Identify and communicate issues arising in the workplace Issues and problems are identified as they arise Information regarding problems and issues are organized coherently to ensure clear and effective communication Dialogue is initiated with appropriate personnel Communication problems and issues are raised as they Types of issues and problems in the workplace Written and electronic communication methods Communication barriers affecting workplace discussions Identifying cause of problems Communicating with the Master of the Ship on the possible shortage of the food supply due to change of ship’s port Identifying problems and issues Organizing information on problems and issues Relating problems and issues of call/ voyage
UNIT OF COMPETENCY : LEAD SMALL TEAMS UNIT CODE : 500311110 UNIT DESCRIPTOR : This unit covers the knowledge, skills and attitudes to lead small teams including setting and maintaining team and individual performance standards. ELEMENT PERFORMANCE CRITERIA Italicized terms are elaborated in the REQUIRED KNOWLEDGE REQUIRED SKILLS Provide team leadership Work requirements are identified and presented to team members Reasons for instructions and requirements are communicated to team members Team members’ queries and concerns are recognized, discussed and with policies and procedures 1.2 How performance expectations are set 1.3 Methods of Monitoring Performance 1.4 Client expectations 1.5 Team member’s duties and responsibilities 1.6 Definition of Team 1.7 Skills and techniques in promoting team building 1.8 Up-to-date dissemination of instructions and requirements to members 1.9 Art of listening and treating individual team members concern skills required for leading building skills skills skills Assign responsibilities Duties, and responsibilities are allocated having regard to the skills, knowledge and aptitude required to properly undertake the assigned task and according to company policy Duties are allocated having regard to individual preference, domestic and personal considerations, whenever possible Concept of delegation How to delegate Understanding individual differences Methods of monitoring performance Duties and responsibilities of each team member Knowledge in identifying each team member duties and responsibilities Delegating skills Identifying individual skills, knowledge and attitude as basis for allocating responsibilities Identifying each team member duties and responsibilities Set performance expectations for team members Performance expectations are established based on client needs and according to assignment requirements Definition of performance indicators/ criteria Definition of team goals and expectations Identifying performance indicators Evaluating performance
Performance expectations are based on individual team members duties and area of responsibility Performance expectations are discussed and disseminated to individual team members Methods of monitoring performance Client expectations Team members duties and responsibilities Defining performance expectations criteria Setting individual performance target/ expectation indicators Supervised team performance Monitoring of performance takes place against defined performance criteria and/or assignment instructions and corrective action taken if required Team members are provided with feedback, positive support and advice on strategies to overcome any deficiencies Performance issues cannot be rectified or addressed within the team are referenced to appropriate personnel according to employer policy Team members are kept informed of any changes in the priority allocated to assignments or which might impact on client/customer needs and satisfaction Team operations are monitored to ensure that employer/client needs and requirements are met Follow-up communication is provided on all issues affecting the team All relevant documentation is completed in accordance with company procedures Understanding Monitoring of work How to undertake corrective action Understanding feedback and procedure Feedback reporting procedure Methods of monitoring performance Team member’s duties and responsibilities Monitoring team operation to ensure client and satisfaction Monitoring skills Setting priorities Evaluating performance Informal/ formal counseling skills
