(a) Implementation. The provisions of this section
shall be implemented by school districts beginning with the 2022-2023
school year.
(1) No later than August 31, 2022, the commissioner
of education shall determine whether instructional materials funding
has been made available to Texas public schools for materials that
cover the essential knowledge and skills identified in this section.
(2) If the commissioner makes the determination that
instructional materials funding has been made available, this section
shall be implemented beginning with the 2022-2023 school year and
apply to the 2022-2023 and subsequent school years.
(3) If the commissioner does not make the determination
that instructional materials funding has been made available under
this subsection, the commissioner shall determine no later than August
31 of each subsequent school year whether instructional materials
funding has been made available. If the commissioner determines that
instructional materials funding has been made available, the commissioner
shall notify the State Board of Education and school districts that
this section shall be implemented for the following school year.
(b) General requirements. This course is recommended
for students in Grades 11 and 12. Prerequisite: Medical Terminology.
Students shall be awarded one credit for successful completion of
this course.
(c) Introduction.
(1) Career and technical education instruction provides
content aligned with challenging academic standards, industry-relevant
technical knowledge, and college and career readiness skills for students
to further their education and succeed in current and emerging professions.
(2) The Health Science Career Cluster focuses on planning,
managing, and providing therapeutic services, diagnostic services,
health informatics, support services, and biotechnology research and
development.
(3) Medical Billing and Coding familiarizes students
with the process, language, medical procedure codes, requirements
of Health Insurance Portability and Accountability Act (HIPAA), and
skills they will need to make accurate records. Students will develop
an understanding of the entire process of the revenue cycle and how
to effectively manage it. The program is designed to prepare students
for employment in a variety of health care settings as entry level
coder, medical billing specialist, and patient access representative.
(4) Students are encouraged to participate in extended
learning experiences such as career and technical student organizations
and other leadership or extracurricular organizations.
(5) Statements that contain the word "including" reference
content that must be mastered, while those containing the phrase "such
as" are intended as possible illustrative examples.
(d) Knowledge and skills.
(1) The student demonstrates professional standards/employability
skills required by the healthcare industry. The student is expected
to:
(A) demonstrate the ability to communicate and use
interpersonal skills effectively;
(B) compose written communication, including emails
using correct spelling, grammar, formatting, and confidentiality;
(C) use appropriate medical terminology and abbreviations;
and
(D) model courtesy and respect for patients and team
members in the multi-disciplinary healthcare setting and maintain
good interpersonal relationships.
(2) The student explores career opportunities in revenue
cycle management. The student is expected to:
(A) identify professional opportunities within the
medical billing and revenue cycle management professions;
(B) demonstrate ethical billing and coding practices
as outlined by professional associations guidelines; and
(C) investigate professional associations applicable
to the field of health informatics such as American Academy of Professional
Coders (AAPC), American Health Information Management Association
(AHIMA), Healthcare Billing and Management Association (HBMA), and
American Association of Healthcare Administrative Management (AAHAM).
(3) The student explains the ethical and legal responsibilities
of personnel in medical billing and coding. The student is expected
to:
(A) identify major administrative agencies that affect
billing and coding such as Centers for Medicare and Medicaid Services
(CMS) and the Office of the Inspector General (OIG);
(B) identify major laws and regulations that impact
health information, including HIPAA, the Stark Law, the Fair Debt
Collection Practices Act, and the False Claims Act;
(C) analyze legal and ethical issues related to medical
billing and coding, revenue cycle management, and documentation within
the medical record;
(D) research compliance laws;
(E) identify appropriate documentation required for
the release of patient information;
(F) differentiate between informed and implied consent;
(G) compare and contrast use of information and disclosure
of information; and
(H) evaluate cases for insurance fraud and abuse.
(4) The student identifies the body systems to support
proficiency in billing and coding. The student is expected to:
(A) explain the sections and organizations of the International
Classification of Diseases and Related Health Problems, 10th Revision,
Clinical Modification (ICD-10-CM) and Current Procedural Terminology
(CPT) coding manuals by identifying the anatomy and physiology of
body systems and how they apply to medical billing and coding, including:
(i) the integumentary system;
(ii) the skeletal system;
(iii) the muscular system;
(iv) the cardiovascular system;
(v) the respiratory system;
(vi) the digestive system;
(vii) the endocrine system;
(viii) the urinary system;
(ix) the reproductive system; and
(x) the nervous system and special senses; and
(B) identify mental, behavioral, and neurodevelopmental
disorders and how they apply to medical billing and coding.
(5) The student demonstrates proficiency in the use
of the ICD-10-CM, CPT, and Healthcare Common Procedure Coding System
(HCPCS) coding systems. The student is expected to:
(A) apply coding conventions and guidelines for appropriate
charge capture;
(B) describe the process to update coding resources;
(C) assign and verify diagnosis and procedure codes
to the highest level of specificity, and, as applicable, HCPCS level
II codes and modifiers in accordance with official guidelines;
(D) describe the concepts of disease groupings and
procedure-code bundling; and
(E) identify coding compliance, including medical necessity.
(6) The student understands revenue cycle management.
The student is expected to:
(A) define revenue cycle management;
(B) differentiate between various types of employer-sponsored
and government-sponsored insurance models, including health maintenance
organization (HMO), preferred-provider organization (PPO), Medicare,
Medicaid, TRICARE, high deductible health plans, and workers' compensation;
(C) define Medicare Administrative Contractors (MACs)
and investigate the administrative services provided by the MAC for
Texas;
(D) describe the patient scheduling and check-in process,
including verifying insurance eligibility, obtaining pre-authorization,
and processing appropriate patient authorization and referral forms;
(E) describe the sections of the CMS-1500 form to prepare
and submit mock clean claims electronically or manually;
(F) differentiate between primary and secondary insurance
plans to initially process crossover claims;
(G) interpret remittance advice to determine financial
responsibility of insurance company and patient, including a cash-paying
patient;
(H) analyze reason for insurance company denials or
rejections and determine corrections or appeals required; and
(I) analyze an aging report and how it relates to the
revenue cycle.
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