Florida Department of Education
Curriculum Framework 

Program Title: 	Medical Coder/Biller 
Program Type: 	Career Preparatory
Career Cluster: 	Health Science

Career Certificate Program	
Program Number	H170529	
CIP Number	0351071403	
Grade Level	30, 31	
Program Length	1110 hours	
Teacher Certification	Refer to the Program Structure section.	
CTSO	HOSA	
SOC Codes (all applicable) 	For program SOC codes, please see the Program and Course Tables section of the CTE Program Resources page linked below.	
CTE Program Resources 	http://www.fldoe.org/academics/career-adult-edu/career-tech-edu/program-resources.stml	
Basic Skills Level	Computation (Mathematics):	9	Communications (Reading and Language Arts):	11	

Purpose

This program offers a sequence of courses that provides coherent and rigorous content aligned with challenging academic standards and relevant technical knowledge and skills needed to prepare for further education and careers in the Health Science career cluster; provides technical skill proficiency, and includes competency-based applied learning that contributes to the academic knowledge, higher-order reasoning and problem-solving skills, work attitudes, general employability skills, technical skills, and occupation-specific skills, and knowledge of all aspects of Health Science career cluster. The program is designed to prepare students for employment in a variety of health care settings as entry level coder, medical record coder, coding technicians, or coding clerks, or medical coder/biller (Medical Records and Health Information Technicians). 

The content includes but is not limited to medical terminology, anatomy and physiology, coding systems, fundamentals of disease process including pharmacology, health care delivery systems, basics of medical records services, ethical and legal responsibilities, safety/security procedures, basic data processing, and employability skills.

Additional Information relevant to this Career and Technical Education (CTE) program is provided at the end of this document.

Program Structure

This program is a planned sequence of instruction consisting of 2 occupational completion points.

This program is comprised of courses which have been assigned course numbers in the SCNS (Statewide Course Numbering System) in accordance with Section 1007.24 (1), F.S.  Career and Technical credit shall be awarded to the student on a transcript in accordance with Section 1001.44(3) (b), F.S.

To teach the courses listed below, instructors must hold at least one of the teacher certifications indicated for that course.

The following table illustrates the postsecondary program structure:

OCP	Course Number	Course Title	Teacher Certification	Length	
A	HIM0009	Introduction to Health Information Technology	CER COD SP 7 G
MED RECTEC 7G 
MED ASST 7G 
MED TRANS 7G	90 hours	
B	HIM0091	Medical Coder/Biller I		350 hours	
	HIM0092	Medical Coder/Biller II		350 hours	
	HIM0093	Medical Coder/Biller III		320 hours	

Florida’s Career Readiness Skills for CTE Programs

Employability Skills	
01.0	Apply academic skills to workplace scenarios.	
01.01	Use reading skills.	
01.02	Use writing skills.	
01.03	Use mathematical strategies and procedures.	
01.04	Use scientific principles and procedures.	
02.0	Design a solution to an industry problem.	
02.01	Use critical thinking.	
02.02	Use creativity.	
02.03	Make sound decisions.	
02.04	Solve problems.	
02.05	Reason. 	
02.06	Plan and organize.	
03.0	Manage resources within an industry project	
03.01	Manage time.	
03.02	Manage money or resources.	
03.03	Manage materials.	
03.04	Manage personnel.	
04.0	Oversee the subcomponents, operations and output of a technical or organizational system.	
04.01	Manage systems.	
04.02	Monitor systems.	
04.03	Improve systems.	
05.0	Use information for decision making.	
05.01	Locate information.	
05.02	Organize information.	
05.03	Use information.	
05.04	Analyze information.	
05.05	Communicate information.	
06.0	Apply relevant technology to workplace scenarios to aid productivity.	
06.01	Use technology.	
07.0	Interpret and express interpersonal communication.	
07.01	Communicate verbally.	
07.02	Listen actively.	
07.03	Comprehend written material.	
07.04	Convey information in writing.	
07.05	Communicate nonverbally.	
07.06	Interpret nonverbal communication.	
08.0	Interact with others to accomplish workplace goals.	
08.01	Collaborate with others in a team.	
08.02	Respond to customer needs.	
08.03	Exercise leadership.	
08.04	Negotiate to resolve conflict.	
08.05	Respect others.	
09.0	Manage personal behavior to maximize productivity and professional growth.	
09.01	Demonstrate responsibility and self-discipline.	
09.02	Adapt and show flexibility.	
09.03	Work independently.	
09.04	Demonstrate a willingness to learn.	
09.05	Demonstrate integrity.	
09.06	Demonstrate professionalism.	
09.07	Take initiative.	
09.08	Display positive attitude.	
09.09	Take responsibility for professional growth.	
Job Attainment	
10.0	Find, assess and apply to job opportunities.	
10.01	Identify online job posts relevant to his or her career aspirations.	
10.02	Compare and contrast the job posts’ required qualifications, job duties, compensation, benefits and employers. 	
10.03	Define what information, documentation and writing prompts are required for the positions.	
11.0	Communicate personal competence, character and fit for a job opportunity.	
11.01	Develop a resume.	
11.02	Write a cover letter.	
11.03	Curate a professional portfolio that includes work products.	
11.04	Prepare for and experience a mock job interview.	
12.0	Cultivate and leverage relationships to professionally advance.	
12.01	Request a signed reference letter, letter of recommendation and/or an online skill/professionalism endorsement. 	
12.02	Develop a plan to cultivate a professional digital footprint.	
12.03	Develop a networking plan for a specific industry of interest.	