RANGE OF VARIABLES VARIABLE RANGE Work requirements Client Profile Assignment instructions Team member’s concerns Roster/shift details Monitor performance Formal process Informal process Feedback Formal process Informal process Performance issues Work output Work quality Team participation Compliance with workplace protocols Safety Customer service EVIDENCE Critical aspects of Competency Assessment requires evidence that the candidate: Maintained or improved individuals and/or team performance given a variety of possible scenario Assessed and monitored team and individual performance against set criteria Represented concerns of a team and individual to next level of management or appropriate specialist and to negotiate on their behalf Allocated duties and responsibilities, having regard to individual’s knowledge, skills and aptitude and the needs of the tasks to be performed Set and communicated performance expectations for a range of tasks and duties within the team and provided feedback to team members Resource Implications The following resources MUST be provided: Access to relevant workplace or appropriately simulated environment where assessment can take place Materials relevant to the proposed activity or task Methods of Assessment Competency in this unit may be assessed through: Written Examination Oral Questioning Portfolio Context for Assessment Competency assessment may occur in workplace or any appropriately simulated environment Assessment shall be observed while task are being undertaken whether individually or in-group
UNIT OF COMPETENCY: DEVELOP AND PRACTICE NEGOTIATION SKILLS UNIT CODE : 500311111 UNIT DESCRIPTOR : This unit covers the skills, knowledge and attitudes required to collect information in order to negotiate to a desired outcome and participate in the negotiation. ELEMENT PERFORMANCE CRITERIA Italicized terms are elaborated in the REQUIRED KNOWLEDGE REQUIRED SKILLS 1. Plan negotiations 1.1 Information on preparing for negotiation is identified and included in the plan 1.2 Information on creating nonverbal environments for positive negotiating is identified and included in the plan 1.3 Information on active listening is identified and included in the plan 1.4 Information on different questioning techniques is identified and included in the plan 1.5 Information is checked to ensure it is correct and date 1.1 Knowledge on Codes of practice and guidelines for the organization 1.2 Knowledge of organizations policy and procedures for negotiations 1.3 Decision making and conflict resolution strategies procedures 1.4 Concept of negotiation 1.1 Communication skills (verbal and listening) 1.2 Active listening 1.3 Setting conflict 1.4 Preparing conflict resolution 1.5 Problem solving strategies on how to deal with unexpected questions and attitudes during negotiation 1.6 Interpersonal skills to develop rapport with other parties 2. Participate in negotiations Criteria for successful outcome are agreed upon by all parties Desired outcome of all parties are considered Appropriate language is used throughout the negotiation A variety of questioning techniques are used The issues and processes are documented and agreed upon by all parties Possible solutions are discussed and their viability assessed Areas for agreement are confirmed and recorded Follow-up action is agreed upon by all parties 2.1 Outcome of negotiation 2.2 Knowledge on Language 2.3 Different Questioning techniques 2.4 Problem solving strategies on how to deal with unexpected questions and attitudes during negotiation 2.1 Negotiating skill 2.2 Communication skills (verbal and listening) 2.3 Observation skills 2.4 Interpersonal skills to develop rapport with other parties 2.5 Applying effective questioning techniques 2.6 Setting conflict
Possible cause statements are developed based on findings Fundamental causes are identified per results of investigation conducted Enterprise quality, OHS and environmental requirements Enterprise information systems and data collation Industry codes and standards Determine corrective action All possible options are considered for resolution of the problem Strengths and weaknesses of possible options are considered Corrective actions are determined to resolve the problem and possible future causes Action are developed identifying measurable objectives, resource needs and timelines in accordance with safety and operating procedures Understanding the procedure in undertaking corrective action Principles of decision making strategies and techniques Enterprise information systems and data collation Action planning Identifying and clarifying the nature of the problem Devising the best solution Evaluating the solution developed plan to rectify the problem corrective and preventive actions based on root cause analysis Provide recommendation/s to manager Reports on recommendations are prepared according to procedures. Recommendations are presented to appropriate personnel. Recommendations are followed-up, if required How to make a report and recommendation Writing report and
3. Analyze results 3.1 Result of application is reviewed based on expected and required specifications and outcome 3.2 Appropriate action is applied in case of 3.1 Techniques in analyzing the results 3.2 Process in reviewing the results 3.3 Precision and accuracy 3.4 Four fundamental operations 3.5 Steps in solving problem 3.6 Standard formulas 3.7 Conversion measurement 3.1 Analyzing the result based on the specified requirements 3.2 Interpreting and communicating the results of the analysis
