STANDARD 1.0 DISTINGUISH AMONG VARIOUS HEALTHCARE DELIVERY SYSTEMS
1.1   Identify private healthcare facilities (i.e., hospitals, extended care facilities, long-term care services, etc.)
1.2   Identify government  healthcare agencies (i.e., public health services, critical access hospitals, etc.)
1.3   Identify voluntary  health agencies (i.e., American Heart Association, American Cancer  society, National Lung  Institute, nonprofit hospitals, visiting nurse associations, local service organizations,  etc.)
1.4   Identify ambulatory care services (i.e., private medical practices, hospital-based ambulatory  care services, outpatient surgical services, etc.)
1.5   Define subacute and acute care

STANDARD 2.0 USE MEDICAL TERMINOLOGY AS APPLIED IN HEALTHCARE SYSTEMS
2.1   Use medical terminology as it relates to patient medical records
2.2   Explain  the division  of medical word  parts
2.3   Identify medical words by combining  forms
2.4   Explain  medical terminology prefixes and  suffixes

STANDARD 3.0 DEMONSTRATE AN UNDERSTANDING OF BODY SYSTEMS AND HUMAN ANATOMY
3.1   Identify body  planes and  directions
3.2   Identify body  cavities [e.g., dorsal cavities (cranial and spinal) and ventral cavities (thoracic, abdominal,  pelvic)]
3.3   Identify body  regions and  quadrants
3.4   Identify the basic structure and describe the function of the skeletal system
3.5   Identify basic structure and describe the function of the muscular system
3.6   Identify basic structure and describe the function of the digestive system
3.7   Identify basic structure and describe the function of the circulatory system
3.8   Identify basic structure and describe the function of the respiratory system
3.9   Identify basic structure and describe the function of the central and peripheral nervous  system
3.10   Identify the basic structure and describe the function of the urinary system
3.11   Identify the basic structure and describe the function of the integumentary system
3.12   Identify basic structure and describe the function of the endocrine system
3.13   Identify the basic structure and describe the function of the reproductive system
3.14   Identify basic structure and describe the function of the lymphatic and  immune system
3.15   Describe the medical specialties associated with the body system (e.g., Cardiologist,  OB/GYN, Urologist, Pulmonologist, Dermatologist, Orthopedist, and Otolaryngology)

STANDARD 4.0 EXAMINE THE PROCESS OF MEDICAL CODING
4.1   Interpret medical nomenclatures (vocabulary  of medical and clinical terms) and classification systems when coding  diseases and procedures  [e.g., ICD-10-CM  (diagnosis),  ICD-10-PCS  (facility procedure billing codes), CPT (professional procedure codes), and  HCPCS (durable medical codes)]
4.2   Discuss the links between CPT codes and  ICD-10-CM  codes  in relation to medical necessity for reimbursement for charges billed
4.3   Use source documents when coding  diseases and  operations
4.4   Apply  processes and  procedures for coding  diagnoses with accuracy and completeness
4.5   Describe the integration of paper records with electronic records through indexing

STANDARD 5.0 APPLY PAYER GUIDELINES
5.1   Explain  the Medicare National Correct Coding  Initiative
5.2   Explain  third-party payers [e.g., Medicare, Medicaid (AHCCCS),  and  commercial and private insurers]
5.3   Explain  the difference between  HMOs, PPOs, EPOs, IOSs, IPAs, and consumer directed plans
5.4   Explain  the use of the master patient index to improve quality care, reduce costs, and  increase efficiency
5.5   Verify accurate collection of proper patient demographic and  insurance information
5.6   Verify patient insurance eligibility and benefits, authorization, and  referral (e.g., pre-authorization,  pre-certification, and pre- determination)
5.7   Interpret remittance advice to determine the financial responsibility of the patient and the insurance company  and post payments
5.8   Identify accounts that are ready for final billing and  how  to obtain information for accounts that are not ready for billing
5.9   Interpret collection policies and laws for accounts that govern  collection [e.g., Federal Trade Commission Act (FTCA) and Fair Debt Collection Practices Act (FDCPA)]

STANDARD 6.0 EXECUTE HEALTHCARE PRIVACY, CONFIDENTIALITY, AND LEGAL AND ETHICAL METHODS RELATED TO MEDICAL RECORDS
6.1   Explain  HIPAA Privacy  Rule standards to maintain compliance with the privacy and  security of Protected Health Information (PHI)
6.2   Define the safeguards of the HIPAA  Security Rule
6.3   Apply  policies and  procedures for use and disclosure of  Protected Health Information (PHI) in compliance with HIPAA standards
6.4   Identify appropriate release of  patient-specific data to authorized  users per HIPAA  guidelines
6.5   Describe how and  when  to de-identify Protected Health Information (PHI) as directed by HIPAA  regulations
6.6   Analyze  the process for investigating audit compliance
6.7   Identify components  used in internal audits of medical records (e.g., consent forms, Release of Information forms (ROI), and signature on file)
6.8   Evaluate methods to protect patients’ rights through legal, moral, and ethical measures (e.g., HIPAA,  legal liability, and malpractice)

STANDARD 7.0 PERFORM SCHEDULING AND OTHER MEDICAL OFFICE FUNCTIONS
7.1   Obtain and verify patient information for scheduling registration and  check-in
7.2   Schedule patient appointments (paper and  electronic) and provide  patients with complete appointment information
7.3   Process and maintain security of mail, email, and faxes
7.4   Apply  telephone etiquette to telephone calls
7.5   Obtain prior authorization  and  benefit information from insurance companies
7.6   Process patient for checkout including any additional instructions
7.7   Purge and  back up  patient paper and  electronic records

STANDARD 8.0 MAINTAIN THE MEDICAL RECORDS SYSTEM
8.1   Collect and input patient demographics  (i.e., name, address,  contact information, etc.)
8.2   Collect and input patient insurance, payment guarantor  information, and necessary signed consent forms
8.3   Collect and input medical history (i.e., allergies, social history, family history, current medications, etc.)
8.4   Record provider service notes and instructions, including patient communications regarding the instructions
8.5   Record ordered  tests and procedures and the results
8.6   Explain  the purpose  of superbills, charge tickets, and encounter  forms
8.7   Explain  the legalities of recording changes,  additions, and  deletions in the medical record

STANDARD 9.0 APPLY REVENUE MANAGEMENT TASKS
9.1   Explain  key components in the healthcare revenue cycle (i.e., scheduling,  patient registration and  eligibility of insurance, upfront patient collections, medical billing and patient collections, etc.)
9.2   Explain  the financial accounting processes (i.e., primary or secondary  insurance to be billed, fees for returned checks, statements, cash-pay fee schedule, doctor’s fee schedule, interest or finance charges, etc.)
9.3   Explain  resource allocation and  data analytics when  managing budgets
9.4   Identify the benefits of revenue management

STANDARD 10.0 UTILIZE MEDICAL RECORDS TECHNOLOGIES REPORTING
10.1   Describe the basic need for statistical reports for clinical Quality Improvement  (QI) measures including the clinical process and financial measures
10.2   Compile medical care and  census data for continuity of care records (e.g., statistical reports on diseases treated, surgery performed, and  use of hospital beds  for clinical audits)
10.3   Define Diagnosis-Related Groups (DRGs) and  outliers when classifying patients for purposes of payment