Standards

After successfully completing this program, the student will be able to perform the following:

01.0	Demonstrate an understanding of healthcare organizations and health occupations.
02.0	Demonstrate the ability to communicate and use interpersonal skills effectively.
03.0	Explore health informatics as health professional.
04.0	Apply Knowledge of health data concepts.
05.0	Manage the adoption of multiple formats of health records and the function of digital applications.
06.0	Apply Health Information Technology Principles.
07.0	Apply classification systems, clinical vocabularies and terminologies.
08.0	Evaluate ethical issues in Health Information professions.
09.0	Demonstrate compliance with laws, regulations, and standards that impact healthcare.
10.0	Apply policies, regulations, and standards to the management of information associated with treatment, payment, and operations (TPO). 
11.0	Demonstrate computer knowledge and skills.
12.0	Demonstrate employability skills.
13.0	Describe the anatomy and physiology of the human body.
14.0	Demonstrate proficiency in the application of medical terminology.
15.0	Demonstrate an understanding of the fundamentals of disease processes in relation to the human body, including pharmacology.
16.0	Demonstrate proficiency in current medical code set systems and technology-assisted coding solutions.
17.0	Demonstrate proficiency in complex coding scenarios and value-based care requirements.
18.0	Articulate health information services within modern healthcare delivery systems related to the medical coder/biller.
19.0	Ensure professional and ethical behavior of a medical coder/biller in an evolving digital healthcare environment.
20.0	Participate in healthcare revenue cycle management processes.
21.0	