1. Study/select appropriate technology of different technologies is determined based on job requirements Appropriate technology is selected as per work specification 1.1 Awareness on technology and its function 1.2 Communication techniques 1.3 Health and safety procedure 1.4 Company policy in relation to relevant technology 1.5 Machineries/ equipment and their application 1.6 Software programs 1.1 Identifying relevant technology on job 2. Apply relevant technology Relevant technology is effectively used in carrying out function Applicable software and hardware are used as per task requirement Management concepts are observed and practiced as per established industry practices 2.1 Knowledge on operating instructions 2.2 Understanding software and hardware system 2.3 Communication techniques 2.4 Health and safety procedure 2.5 Company policy in relation to relevant technology 2.6 Different management concepts 2.7 Technology adaptability 2.1 Applying relevant technology 2.2 Communicating skills 2.3 Using software applications skills 2.4 Conducting risk assessment 3. Maintain/ enhance relevant technology Maintenance of technology is applied in accordance with the industry standard operating procedure, manufacturer’s operating guidelines and occupational health and safety 3.1 Awareness on technology and its function 3.2 Repair and maintenance procedure 3.3 Health and safety procedure 3.4 Company policy in relation to Performing troubleshooting skills Identifying failures or defects 3.3 Communication skills 3.4 Applying corrective and
procedure to ensure its operative ability Updating of technology is maintained through continuing education or training in accordance with job requirement Technology failure/ defect is immediately reported to the concern/responsible person or section for appropriate action relevant technology 3.6 Upgrading of technology 3.7 Organizational set-up/work flow preventive maintenance
Information on the quality and other indicators of production performance is recorded in accordance with workplace procedures Deviations from specified quality standards, causes are documented and reported in accordance with the workplace’ standards operating procedures Quality Indicators Engage in quality improvement Process improvement procedures are participated in relation to workplace assignment Work is carried out in accordance with process improvement procedures Performance of operation or quality of product or service to ensure customer satisfaction is monitored Quality improvement processes Company customers defined Solution providing and decision-making 3.2 Practice company process improvement procedure
UNIT TITLE : PERFORM COMPUTER OPERATIONS UNIT CODE : ELC311203 UNIT DESCRIPTOR : This unit covers the knowledge, skills, (and) attitudes and values needed to perform computer operations which include inputting, accessing, producing and transferring data using the appropriate hardware and software ELEMENT PERFORMANCE CRITERIA Italicized Bold terms are elaborated in the REQUIRED KNOWLEDGE REQUIRED SKILLS Plan and prepare for task to be undertaken Requirements of task are determined according to job specifications Appropriate hardware and software are selected according to task assigned and required outcome Task is planned to ensure OH & S guidelines and procedures are followed Client -specific guidelines and procedures are followed. Required data security guidelines are applied in accordance with existing procedures. Main types of computers and basic features of different operating systems Main parts of a computer Information on hardware and software 1.4 Data security guidelines Reading and comprehension skills required to interpret work instruction and to interpret basic user manuals. Communication skills to identify lines of communication, request advice, follow instructions and receive feedback. 1.3 Interpreting user manuals and security guidelines data into computer Data are entered into the computer appropriate program/application in accordance with company procedures Accuracy of information is checked and information is in accordance with standard operating procedures Inputted data are stored in storage media according to requirements Work is performed within ergonomic guidelines Basic ergonomics of keyboard and computer user Storage devices and basic categories of memory Relevant types of software Technology skills to use equipment safely including keyboard skills. 2.2 Entering data Access information using computer Correct program/ application is selected based on job requirements Program/application containing the information required is 3.1 General security, privacy legislation and copyright 3.2 Productivity Application 3.1 Accessing information 3.2 Searching and browsing files and data
