Course Tier: 1 - Entry Level
This course provides an overview of the entire healthcare data system including regulatory agencies, code-sets, standard transactions, and the importance of security and accountable oversight. This course provides a solid, basic health data, foundation in 5 lessons. This course was designed for any entry-level learner ready to join the healthcare data community or for a person needing a refresher on the basics of health data (specifically as a pre-requisite to higher level reporting and analytics courses offered).
This course presents data in both online text and video form. It also includes downloadable comprehensive documentation and tools which support and supplement the online learning materials. All content is available after purchase.
Explore the Course Synopsis
The Healthcare Data Machine
Understanding how data moves through the healthcare system is essential. Being able to operate from a platform that accounts for the notion that health data is constantly shifting will be the best position for healthcare data analysts.
The Shift to Electronic Healthcare Data
Industry regulations and best practices are pushing health data into the technology realm with increasing ferver and force. This shift from paper records to electronic formats brings connectivity but also brings many considerations related to privacy and security. This concise overview will serve as a primer.
Economic Healthcare Sectors
- Government Programs – A comprehensive look into the legislative and structural history of the major governmental healthcare sector entities. This includes the Federal Medicare Program, Federal and State Medicaid and Child Health Programs. It also introduces the concept of Dual Eligibility within government programs.
- Commercial Market – A linear history of the development of the commercial healthcare payer market. This covers important policy and commercial product inceptions and drivers.
Policy and Oversight
A look into the administrative agencies and groups that dictate and facilitate administrative and clinical healthcare policy, guidelines, and key performance indicators.
Building Blocks of Health Data
An overview of the basic sources of health data variables. Specifically, a look at the way that medical records, healthcare claims, and other base healthcare documents and transactions fit together.
Privacy & Security
An introduction to the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the implications it had on privacy and security mandates within health data. This section also reviews Protected Health Information (PHI) identifiers and their important role in health data.
Creating & Capturing Health Data
A look at the complete flow of data including capture at encounter, documentation into medical records, medical billings, claims processing, and analysis and reporting.
Standard Healthcare Claim Forms
This section introduces standard claims forms and current HIPAA transactions standards. A brief introduction into formats such as HL7, DICOM, and the SNOMED CT System is also included.
ANSI X12 Transactions in Detail
A detailed and organized look into the various ANSI X12 healthcare transaction types. This includes enrollment, eligibility, service pre-authorization, claims billing, claims adjudication, claims payment, and provider information processes. Secondary data source topics such accumulator and encounter files will also be covered.
This section provides an excellent road map for visualizing how all of the pieces of ANSI X12 fit together.
Standard Claim Healthcare Code Sets
- ANSI X12 Transaction Code Sets
- Place of Service Codes
- Type, Class, & Frequency Codes
- CPT Codes (Category I, II, & III)
- HCPCS Codes
- CDT Codes
- Procedure Code Modifiers
- ICD-10-CM Diagnosis Codes
- ICD-9-CM and GEMs Mappings
- Revenue Codes
- ICD-10-PCS Procedure Codes
Provider Identification Systems
- Facillity Claim Specific Code Sets
- Revenue Codes
- Admission Type Codes
- Admission Source Codes
- Patient Status Codes
- Condition Codes
- Occurrence Codes
- Value Codes
- Provider Specialty Classification Systems
- Provider Taxonomy Codes
- National Provider Identifiers (NPIs)
- Physician Extenders
Pharmacy Claim Standard Code Sets
- National Drug Codes (NDCs)
- Generic Product Identifier (GPI) Codes
- Generic Sequence Numbers (GSNs)
- Dispense as Written (DAW) Codes
- The AHFS Pharmacologic-Therapeutic Classification System
Laboratory Test/Result Standard Code Sets
- Logical Observation Identifiers Names and Codes (LOINC)