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Medical Coding and Claims Processing NC III

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13 views68 pages

Medical Coding and Claims Processing NC III

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nnek7089

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TRAINING REGULATIONS

MEDICAL CODING AND CLAIMS

PROCESSING NC III

SERVICES SECTOR

TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY

East Service Road, South Superhighway, Taguig City, Metro Manila

0
TABLE OF CONTENTS
ICT SECTOR
MEDICAL CODING AND CLAIMS PROCESSING
NATIONAL LEVEL III

Page No.

SECTION 1 MEDICAL CODING AND CLAIMS

1
PROCESSING NC III QUALIFICATION

SECTION 2 ■ COMPETENCY STANDARDS 2 – 40

 Basic Competencies 2 - 21

 Common Competencies 22 - 29

 Core Competencies 30 - 40

SECTION 3 ■ TRAINING ARRANGEMENTS 42 – 57

3.1 Curriculum Design 42 - 53

3.2 Training Delivery 54 - 54

3.3 Trainee Entry Requirements 55

3.4 List of Tools, Equipment and

56
Materials

3.5 Training Facilities 56

3.6 Trainers Qualification 57

3.7 Institutional Assessment 57

SECTION 4 ASSESSMENT AND CERTIFICATION

58 - 59
ARRANGEMENTS

COMPETENCY MAP 60

DEFINITION OF TERMS 61 – 65

ACKNOWLEDGEMENT 65

0
TESDA-SOP-QSO-01-F08

TRAINING REGULATIONS FOR

MEDICAL CODING AND CLAIMS PROCESSING NC III

Section 1 MEDICAL CODING AND CLAIMS PROCESSING NC III QUALIFICATIONS

The MEDICAL CODING AND CLAIMS PROCESSING NC III Qualification consists of

competencies that a person must achieve to demonstrate a proficiency in assigning
internationally prescribed diagnostic and procedural codes associated with billing and
reimbursement in compliance with clinical documentation requirements.

This Qualification is packaged from the competency map of the Information and
Communication Technology Industry (Service sector) as shown in Annex A.

The units of competency comprising this qualification include the following:

Code BASIC COMPETENCIES

5 00 311 1 09 Lead workplace communication
5 00 311 1 10 Lead small teams
5 00 311 1 11 Develop and practice negotiation skills
5 00 311 1 12 Solve problems related to work activities
5 00 311 1 13 Use mathematical concepts and techniques
5 00 311 1 14 Use relevant technologies

Code COMMON COMPETENCIES

ICT315202 Apply quality standards
ICT311203 Perform computer operations

Code CORE COMPETENCIES

ICT325301 Assign medical codes
ICT325302 Process medical claims/billing
ICT325303 Manage medical claims

A person who has achieved this Qualification is competent to be:

 Medical/Clinical Coding Specialist

 Medical/Clinical Claims Specialist

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TR - MEDICAL CODING AND CLAIMS PROCESSING NC III (Amended) Promulgated June 16, 2015 Page 1
TESDA-SOP-QSO-01-F08

SECTION 2: COMPETENCY STANDARDS

This section gives the details of the contents of the basic, common, and core units
of competency required for MEDICAL CODING AND CLAIMS PROCESSING NC III.

BASIC COMPETENCIES

UNIT OF COMPETENCY : LEAD WORKPLACE COMMUNICATION

UNIT CODE : 500311109

UNIT DESCRIPTOR : This unit covers the knowledge, skills and attitudes required
to lead in the dissemination and discussion of ideas,
information and issues in the workplace.
PERFORMANCE CRITERIA REQUIRED REQUIRED SKILLS
ELEMENT Italicized terms are elaborated in KNOWLEDGE
the Range of Variables
1. Communicate 1.1. Appropriate 1.1. Organization 1.1. Organizing
information communication method requirements for information
about is selected written and 1.2. Understanding and
workplace 1.2. Multiple operations electronic conveying intended
processes involving several topics communication meaning
areas are communicated methods 1.3. Participating in
accordingly variety of workplace
1.3. Questions are used to gain
1.2. Effective verbal discussions
communication
extra information 1.4. Complying with
methods
1.4. Correct sources of organization
information are identified 1.3. Methods of requirements for
1.5. Information is selected and Communication the use of written
organized correctly 1.4. Types of and electronic
1.6. Verbal and written Question communication
reporting is undertaken methods
1.5. Communication 1.5. Reporting
when required
Tools occupational
1.7. Communication skills are
maintained in all situations 1.6. Questioning hazards during
Techniques safety meeting
2. Lead 2.1. Response to workplace 2.1 Leading as a 2.1 Communicating
workplace issues are sought management effectively
discussions 2.2. Response to workplace function 2.2 Consulting the
issues are provided 2.2 Barriers of crew on the
immediately communication prepared menu for
2.3. Constructive contributions 2.3 Effective verbal the month
are made to workplace communication
discussions on such issues methods
as production, quality and 2.4 Method/
safety techniques of
2.4. Goals/objectives and discussion
action plan are undertaken 2.5 How to lead
in the workplace are discussion
communicated 2.6 How to solicit
response
2.7 Goal setting and