accessed according to company procedures Desktop icons are correctly selected, opened and closed for navigation purposes Keyboard techniques are carried out in line with OH & S requirements for safe use of keyboards 3.3 Business Application Produce/ output data using computer system Entered data are processed using appropriate software commands Data printed out as required using computer hardware/peripheral devices in accordance with standard operating procedures Files, data are transferred between compatible systems using computer software, hardware/ peripheral devices in accordance with standard operating procedures Computer application in printing, scanning and sending facsimile Types and function of computer peripheral devices 4.1 Computer data processing 4.2 Printing of data 4.3 Transferring files and data Maintain computer equipment and systems Systems for cleaning, maintenance and replacement of consumables are implemented Procedures for ensuring security of data, including regular back-ups and virus checks are implemented in accordance with standard operating procedures file maintenance procedures are implemented in line with the standard operating procedures 5.1 Computer equipment/system basic maintenance procedures 5.2 Viruses 5. 3 OH & S principles and responsibilities 5.4 Calculating computer capacity 5.5 System Software 5.6 Basic file maintenance procedures Removing computer viruses from infected machines Making backup files
UNIT TITLE : PROCESS MEDICAL CLAIMS/BILLING UNIT CODE : ICT325302 UNIT DESCRIPTOR : This unit covers the skills, knowledge and attitude necessary to process medical claims/billing. It covers preparation of requirements for screening and processing of claims/billing. ELEMENT PERFORMANCE CRITERIA Italicized terms are elaborated in the Range of Variables REQUIRED KNOWLEDGE REQUIRED SKILLS Prepare requirements for claims processing Data are gathered from patient’s record as provided by the client. Patient’s medical record are created or updated based on claims processing requirements Medical provider’s demographics are checked and updated based on claims processing requirements Medical Terminology Systems of the body (e.g., skeletal, respiratory, cardiovascular) Human anatomy Human physiology Fundamental nature of a disease process, signs, symptoms and methods of treatment Common medical conditions Medical investigations and procedures Injuries Common abbreviations for medical and pharmacological terms (e.g., BCG, HRT) Common medications Commonly used medical equipment and instruments Laboratory testing methods Diagnostic and surgical procedures Laboratory values and significance Medico-legal terminology Medical Documentation Medical claim process Healthcare Laws and Ethics Essential of healthcare insurance Medical Coding Systems Diagnosis code set Procedure Code Set Supplies Code Set Analytical skills Reading and comprehension skills Researching skills Basic mathematical skills Communication skills Computer skills
Client’s specific guidelines/ coding and claims processing standards 5S and 3Rs Screen claims Claims are checked for authorization, eligibility based on provider and/or subscriber contract with the payer Completeness of claims documentation are checked in accordance with payer requirements Lacking data based on the initial screening result are requested from medical provider Medical Terminologies Medical Documentation Medical claim process Healthcare Laws and Ethics Essential of healthcare insurance Medical Coding Systems International Classification of Diseases Current Procedural Terminology Healthcare Common Procedure Coding System Client’s specific guidelines/ coding and claims processing standards Analytical skills Reading and comprehension skills Researching skills mathematical skills Communication skills Computer skills Process claims/billing Encode patient, provider and/or billing information Determine reimbursable procedures and/or services based on existing insurance contract or provider contract or any existing reimbursement guidelines Billing information is verified for completeness of data based on the required fields. Determine billing address and facility based on insurance contract Medical Terminologies Medical Documentation Medical claim process Healthcare Laws and Ethics Essential of healthcare insurance Medical Coding Systems include but not limited to: Diagnosis Code Set Procedure Code Set Supplies Code set Client’s specific guidelines/ coding and claims processing standards Analytical skills Reading and comprehension skills Researching skills Basic mathematical skills Communication skills Computer skills