Florida Department of Education
Student Performance Standards

Program Title: 	Medical Coder/Biller
Career Certificate Program Number: 	H170529

Course Number: HIM0009
Occupational Completion Point: A
Introduction to Health Information Technology – 90 Hours	
01.0	Demonstrate an understanding of healthcare organizations and health occupations.  The student will be able to:	
01.01	Discuss the evolution of healthcare.	
01.02	Demonstrate an understanding of the infrastructure of healthcare in the United States.	
01.03	Discuss healthcare regulatory agencies and organizations.	
01.04	Recognize levels of education, credentialing requirements, employment opportunities, workplace environments, and career growth potential.	
01.05	Differentiate the roles of various providers and disciplines throughout the continuum of healthcare and respond to their information needs. 	
02.0	Demonstrate the ability to communicate and use interpersonal skills effectively.  The student will be able to:	
02.01	Apply basic speaking and active listening skills with meaningful feedback. 	
02.02	Identify characteristics of successful and unsuccessful communication including barriers	
02.03	Demonstrate emotional intelligence (e.g., recognize verbal and non-verbal cues).	
02.04	Demonstrate effective professional communication using correct spelling, grammar, formatting, and confidentiality. 	
02.05	Use appropriate medical terminology and abbreviations. 	
02.06	Promote health information training and awareness to internal/external stakeholders. 	
02.07	Model communication skills to varied levels of understanding and cultural orientation including generational differences, cultural, socioeconomic, ethnic, and religious groups.	
02.08	Distinguish between subjective and objective information. 	
03.0	Explore health informatics as health profession.  The student will be able to:	
03.01	Discuss the past, present, and future of health information.	
03.02	Examine professional opportunities related to health information.	
03.03	Demonstrate knowledge of industry-recognized credentials and professional associations applicable to the field of health information.	
04.0	Apply knowledge of health data concepts.  The student will be able to:	
04.01	Examine various health data uses and data sets. 	
04.02	Identify various characteristics of health data quality and emerging standards.	
05.0	Manage the adoption of multiple formats of health records and the function of digital applications.  The student will be able to:	
05.01	Apply regulations and requirements of health information to the continuum of care.	
05.02	Analyze health information as it relates to treatment, payment, and operations (TPO). 	
06.0	Apply Health Information Technology- principles.  The student will be able to:	
06.01	Explain how changing regulations and technology impact the health information field.	
06.02	Validate the accuracy, integrity, and reliability of information from health information systems and applications in healthcare.	
06.03	Demonstrate proficiency and understanding of creation, use, storage, retrieval, and exchange of health data.	
07.0	Apply classification systems, clinical vocabularies and terminologies.  The student will be able to:	
07.01	Demonstrate the use of classification systems, clinical vocabularies, terminologies and nomenclatures. 	
08.0	Evaluate ethical issues in Health Information professions.  The student will be able to:	
08.01	Interpret the industry-recognized code of ethics for healthcare information practices.	
08.02	Analyze ethical issues related to health information.	
08.03	Manage ethical issues related to treatment, payment, and operations.	
09.0	Demonstrate compliance with laws, regulations, and standards that impact healthcare.  The student will be able to:	
09.01	Advocate the importance of maintaining ethical and legal standards in gathering, managing, and analyzing health information. 	
09.02	Identify all regulations, laws and standards that impact health information including the Health Insurance Portability and Accountability Act (HIPAA). 	
09.03	Explain the composition of the legal health record.	
09.04	Apply health information policies and procedures for privacy, confidentiality, and security. 	
09.05	Articulate legal terms and processes that impact healthcare. 	
10.0	Apply policies, regulations, and standards to the management of information associated with treatment, payment, and operations (TPO).  The student will be able to:	
10.01	Describe how regulatory change impacts workflow. 	
10.02	Demonstrate knowledge of policies and procedures for access and disclosure of protected health information to authorized users.	
10.03	Adhere to appropriate and applicable accrediting agency guidelines.	
11.0	Demonstrate computer knowledge and skills.  The student will be able to:	
11.01	Demonstrate the ability to create, manage, organize, attach, and retrieve files.	
11.02	Demonstrate the ability to connect to and perform research using search engines and by identifying reputable websites.	
11.03	Demonstrate proficiency in word processing, spreadsheets, and presentation software.	
11.04	Demonstrate the ability to manage software programs. 	
11.05	Demonstrate knowledge of safe computer practices and security procedures such as encryption, passwords and biometrics.	
12.0	Demonstrate employability skills.  The student will be able to:	
12.01	Identify and exemplify professional traits desirable in a member of the healthcare team. 	
12.02	Demonstrate professional standards of healthcare workers as they apply to hygiene, dress, language, and behavior (e.g., telephone and email etiquette, social media, courtesy and self-introductions).	
12.03	Identify necessary documentation that may be required when applying for a healthcare position. 	
12.04	Model the process to obtain employment, including, but not limited to, job search, cover letter, resume, application, interview, and thank you letter. 	
	