PERFORMANCE CRITERIA REQUIRED REQUIRED SKILLS

ELEMENT Italicized terms are elaborated in KNOWLEDGE
the Range of Variables
action planning
3. Identify and 3.1 Issues and problems are 3.1 Types of issues 3.1 Identifying cause
communicate identified as they arise and problems in of problems
issues arising 3.2 Information regarding the workplace 3.2 Communicating
in the problems and issues are 3.2 Written and with the Master of
workplace organized coherently to electronic the Ship on the
ensure clear and effective communication possible shortage
communication methods of the food supply
3.3 Dialogue is initiated with 3.3 Communication due to change of
appropriate personnel barriers affecting ship’s port
3.4 Communication problems workplace 3.3 Identifying
and issues are raised as discussions problems and
they arise issues
3.4 Organizing
information on
problems and
issues
3.5 Relating problems
and issues of call/
voyage

RANGE OF VARIABLES

VARIABLE RANGE
1. Methods of 1.1. Non-verbal gestures
communication 1.2. Verbal
1.3. Face to face
1.4. Two-way radio
1.5. Speaking to groups
1.6. Using telephone
1.7. Written
1.8. Internet

EVIDENCE GUIDE

1. Critical aspects of Assessment requires evidence that the candidate:

Competency 1.1. Dealt with a range of communication/information at one
time
1.2. Made constructive contributions in workplace issues
1.3. Sought workplace issues effectively
1.4. Responded to workplace issues promptly
1.5. Presented information clearly and effectively written form
1.6. Used appropriate sources of information
1.7. Asked appropriate questions
1.8. Provided accurate information

2. Resource The following resources MUST be provided:

Implications 2.1. Variety of Information
2.2. Communication tools
2.3. Simulated workplace

3. Methods of Competency in this unit must be assessed through

Assessment 3.1. Written Examination
3.2. Oral Questioning
3.3. Portfolio

4. Context for 4.1. Competency may be assessed in the workplace or in

Assessment simulated workplace environment

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.

PERFORMANCE CRITERIA REQUIRED REQUIRED

ELEMENT Italicized terms are elaborated in KNOWLEDGE
the Range of Variables
SKILLS
1. Provide team 1.1. Work requirements are 1.1. Company policies 1.1. Communication
leadership identified and presented and procedures skills required
to team members 1.2 How performance for leading
1.2. Reasons for instructions expectations are set teams
and requirements are 1.3 Methods of 1.2. Team building
communicated to team Monitoring skills
members Performance 1.3. Negotiating
1.3. Team members’ queries 1.4 Client expectations skills
and concerns are 1.5 Team member’s 1.4. Evaluation skills
recognized, discussed duties and
and dealt with 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
2. Assign 2.1 Duties, and 2.1 Concept of delegation 2.1 Delegating skills
responsibilities responsibilities are 2.2 How to delegate 2.2 Identifying
allocated having regard to 2.3 Understanding individual skills,
the skills, knowledge and individual differences knowledge and
aptitude required to 2.4 Methods of attitude as basis
properly undertake the monitoring for allocating
assigned task and performance responsibilities
according to company 2.5 Duties and 2.3 Identifying each
policy responsibilities of team member
2.2 Duties are allocated each team member duties and
having regard to individual 2.6 Knowledge in responsibilities
preference, domestic and identifying each team
personal considerations, member duties and
whenever possible responsibilities
3. Set 3.1 Performance 3.1 Definition of 3.1 Identifying
performance expectations are performance performance
expectations established based on indicators/ criteria indicators
for team client needs and 3.2 Definition of team 3.2 Evaluating
members according to assignment goals and performance
requirements expectations