UNIT TITLE : MANAGE MEDICAL CLAIMS UNIT CODE : ICT325303 UNIT DESCRIPTOR : This unit covers the skills, knowledge and attitude necessary to manage medical claims. It covers managing account receivable, denials/ rejections and underpaid medical claims. ELEMENT PERFORMANCE CRITERIA Italicized terms are elaborated in the Range of Variables REQUIRED KNOWLEDGE REQUIRED SKILLS Manage account receivable Processed and submitted claims are tracked and monitored based on enterprise or client requirements Pending claims are followed-up from payer and/or patient in accordance with enterprise policy Supporting documents are Identified and requested from the medical provider based on payer requirements (when necessary) Posting of payments are performed in accordance with enterprise/client’s policy Medical Terminology Systems of the body (e.g., skeletal, respiratory, cardiovascular) Human anatomy Human physiology Fundamental nature of a disease process, signs, symptoms and methods of treatment Common medical conditions Medical investigations and procedures Injuries Common abbreviations for medical and pharmacological terms (e.g., BCG, HRT) Common medications Commonly used medical equipment and instruments Laboratory testing methods Diagnostic and surgical procedures Laboratory values and significance Medico-legal terminology Medical Documentation Medical claim process Analytical skills Reading and comprehension skills Researching skills Basic mathematical skills Communication skills Computer skills
Healthcare Laws and Ethics Essential of healthcare insurance Medical Coding Systems include but not limited to: Diagnosis code set Procedure code set Supplies Code set Client-specific guidelines and coding and claims processing standards 5S and 3Rs Manage denied/ rejected claims Denied/ Rejected claims are reviewed based on the explanation of benefits from the insurance company. Reasons for denial/rejections are verified with payer’s adjusters in line with enterprise policy. Necessary adjustments are made on the explanation of benefits from the insurance company. Supporting documents are Identified and requested from the medical provider based on the payer requirements. Adjusted claims are in compliance with payer’s requirements Medical Terminologies Medical Documentation Medical claim process Healthcare Laws and Ethics Essential of healthcare insurance Medical Coding Systems Diagnosis Code set Procedure Code set Supplies Code set Client’s specific guidelines / Coding and claims standards 5S and 3Rs Analytical skills Reading and comprehension skills Researching skills Basic mathematical skills Communication skills Computer skills Manage underpaid claims Underpaid claims are reviewed based on the explanation of benefits from the insurance company. Medical Terminologies Medical Documentation Medical claim process Analytical skills Reading and comprehension skills Researching skills
Reasons for underpayment are verified with payer’s adjusters in line with enterprise policy. Supporting documents are prepared based on payer requirements. Underpaid claims are together with appeal request in line with enterprise/client’s policy. Healthcare Laws and Ethics Essential of healthcare insurance Medical Coding Systems Diagnosis Code set Procedure Code Set Supplies Code set Client’s specific guidelines / Coding and Claims Standards 5S and 3Rs Basic mathematical skills Communication skills Computer skills
RANGE OF VARIABLES VARIABLE RANGE Supporting documents May include but not limited to: Patient’s record (diagnostic examination result) Medical provider’s notes Diagnoses code set, procedure code set and supplies code set Billing record Posting of payments May be classified as: fully paid under paid rejected or denied Rejected claims May be caused by but not limited to: Incomplete/incorrect patient information Illegible/unreadable documents Incorrect medical codes Incomplete/incorrect providers information Reasons for underpayment May include but not limited to: Medically unnecessary procedure, supplies and/or equipment Not covered by benefit plan Exceeded coverage plan Unauthorized procedure, supplies and/or equipment Duplicate billing Bundled medical procedure codes EVIDENCE GUIDE Critical aspects of competency Assessment must show that the candidate: Managed account receivable Managed rejection/denials Managed underpayment Methods of assessment The following may be used to objectively assess the candidate: Demonstration with oral Questioning Written test Portfolio with interview Resource implication The following resources May be provided: diagnosis coding manuals Procedures/Services and supplies coding Manuals and/or their equivalent Mockup/Sample Medical documentation Context of Assessment Assessment may be conducted in the workplace or in a simulated environment.