Course Number: HIM0091
Occupational Completion Point: B
Medical Coder/Biller I – 350 Hours	
13.0	Describe the anatomy and physiology of the human body.  The student will be able to:	
13.01	Describe the structure and function of the respiratory system.	
13.02	Describe the structure and function of the circulatory system.	
13.03	Describe the structure and function of the musculoskeletal and connective tissue systems.	
13.04	Describe the structure and function of nervous and sensory systems.	
13.05	Describe the structure and function of the reproductive system.	
13.06	Describe the structure and function of the urinary system.	
13.07	Describe the structure and function of the digestive system.	
13.08	Describe the structure and function of the endocrine system.	
13.09	Describe the structure and function of the integumentary system. 	
13.10	Describe major psychiatric disorders. 	
14.0	Demonstrate proficiency in the application of medical terminology.  The student will be able to:	
14.01	Identify word parts of medical terminology in daily use.	
14.02	Build, spell and pronounce correctly, appropriate terms from word parts and be able to define the word.	
14.03	Identify word parts and be able to build, spell, and understand new words with those parts.	
14.04	Spell and use medical abbreviations.	
14.05	Identify terminology specific to healthcare settings including surgical, medical, and therapeutic.	
14.06	Apply medical reference sources.	
15.0	Demonstrate an understanding of the fundamentals of disease processes in relation to the human body, including pharmacology.  The student will be able to:	
15.01	Demonstrate an understanding of the predisposing factors and direct causes of disease as they relate to the human body.	
15.02	Demonstrate an understanding of the general pathogenesis and morphology of disease and its role in the disease process.	
15.03	 Demonstrate an understanding of pharmacological agents, uses, treatments, and utilize drug reference sources.	
15.04	Identify and use diagnostic test terminology.	
	
Course Number: HIM0092
Occupational Completion Point: B
Medical Coder/Biller II – 350 Hours	
16.0	Demonstrate proficiency in current medical code set systems and technology-assisted coding solutions.  The student will be able to:	
16.01	Apply coding conventions and guidelines when utilizing Computer-Assisted Coding (CAC) and Natural Language Processing (NLP) technologies.	
16.02	Implement processes for maintaining and updating coding resources, including automated updates and coding software maintenance. 	
16.03	Validate codes using both manual and automated systems, including diagnosis, procedure, HCPCS level II codes, APCs, and applicable modifiers and groupings according to current official guidelines.	
16.04	Perform coding using current versions of ICD-10-CM, ICD-PCS, CPT, and HCPCS Level II in both traditional and virtual healthcare settings, including telehealth services. 	
16.05	Analyze the impact of Social Determinants of Health (SDoH) coding on revenue cycle management and in Clinical Documentation Integrity (CDI) programs using modern technology solutions. 	
16.06	Evaluate documentation compliance using automated auditing tools and Artificial Intelligence (AI)-assisted documentation improvement systems.	
17.0	Demonstrate proficiency in complex coding scenarios and value-based care requirements.  The student will be able to:	
17.01	Apply coding concepts to complex cases, including post-acute care and virtual health encounters.	
17.02	Utilize advanced analytics tools to assess case-mix index, hierarchical condition categories (HCCs), risk adjustment, and quality metrics for value-based reimbursement.	
17.03	Analyze cases across the contemporary healthcare continuum, including remote patient monitoring and digital health services.	
17.04	Apply various classification systems, including ICD-O, DSM, ICF, and emerging code sets for precision medicine and genomics.	
18.0	Articulate health information services within modern healthcare delivery systems related to the medical /coder/biller.  The student will be able to:	
18.01	Collaborate with interdisciplinary teams in various departments through digital communication platforms and shared health information systems. 	
18.02	Utilize electronic health records (EHRs) and other digital health information systems content in various settings.	
18.03	Educate stakeholders on regulatory compliance, including information blocking rules, interoperability requirements, and privacy regulations.	
	
Course Number: HIM0093
Occupational Completion Point: B
Medical Coder/Biller III – 320 Hours	
19.0	Ensure professional and ethical behavior of a medical coder/biller in an evolving digital healthcare environment.  The student will be able to:	
19.01	Advocate for the role of the Medical Coder/Biller in data analytics and population health management.	
19.02	Adhere to ethical coding practices in AI and automated coding systems.	
20.0	Participate in healthcare revenue cycle management processes.  The student will be able to:	
20.01	Prepare claims using electronic claims submission systems and automated verification tools. 	
20.02	Analyze various payment methodologies (e.g., value-based and alternative payment models).	
20.03	Utilize modern accounting software and patient financial engagement platforms. 	
20.04	Apply reimbursement methodologies for emerging healthcare delivery models, including telehealth and remote patient monitoring in various settings.	
20.05	Maintain digital charge capture system and management tools in various settings. 	
20.06	Implement compliance strategies for regulatory requirements (e.g., price transparency and surprise billing regulations). 	