PERFORMANCE CRITERIA REQUIRED REQUIRED

ELEMENT Italicized terms are elaborated in KNOWLEDGE
the Range of Variables
SKILLS
3.2 Performance 3.3 Methods of 3.3 Setting
expectations are based monitoring individual
on individual team performance performance
members duties and area 3.4 Client expectations target/
of responsibility 3.5 Team members expectation
3.3 Performance duties and indicators
expectations are responsibilities
discussed and 3.6 Defining performance
disseminated to expectations criteria
individual team members
4. Supervised 4.1 Monitoring of 4.1 Understanding 4.1 Monitoring skills
team performance takes Monitoring of work 4.2 Setting priorities
performance place against defined 4.2 How to undertake 4.3 Evaluating
performance criteria corrective action performance
and/or assignment 4.3 Understanding 4.4 Informal/ formal
instructions and feedback and counseling skills
corrective action taken if procedure
required 4.4 Feedback reporting
4.2 Team members are procedure
provided with feedback, 4.5 Methods of
positive support and monitoring
advice on strategies to performance
overcome any 4.6 Team member’s
deficiencies duties and
4.3 Performance issues responsibilities
which cannot be rectified 4.7 Monitoring team
or addressed within the operation to ensure
team are referenced to client needs and
appropriate personnel satisfaction
according to employer
policy
4.4 Team members are kept
informed of any changes
in the priority allocated to
assignments or tasks
which might impact on
client/customer needs
and satisfaction
4.5 Team operations are
monitored to ensure that
employer/client needs
and requirements are
met
4.6 Follow-up communication
is provided on all issues
affecting the team
4.7 All relevant
documentation is
completed in accordance
with company
procedures

RANGE OF VARIABLES

VARIABLE RANGE
1.1. Client Profile
1. Work requirements
1.2. Assignment instructions
2. Team member’s concerns 2.1. Roster/shift details
3.1. Formal process
3. Monitor performance
3.2. Informal process
4.1. Formal process
4. Feedback
4.2. Informal process
5.1. Work output
5. Performance issues
5.2. Work quality
5.3. Team participation
5.4. Compliance with workplace protocols
5.5. Safety
5.6. Customer service

EVIDENCE GUIDE

1. Critical aspects of Assessment requires evidence that the candidate:

Competency 1.1. Maintained or improved individuals and/or team
performance given a variety of possible scenario
1.2. Assessed and monitored team and individual
performance against set criteria
1.3. Represented concerns of a team and individual to next
level of management or appropriate specialist and to
negotiate on their behalf
1.4. Allocated duties and responsibilities, having regard to
individual’s knowledge, skills and aptitude and the needs
of the tasks to be performed
1.5. Set and communicated performance expectations for a
range of tasks and duties within the team and provided
feedback to team members
2. Resource The following resources MUST be provided:
Implications 2.1. Access to relevant workplace or appropriately simulated
environment where assessment can take place
2.2. Materials relevant to the proposed activity or task
3. Methods of Competency in this unit may be assessed through:
Assessment 3.1. Written Examination
3.2. Oral Questioning
3.3. Portfolio
4. Context for 4.1. Competency assessment may occur in workplace or any
Assessment appropriately simulated environment
4.2. 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.
PERFORMANCE CRITERIA REQUIRED REQUIRED SKILLS
ELEMENT Italicized terms are elaborated in the KNOWLEDGE
Range of Variables
1. Plan 1.1 Information on preparing 1.1 Knowledge on 1.1 Communication
negotiations for negotiation is Codes of skills (verbal
identified and included in practice and and listening)
the plan guidelines for 1.2 Active listening
1.2 Information on creating the 1.3 Setting conflict
nonverbal environments organization 1.4 Preparing
for positive negotiating is 1.2 Knowledge of conflict
identified and included in organizations resolution
the plan policy and 1.5 Problem solving
1.3 Information on active procedures for strategies on
listening is identified and negotiations how to deal with
included in the plan 1.3 Decision unexpected
1.4 Information on different making and questions and
questioning techniques conflict attitudes during
is identified and included resolution negotiation
in the plan strategies 1.6 Interpersonal
1.5 Information is checked to procedures skills to develop
ensure it is correct and up- 1.4 Concept of rapport with
to- date negotiation other parties
2. Participate in 2.1 Criteria for successful 2.1 Outcome of 2.1 Negotiating skill
negotiations outcome are agreed upon negotiation 2.2 Communication
by all parties 2.2 Knowledge on skills (verbal
2.2 Desired outcome of all Language and listening)
parties are considered 2.3 Different 2.3 Observation
2.3 Appropriate language is Questioning skills
used throughout the techniques 2.4 Interpersonal
negotiation 2.4 Problem skills to develop
2.4 A variety of questioning solving rapport with
techniques are used strategies on other parties
2.5 The issues and processes how to deal with 2.5 Applying
are documented and unexpected effective
agreed upon by all parties questions and questioning
2.6 Possible solutions are attitudes during techniques
discussed and their negotiation 2.6 Setting conflict
viability assessed
2.7 Areas for agreement are
confirmed and recorded
2.8 Follow-up action is agreed
upon by all parties