4. workplace problem related to work activities 4.1 Explain the analytical techniques Observation, investigation & analytical techniques Brainstorming Cause and effect diagrams Conduct investigation and root cause analyses and implement corrective actions Perform analytical skills in solving problem related to work Direct observation Simulation Written test Demonstration 2 4.2 Identify the problem Normal operating parameters & product quality Identifying & clarifying the nature of problem Application of analytical techniques Evaluate the present status of the performance against the established safety, quality and environmental policies of the workplace Discussion in identifying and clarifying the nature of problem Simulation/ role playing Discussion Simulation Written exam Practical/ performance test Demonstration 1 hour 4.3 Determine the possible cause/s of the problem Non-routine process and quality problems Teamwork and work allocation problem Safety and emergency situations and incidents Implement corrective or preventive actions based on root cause analyses View video presentation on possible cause of problem in the workplace Writeshop on the determining problems in the workplace Case studies Multimedia presentation Writeshop Written exam Interviews Written Test 1 hour 5. Use mathematical concepts and techniques Identify mathematical tools and techniques to solve problem Measurement system Basic measuring tools/devices Practice mathematical concepts to solve problem in the workplace Direct observation Demonstration Written exam Practical/ performance test 1 hour mathematical procedures/ solution Fundamental operation (addition, subtraction, division, multiplication) Practice linear measurements and conversion Practice mathematical calculation on workplace situation Simulation/ role playing Demonstration Written exam Practical/ performance test 2
Analyze results Precision and accuracy Compare the results against the new requirements and identify gaps Analysis of result Case studies Demonstration Written exam Interviews 2 hours 6. Use relevant technologies Identify appropriate technology Awareness on technology and its function Communication techniques Film Viewing regarding technology and its benefits Identify different technology applicable to workplace Direct observation Multimedia presentation Written exam Demonstration 2 hours Apply relevant technology Study different relevant technology in the workplace Relate 5s to technology Conduct risk assessment for a routine or non-routine task in the workplace using the established systems Application of relevant technology to the workplace Direct observation Simulation/ role playing Written exam Demonstration 2 Maintain/ enhance relevant technology Corrective and preventive maintenance Upgrading of technology Communication Skills Organizational set–up / work flow Identify monthly maintenance tasks based on the Planned Maintenance System Application of corrective and preventive maintenance to workplace Case studies Simulation/ role playing Interviews Demonstration 2 hours 32 hours Note: competencies may be embedded in the core competencies. COMMON COMPETENCIES 18 hrs Unit of Competency Learning Outcomes Learning Contents Practical Activities Methodologies Assessment Methods Nominal Duration
Quality Standards Assess quality of received materials Relevant production processes, materials and products Characteristics of materials, software and hardware used in production processes Quality checking procedures Quality Workplace procedures Identification of faulty materials Checking quality of materials or component parts as per manufacturer’s standards Interpreting specifications or symbols Field trip Symposium Video clips Simulation/ Role playing On the job training Written test Demonstration & questioning Observation & questioning 3 hours Assess own work Safety and environmental aspects of production processes Fault identification and reporting Workplace procedure in documenting completed work Workplace Quality Indicators Observing safety and environmental aspects of production processes Preparing technical reports Performing procedures in the workplace Field trip Symposium Film showing Simulation On the job training Demonstration & questioning Observation & questioning Third party report 3 hours Engage in quality improvement Quality improvement processes IEC/ISO standards Environmental and safety standards Implementing continuous improvement Field trip Symposium Film showing Simulation On the job training Demonstration & questioning Observation & questioning Third party report 2 hours Perform Computer Operations Plan and prepare for task to be undertaken Main of computers and basic features of different operating systems Main parts of a computer Planning and preparing computer operation activity Modular Film showing Computer based training (e-learning) Project method On the job training Demonstration & questioning Observation & questioning Third party report 3 hours
