. 	
02.09	 Provide health information education to internal/external stakeholders.	
02.10	Adapt communication skills to varied levels of understanding and cultural orientation including diverse age, cultural, economic, ethnic, and religious groups. 	
02.11	Distinguish between and identify subjective and objective information. 	
03.0	Explore health information as an allied health profession. – The student will be able to:	
03.01	Discuss the history of health information management.	
03.02	Discuss the professional opportunities within the health information professions.	
03.03	Demonstrate knowledge of professional associations applicable to the field of health information.	
04.0	Demonstrate an understanding of health data concepts. – The student will be able to:	
04.01	Describe the various uses of primary and secondary health data and data sets. 	
04.02	Identify various characteristics of health data quality and standards.	
05.0	Identify the functions of a health record. – The student will be able to:	
05.01	Demonstrate an understanding of the various formats of the health record.	
05.02	Explain the various uses of a health information as it relates to treatment, payment, and operations (TPO). 	
06.0	Demonstrate an understanding of Health Information Technology. – The student will be able to:	
06.01	Discuss how changing regulations and technology impact the health information field.	
06.02	Interpret information from health information systems and applications in healthcare.	
06.03	Demonstrate an understanding of creation, use, storage, retrieval, and exchange of health data.	
07.0	Discuss classification systems, clinical vocabularies and terminologies. – The student will be able to:	
07.01	Explain the use of classification systems, clinical vocabularies, and terminologies as they relate to Health Information Management and nomenclatures. 	
08.0	Evaluate ethical issues in Health Information Professions. – The student will be able to:	
08.01	Describe the code of ethics consistent with healthcare occupations.	
08.02	Analyze ethical issues related to health information.	
08.03	Manage ethical issues related to coding and billing/ healthcare documentation.	
09.0	Demonstrate compliance with laws, regulations, and standards that impact healthcare. – The student will be able to:	
09.01	Promote the importance of maintaining ethical and legal standards in compilation and usage of health information. 	
09.02	Identify all laws and standards that impact health information including the Health Insurance Portability and Accountability Act (HIPAA). 	
09.03	Explain the composition of the legal health record.	
09.04	Apply health information policies and procedures for privacy, confidentiality, and security. 	
09.05	Articulate legal terms and processes that impact healthcare. 	
10.0	Apply policies, regulations, and standards to the management of information associated with treatment, payment, and operations (TPO). – The student will be able to:	
10.01	Describe how to adapt workflow necessitated by regulatory change. 	
10.02	Demonstrate knowledge of policies and procedures for access and disclosure of protected health information to authorized users.	
10.03	Adhere to appropriate and applicable accrediting agency guidelines.	
11.0	Demonstrate computer knowledge and skills. – The student will be able to:	
11.01	Demonstrate the ability to create, manage, organize, attach, and retrieve files.	
11.02	Demonstrate ability to connect to and perform research on the internet by identifying reliable reputable websites.	
11.03	Demonstrate proficiency in word processing, spreadsheets, and presentation software.	
11.04	Demonstrate the ability to install software programs. 	
11.05	Demonstrate knowledge of safe computer practices and security procedures including but not limited to encryption, passwords and biometrics.	
12.0	Demonstrate employability skills. – The student will be able to:	
12.01	Identify and exemplify personal traits or attitudes desirable in a member of the healthcare team. 	
12.02	Model professional standards of healthcare workers as they apply to hygiene, dress, language, confidentiality and behavior (i.e. courtesy and self-introductions).	
12.03	Identify documents that may be required when applying for a job. 	
12.04	Perform the process to obtain employment: job search, cover letter, resume, application, and thank you letter. 	

