MCC Program Study Schedule – CCS-P Designation

This guide is designed to help you through the Medical Coder Certification (MCC) program with a CCS-P designation.

General Study Tips

1. Set a realistic and reasonable study pace. If you have already scheduled your CCS-P exam with AHIMA and the Prometric Testing Center, do not wait until the last minute to study. If success is not achieved on the first try, allow ample time to prepare and contact MMI with any known information of your weak areas should you wish for a concentrated study effort. Be aware, AHIMA does allow one free re-take within the initial exam fee within one year of failing the exam. Though 90 days must elapse prior to the retake.

2. If possible, study in a quiet environment.

3. Work at a desk or table. DO NOT lie down on a couch or bed to study. Take a break, if you need it.

4. Find the best time of the day to study. Many people find it easier to study at night, some find the morning better.

5. Upon completion of most chapters there is a homework quiz. Take these and the cumulative quizzes. These quizzes will give you an idea of your progress as you move through the MCC manual.

6. Contact your instructor if you need help understanding any of the material, or if you require clarification of any concepts in the MCC program. The staff at the Medical Management Institute (MMI) is committed to your education and certification.

The following is summarized information regarding the exam for your desired credentials:

CCS-P: Certified Coding Specialist – Physician-based

Granting Organization: AHIMA (American Health Information Management Association)

Exam: Administerd by Prometric Services at specific physical locations

Content Requirements: CPT, ICD-9-CM Vol. I & II and HCPCS II Coding, Evaluation and Management (E/M), Anatomy, Medical Terminology, Coding with Modifiers, Coding Principals and HIPAA

Scoring: The CCS-P exam is separated into two Phases; Phase I & Phase II. Phase 1 contains 60 multiple-choice questions and Phase 2 consists of medical records coding (total of 16 records). This exam is administered by Prometric (an outside testing service), and graded using the Agnoff procedure. Each exam is graded by the Examination Construction Committee to adjust for fluctuations in exam difficulty.

Notification of Score: When sufficient candidate volume is reached; average: 4-6 weeks

The following is a full outline, put out by AHIMA, regarding the CCS-P Exam:

Certified Coding Specialist – Physician-Based (CCSP) Examination Content Outline

Number of Questions on Exam: 60 multiple-choice (Part 1) / 16 Medical Record Coding (Part 2) Exam Time: 4 hours

DOMAIN I. Health Information Documentation (18%) TASKS.

1. Locate appropriate source documents within the health record for coding or data collection.

2. Interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, pharmacology, and medical terminology to identify codeable diagnoses and/or procedures.

3. Determine when additional clinical documentation is needed to assign and/or validate the diagnosis and/or procedure code(s).

4. Consult with/query physicians and/or non-physician practitioners when additional information is needed for coding and/or to clarify conflicting or ambiguous information.

5. Consult clinical reference materials to enable interpretation of health information documentation.

6. Determine those elements of the documentation that are extraneous or unnecessary for coding purposes

DOMAIN II. ICD-9-CM Diagnosis Coding (24%) TASKS.

1. Apply ICD-9-CM conventions, formats, instructional notations, tables, and definitions to select diagnoses, conditions, problems, or other reasons for the encounter.

2. Assign ICD-9-CM code by applying "Diagnostic Coding and Reporting Guidelines for Outpatient Services (Hospital-Based and Physician Office)”.

3. Consult AHA Coding Clinic to assist in proper assignment of diagnostic codes.

DOMAIN III. CPT and HCPCS II Coding (24%) TASKS.

1. Apply CPT guidelines, format, and instructional notes to select services, procedures, and supplies that require coding.

2. Assign CPT code(s) for procedures and/or services rendered during the encounter: a. Evaluation and Management (E/M) services; b. Anesthesia; c. Surgery

d. Radiology; e. Pathology and Laboratory; f. Medicine; g. Category III

3. Apply HCPCS II guidelines and instructional notes to select services, procedures, drugs and supplies that require coding.

4. Assign HCPCS II codes for services, procedures, drugs and/or supplies provided. 5. Append modifiers to CPT and/or HCPCS II codes when applicable.

DOMAIN IV. Reimbursement (8%) TASKS.

1. Create and maintain encounter form or charge tickets and/or electronic equivalents.

2. Apply bundling and unbundling guidelines (e.g., National Correct Coding Initiative

[NCCI]).

3. Apply reimbursement methodologies for billing and/or reporting (e.g., OIG, CMS,

Federal Register).

4. Link diagnosis code to the associated procedure code for billing or reporting.

5. Identify, post and submit charges for healthcare services based on documentation

and payer guidelines.

6. Evaluate payer remittance or payment (e.g., RA, EOB, EOMB) reports for

reimbursement and/or denials.

7. Process claim denials and/or appeals

DOMAIN V. Data Quality and Analysis (10%) TASKS.

1. Validate accuracy and completeness of coded data by comparing the documentation to the encounter form or electronic equivalent.

2. Assess the quality of coding and billing using generated reports.

3. Verify the accuracy and completeness of the data on the claim.

4. Conduct coding and billing audits for compliance and trending.

5. Educate health care providers and/or staff regarding reimbursement methodologies, documentation rules and regulations related to coding.

DOMAIN VI. Information and Communication Technologies (6%) TASKS.

1. Use computer systems to ensure data collection, storage, analysis and reporting of information.

2. Use common software applications (e.g., word processing, spreadsheets, email, encoders) in the execution of work processes.

DOMAINVII. Compliance and Regulatory Issues (10%) TASKS.

1. Apply policies and procedures for access to and disclosure of personal health information.

2. Release patient-specific data to authorized individuals.

3. Apply AHIMA Code of Ethics/Standards of Ethical Coding.

4. Recognize/report privacy issues/problems.

5. Protect data integrity and validity using software or hardware technology.

6. Participate in the development of coding policies to ensure compliance with official coding rules and guidelines.

7. Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards (e.g., signature, teaching physician rules, PA co-sign requirements).

8. Recognize/report compliance concerns/findings.