Information on hardware and software Data security guidelines Different Computer specifications Assessment of output product Portfolio Computer- assessment Input data into computer keyboard and computer user Storage devices and basic categories of memory Relevant types of software Encoding of data Saving encoded data Modular Film showing Computer based training (e-learning) Project method On the job training Demonstration & questioning Observation & questioning Third party report Assessment of output product Portfolio Computer- assessment 1 hour Access information using computer General security, privacy legislation and copyright Productivity Application Microsoft office applications Business Application Introduction to Basic Programming software Accessing computer Performing data encoding Creating presentation materials Drafting office communication and documents Modular Film showing Computer based training (e-learning) Project method On the job training Demonstration & questioning Observation & questioning Third party report Assessment of output product Portfolio Computer- assessment 2 hours Produce/ output data using computer system Computer application in printing, scanning and sending facsimile Types and function of computer peripheral devices Printing and scanning of office documents and materials Sending of office/business documents Modular Film showing Computer based training (e-learning) Project method On the job training Demonstration & questioning Observation & questioning Third party report Assessment of output product Portfolio 2 hours
Saving of documents in storage devices CD/DVD USB drives Hard disk drives Computer- based assessment Maintain computer equipment and systems Computer equipment/system basic maintenance procedures Different types of computer viruses Basic file maintenance procedures Performing cleaning of PC parts/hardware components Scanning/Debugging of computer software and applications Performing cleaning and defragmentation of computer files Performing backup of computer files Modular Film showing Computer based training (e-learning) Project method On the job training Demonstration & questioning Observation & questioning Third party report Assessment of output product Portfolio Computer- assessment 2 hours CORE COMPETENCIES 160 hrs Unit of Competency Learning Outcomes Learning Contents Practical Activities Methodologies Assessment Methods Nominal Duration
Assign Medical Codes 1.1 Prepare requirements for medical coding Types and contents of medical record Different type and uses of Medical Codes Identification of types and uses Coding Tools Format and Organization of Coding Tools Healthcare Data Security and Privacy Medical terminology Anatomy and Physiology Analyzing the completeness of a medical record Identifying different types of medical codes and its uses Identifying types of Coding Tools Familiarizing on the format and organization of different coding tools Understanding and its importance in Healthcare Coding and Claims Processing Lecture Discussion Demonstration Written exam Demonstration Interview 16 1.2 Evaluate medical reports Information/Data set necessary in Coding Data management Coding Guidelines and Conventions Current Coding practices Identifying and gathering necessary information or Data sets in Coding Identifying and understanding all the appropriate Coding conventions and guidelines. Identifying standard coding practices Lecture Discussion Demonstration Written exam Demonstration Interview 24 1.3 Assign codes Basic Coding steps Classification of Diagnoses Classification of Procedure and Supply codes Best Practices in Coding Knowing the basic coding steps. Assigning appropriate diagnoses codes Assigning appropriate procedure and supply Applying best practices in coding activities Lecture Discussion Demonstration Written exam Demonstration Interview 80 Process Medical Claims/ Billing 2.1 Prepare requirements for claims processing Medical terminology Medical documentation and billing forms Perform data gathering of requirements for claims processing Discussion Demonstration Case Written exam Demonstration Interview 4
Claims processing requirements Medical provider requirements Third-party payers Patient Information Identify the appropriate claims processing requirement by medical providers Evaluate completeness of claims documents for processing 2.2 Screen claims Healthcare Laws and Ethics Healthcare Insurance and Plans Government Insurance Clearinghouse Medical billing software Basic mathematical tools Precision and accuracy Communication skills Checking claim eligibility and authorization Performing research activities to screen claims Practicing mathematical concept to process claims Identifying and analyzing variances and discrepancies in claims Creating report log to communicate with client Discussion Demonstration Project type Written exam Demonstration Direct observation 12 2.3 Process claims/billing Healthcare Laws and Ethics Medical Coding Systems Client-specific guidelines and claims processing standards Identify correct billing information Maintain data confidentiality and security Demonstrate research capability Apply appropriate guidelines when processing claims Brain storming Discussion Demonstration Written exam Demonstration Interview / questioning 12 Manage medical claims 3.1 Manage account receivable Basic mathematical tools/accounting process Communication skills Research skills Medical documentation Computer operation Record the appropriate payments and balances Create report log to communicate action for payers and providers re documentation Checks various payer portals for payment status and reasons for non-payment Lecture Discussion Demonstration Project type Written exam Demonstration Interview 4