	
Course Number: HIM0091
Occupational Completion Point: B
Medical Coder/Biller I – 350 Hours	
13.0	Describe the anatomy and physiology of the human body. – The student will be able to:	
13.01	Describe the structure and function of the respiratory system.	
13.02	Describe the structure and function of the circulatory system.	
13.03	Describe the structure and function of the musculoskeletal & connective tissue system.	
13.04	Describe the structure and function of nervous and sensory systems.	
13.05	Describe the structure and function of the reproductive system.	
13.06	Describe the structure and function of the urinary system.	
13.07	Describe the structure and function of the digestive system.	
13.08	Describe the structure and function of the endocrine system.	
13.09	Describe the structure and function of the integumentary system. 	
13.10	Describe major psychiatric disorders. 	
14.0	Demonstrate proficiency in the application of medical terminology. – The student will be able to:	
14.01	Identify word parts of medical terminology in daily use.	
14.02	Build, spell and pronounce correctly, appropriate terms from word parts learned and be able to give the meaning of the word.	
14.03	Identify word parts and be able to build, spell and understand new words with those parts.	
14.04	Spell and use medical abbreviations.	
14.05	Identify terminology specific to healthcare settings including surgical, medical, and therapeutic.	
14.06	Apply medical reference sources.	
15.0	Demonstrate an understanding of the fundamentals of disease process in relationship to the human body, including pharmacology. – The student will be able to:	
15.01	Demonstrate an understanding of the predisposing factors and direct causes of disease as they relate to the human body.	
15.02	Demonstrate an understanding of the general pathogenesis and morphology of disease and its role in the disease process.	
15.03	 Demonstrate an understanding of pharmacological agents, uses, treatments, and utilizing drug reference sources.	
15.04	Identify and use diagnostic test terminology.	
	
Course Number: HIM0092
Occupational Completion Point: B
Medical Coder/Biller II – 350 Hours	
16.0	Demonstrate proficiency in use of ICD and HCPCS/CPT coding systems, both manual and automated. – The student will be able to:	
16.01	Apply conventions and guidelines used in coding.	
16.02	Describe the process to update coding resources. 	
16.03	Assign and/or verify diagnosis, procedure, HCPCS level II codes, and applicable modifiers and groupings in accordance with official guidelines. 	
16.04	Utilize ICD-CM, ICD-PCS, CPT (all sections), and HCPSC Level II code sets to assign diagnosis and procedure codes to intermediate and advanced case studies and authentic health records/abstracts. 	
16.05	Describe components of revenue cycle management and clinical documentation improvement including quality indicators as it relates to coding. 	
16.06	Identify any discrepancies, incomplete information, and/or poor documentation practices in relation to coding while following appropriate departmental policies for correcting errors or improving documentation practices. 	
17.0	Perform coding complexities proficiently. – The student will be able to:	
17.01	Apply advanced coding concepts to complex authentic health records/abstracts and/or case studies across the continuum of care.	
17.02	Analyze case-mix, severity of illness systems, and coding quality monitors and reporting.	
17.03	Utilize a variety of simulated patient records from across the continuum of care, interpret data, and assign and/or verify codes.	
17.04	Analyze the various classification systems.	
18.0	Explain the significance of health information services as it relates to the medical coder/biller. – The student will be able to:	
18.01	Describe the functions of a health information management department and how this department interacts with the medical coder/biller.	
18.02	Describe the development of the health record to include all types used in the current industry.	
18.03	Explain the importance of the health record in relation to state and federal agencies, including compliance area. 	
	
Course Number: HIM0093
Occupational Completion Point: B
Medical Coder/Biller III – 320 Hours	
19.0	Demonstrate professional and ethical behavior of a medical coder/biller. – The student will be able to:	
19.01	Explain the scope of work of the Medical Coder/Biller.	
19.02	Demonstrate ethical coding practices as outlined by professional associations.	
20.0	Perform healthcare revenue cycle management processes. – The student will be able to:	
20.01	Prepare and submit applicable payer claims. 	
20.02	Analyze various payer types.	
20.03	Perform patient accounting functions including claims, denials, rejections, appeals, collections, and payment resubmission using applicable software. 	
20.04	Describe characteristics of reimbursement methodology systems across the continuum of care. 	
20.05	Analyze charge master and superbill maintenance. 	
20.06	Understand compliance strategies and reporting as well as regulatory guidelines. 	

Additional Information

Laboratory Activities

Laboratory investigations that include scientific inquiry, research, measurement, problem solving, emerging technologies, tools and equipment, as well as, experimental, quality, and safety procedures are an integral part of this career and technical program/course. Laboratory investigations benefit all students by developing an understanding of the complexity and ambiguity of empirical work, as well as the skills required to manage, operate, calibrate and troubleshoot equipment/tools used to make observations. Students understand measurement error; and have the skills to aggregate, interpret, and present the resulting data. Equipment and supplies should be provided to enhance hands-on experiences for students.