Additional Information

Laboratory Activities

Laboratory investigations that include scientific inquiry, research, measurement, problem solving, emerging technologies, tools and equipment, as well as, experimental, quality, and safety procedures are an integral part of this career and technical program/course. Laboratory investigations benefit all students by developing an understanding of the complexity and ambiguity of empirical work, as well as the skills required to manage, operate, calibrate and troubleshoot equipment/tools used to make observations. Students understand measurement error; and have the skills to aggregate, interpret, and present the resulting data. Equipment and supplies should be provided to enhance hands-on experiences for students.

Special Notes

Students should be encouraged to become members and participate in the activities of the professional organizations:  American Health Information Management Association and/or American Academy of Procedural Coders.  

About AHIMA Credentials:  Completers of the Medical Biller Coder program may take the Certified Coding Associate (CCA) credential exam as the first step in their coding career.  The CCA is an entry-level credential that distinguishes new coders in the job market. Individuals with a CCA credential: 
•	Exhibit a level of commitment, competency, and professional capability usually absent in a newcomer to the field. 
•	Demonstrate a commitment to the coding profession. 
•	Distinguish themselves from non-credentialed coders and those holding credentials from other organizations less demanding of the higher level of expertise required to earn AHIMA certification. 

The CCA should be viewed as the starting point for an individual entering a career as a coder. The AHIMA CCS and CCS-P exams demonstrate mastery level skills in coding.  Most individuals challenge the CCS or CCS-P exams after two or more years of work experience in coding. 
American Health Information Management Association (AHIMA), 919 North Michigan Ave., Suite 2150, Chicago, IL. 60611-5519, (312) 233-1100

The American Academy of Professional Coders (AAPC) sponsors a certification exam for coders with expertise in physician-based settings which leads to the title of Certified Professional Coder (CPC) or Certified Professional Coder Hospital (CPC-H).
American Academy of Professional Coders (AAPC), 309 West 700 South, Salt Lake City, UT 84101, 800-626-2633

Or

The National Healthcare Association also offers a national certification examination for a Certified Billing and Coding Specialist (CBCS).
National Healthcareer Association www.nhanow.com, 7500 West 160th Street, Stilwell, Kansas 66085, 800-499-9092 

The Core should be taken first in the program. Following the successful completion of the core, the student is eligible to take the National Health Care Foundation Skill Standards Assessment with instructor approval and the completion of a portfolio.

Career and Technical Student Organization (CTSO)

CTSOs are co-curricular career and technical student organizations providing leadership training and reinforcing specific career and technical skills. Career and Technical Student Organizations provide activities for students as an integral part of the instruction offered. Other CTSOs not listed in this curriculum framework or recognized by the Florida Department of Education are permissible provided they support student mastery over the standards and benchmarks of this curriculum framework.

Cooperative Training – OJT

On-the-job training is appropriate but not required for this program.  Whenever offered, the rules, guidelines, and requirements specified in the OJT framework apply. 

Basic Skills 

In Career Certificate programs offered for 450 hours or more, in accordance with Rule 6A-10.040, F.A.C., the minimum basic skills grade levels required for postsecondary adult career and technical students to complete this program are:  Computation (Mathematics) and Communications (Reading and Language Arts). These grade level numbers correspond to a grade equivalent score obtained on a state designated basic skills examination.  

Adult students with disabilities, as defined in Section 1004.02, Florida Statutes, may be exempted from meeting the Basic Skills requirements (Rule 6A-10.040).  Students served in exceptional student education (except gifted) as defined in s. 1003.01, F.S., may also be exempted from meeting the Basic Skills requirement.  Each school district and Florida College System Institution must adopt a policy addressing procedures for exempting eligible students with disabilities from the Basic Skills requirement as permitted in Section 1004.91, F.S.

Accommodations

Federal and state legislation requires the provision of accommodations for students with disabilities to meet individual needs and ensure equal access. Postsecondary students with disabilities must self-identify, present documentation, request accommodations if needed, and develop a plan with their counselor and/or instructors. Accommodations received in postsecondary education may differ from those received in secondary education. Accommodations change the way the student is instructed. Students with disabilities may need accommodations in such areas as instructional methods and materials, assignments and assessments, time demands and schedules, learning environment, assistive technology and special communication systems. Documentation of the accommodations requested and provided should be maintained in a confidential file.

Note: postsecondary curriculum and regulated secondary programs cannot be modified.