Performs data entry to post payment 3.2 Manage denied/ rejected claims Explanation of Benefits Insurance Policies Common Reason for denials Measure to Prevent Denied Claims Communication Skills Common Reason for Rejection Rebilling Process for Rejected Claims Identifying the components of an Explanation of Benefits Interpreting Explanation of Benefits of a denied claim Interpreting an Explanation of Benefits of a rejected claims Identifying common reason for claim rejection Identifying solution for identified reason for rejection Lecture Demonstration Case study Written exam Demonstration Interview/ questioning 4 3.3 Manage underpaid claims Common Reason for Underpaid claims Measure to Prevent underpaid Claims Rebilling process for underpaid claims Review and Appeal process Identifying common reason for claims underpayment Identifying measures to prevent underpayment of claims Providing possible solution for identified reason for underpayment Performing Rebilling of underpaid Claims Performing Review and Appeal for underpaid Claims Brain storming Discussion Demonstration Case study Written exam Demonstration Interview 4 160 hours
ANNEX A - COMPETENCY MAP Medical Coding and Claims Processing NC III BASIC COMPETENCIES Receive and Respond to Workplace Communication Work with Others Demonstrate work values Practice housekeeping procedures Participate in Workplace Communication Work in a Team Environment Practice career professionalism Practice occupational health and safety procedures Lead Workplace Communication Lead Small Team Develop and practice negotiation skills Problems Related to Work Activities Use mathematical concepts and techniques Use relevant technologies Utilize Specialist Communication Skills Develop Team and Individuals Apply Problem Solving Techniques in the Workplace Collect, analyze and organize information Plan and Organize Work Promote environmental protection COMMON COMPETENCIES Use Hand Tools Perform Mensuration and Calculation Prepare and Interpret Technical Drawing Apply Quality Standards Perform Computer Operations CORE COMPETENCIES Communicate effectively in a customer contact center Render quality customer service Utilize enterprise/ company technology Conduct contact center campaign Provide specialized support and assistance to customers Manage the activities of a contact center work team Lead a contact center work team Use business technology Use medical technology to out task Produce text from transcription Review/edit documents Manage the activities of a work team Lead a team in delivering quality service Produce cleaned-up and in-between drawings Create 2D models and images Produce 2D colored animation Produce key drawings for animation Produce over-all designs for animation Produce background designs Composite and edit animation sequence Create 3D models and images Produce storyboard for animation Coordinate the production of animation Assign medical codes Process medical claims/billings Manage medical claims DEFINITION OF TERMS GENERAL Certification - is the process of verifying and validating the competencies of a person through assessment
Physiology – the branch of biology concerned with the functions of living things. Protocol – a set of rules and procedures for the control of communication in a communications network. Quality Assurance – methods for ensuring that information systems are free from errors and fraud and provide information products of high quality. Software – computer programs and procedures concerned with the operation of an information system. Standards – measures of performance developed to evaluate the progress of a system toward its objectives System – an assembly of methods, procedures, or techniques unified by regulated interaction to form an organized whole User- friendly – a characteristic of human-operated equipment and systems that makes ACKNOWLEDGEMENTS The Technical Education and Skills Development Authority (TESDA) wishes to extend gratitude and appreciation to the many representatives of business, industry, academe and government agencies and labor groups who donated their time and expertise to the development and validation of these Training Regulations. THE TECHNICAL EXPERT PANEL (TEP) JOSEFINA V. LAUCHANGCO (AAMT) MYLA ROSE M. REYES (SPI Global) MA. CRISTINA G. CORONEL (Pointwest) JEANETTE S. CARRILLO Healthcare Information Management Outsourcing Association of the Philippines (HIMOAP) PETER A. EDU, MD LINA LIZA A. ALCANCES, MD Teledevelopment Services Inc. THERESA D. TIMBANG FLORINDA G. TUVILLO Department of Health - Technical Working Group on ICD - 10 JONATHAN MICHAEL , MD Philippine Health Insurance Corp. Standards & Monitoring Department THE PARTICIPANTS IN THE NATIONAL VALIDATION OF THIS TRAINING REGULATION Healthcare Information Management Outsourcing Association of the Philippines, Inc. (HIMOAP) – Global American Academy of Medical Transcription Teledevelopment Services Inc. Pointwest Technologies Total Transcriptions Solutions Center for Technical Excellence Integrated Schools, Inc. THE BOARD - STANDARDS SETTING SYSTEMS DEVELOPMENT COMMITTEE