Special Notes

Students should be encouraged to become members and participate in the activities of the professional organizations:  American Health Information Management Association and/or American Academy of Procedural Coders.  

About AHIMA Credentials:  Completers of the Medical Biller Coder program may take the Certified Coding Associate (CCA) credential exam as the first step in their coding career.  The CCA is an entry-level credential that distinguishes new coders in the job market. Individuals with a CCA credential: 
•	Exhibit a level of commitment, competency, and professional capability usually absent in a newcomer to the field 
•	Demonstrate a commitment to the coding profession 
•	Distinguish themselves from non-credentialed coders and those holding credentials from other organizations less demanding of the higher level of expertise required to earn AHIMA certification. 

The CCA should be viewed as the starting point for an individual entering a career as a coder. The AHIMA CCS and CCS-P exams demonstrate mastery level skills in coding.  Most individuals challenge the CCS or CCS-P exams after two or more years of work experience in coding. 

American Health Information Management Association (AHIMA)
919 North Michigan Ave., Suite 2150, Chicago, IL. 60611-5519 (312) 233-1100

The American Academy of Professional Coders (AAPC) sponsors a certification exam for coders with expertise in physician-based settings which leads to the title of Certified Professional Coder (CPC) or Certified Professional Coder Hospital (CPC-H).

American Academy of Professional Coders (AAPC)
	309 West 700 South, Salt Lake City, UT 84101 #800-626-2633
	
Or
The National Healthcare Association also offers a national certification examination for a Certified Billing and Coding Specialist (CBCS).

National Healthcareer Association www.nhanow.com
7500 West 160th Street, Stilwell, Kansas 66085 #800-499-9092 

The Core should be taken first in the program. Following the successful completion of the core, the student is eligible to take the National Health Care Foundation Skill Standards Assessment with instructor approval and the completion of a portfolio.

Career and Technical Student Organization (CTSO)

HOSA: Future Health Professionals is the intercurricular career and technical student organization providing leadership training and reinforcing specific career and technical skills. Career and Technical Student Organizations provide activities for students as an integral part of the instruction offered. 

Cooperative Training – OJT

On-the-job training is appropriate but not required for this program.  Whenever offered, the rules, guidelines, and requirements specified in the OJT framework apply. 

Basic Skills 

In Career Certificate programs offered for 450 hours or more, in accordance with Rule 6A-10.040, F.A.C., the minimum basic skills grade levels required for postsecondary adult career and technical students to complete this program are:  Computation (Mathematics) and Communications (Reading and Language Arts). These grade level numbers correspond to a grade equivalent score obtained on a state designated basic skills examination.  

Adult students with disabilities, as defined in Section 1004.02, Florida Statutes, may be exempted from meeting the Basic Skills requirements (Rule 6A-10.040).  Students served in exceptional student education (except gifted) as defined in s. 1003.01, F.S., may also be exempted from meeting the Basic Skills requirement.  Each school district and Florida College System Institution must adopt a policy addressing procedures for exempting eligible students with disabilities from the Basic Skills requirement as permitted in Section 1004.91, F.S.

Accommodations

Federal and state legislation requires the provision of accommodations for students with disabilities to meet individual needs and ensure equal access. Postsecondary students with disabilities must self-identify, present documentation, request accommodations if needed, and develop a plan with their counselor and/or instructors. Accommodations received in postsecondary education may differ from those received in secondary education. Accommodations change the way the student is instructed. Students with disabilities may need accommodations in such areas as instructional methods and materials, assignments and assessments, time demands and schedules, learning environment, assistive technology and special communication systems. Documentation of the accommodations requested and provided should be maintained in a confidential file.

Note: postsecondary curriculum and regulated secondary programs cannot be modified.

Additional Resources

For additional information regarding articulation agreements, Bright Futures Scholarships, Fine Arts/Practical Arts Credit and Equivalent Mathematics and Equally Rigorous Science Courses please refer to:
http://www.fldoe.org/academics/career-adult-edu/career-tech-edu/program-resources.stml