RANGE OF VARIABLES

VARIABLE RANGE
1. Preparing for 1.1 Background information on other parties to the
negotiation negotiation
1.2 Good understanding of topic to be negotiated
1.3 Clear understanding of desired outcome/s
1.4 Personal attributes
1.4.1 self-awareness
1.4.2 self esteem
1.4.3 objectivity
1.4.4 empathy
1.4.5 respect for others
1.5 Interpersonal skills
1.5.1 listening/reflecting
1.5.2 nonverbal communication
1.5.3 assertiveness
1.5.4 behavior labeling
1.5.5 testing understanding
1.5.6 seeking information
1.5.7 self-disclosing
1.6 Analytic skills
1.6.1 observing differences between content
and process
1.6.2 identifying bargaining information
1.6.3 applying strategies to manage process
1.6.4 applying steps in negotiating process
1.6.5 strategies to manage conflict
1.6.6 steps in negotiating process
1.6.7 options within organization and externally
for resolving conflict

2. Nonverbal 2.1 Friendly reception

environments 2.2 Warm and welcoming room
2.3 Refreshments offered
2.4 Lead in conversation before negotiation begins

3. Active listening 3.1 Attentive

3.2 Don’t interrupt
3.3 Good posture
3.4 Maintain eye contact
3.5 Reflective listening

4. Questioning 4.1 Direct

techniques 4.2 Indirect
4.3 Open-ended

EVIDENCE GUIDE

1. Critical aspects of Assessment requires evidence that the candidate:

Competency 1.1 Demonstrated sufficient knowledge of the factors
influencing negotiation to achieve agreed outcome
1.2 Participated in negotiation with at least one person to
achieve an agreed outcome

2. Resource The following resources MUST be provided:

Implications 2.1 Room with facilities necessary for the negotiation
process
2.2 Human resources (negotiators)

3. Methods of Competency may be assessed through:

Assessment 3.1 Written Examination
3.2 Oral questioning
3.3 Portfolio

4. Context for 4.1 Competency to be assessed in real work environment or

Assessment in a simulated workplace setting.

UNIT OF COMPETENCY : SOLVE PROBLEMS RELATED TO WORK ACTIVITIES

UNIT CODE : 500311112
UNIT DESCRIPTOR : This unit of covers the knowledge, skills and attitudes
required to solve problems in the workplace including the
application of problem solving techniques and to determine
and resolve the root cause of problems.

PERFORMANCE REQUIRED REQUIRED

ELEMENT CRITERIA KNOWLEDGE SKILLS
Italicized terms are elaborated
in the Range of Variables
1. Identify the 1.1. Variances are identified 1.1. Competence includes a 1.1 Using
problem from normal operating thorough knowledge and range of
parameters; and product understanding of the formal
quality process, normal problem
1.2. Extent, cause and operating parameters, solving
nature of the problem and product quality to techniques
are defined through recognize non-standard 1.2 Identifying
observation, situations and
investigation and 1.2. Competence to include clarifying
analytical techniques the ability to apply and the nature
1.3. Problems are clearly explain, sufficient for the of the
stated and specified identification of problem
fundamental cause, 1.3 Evaluating
determining the the
corrective action and effectivene
provision of ss of a
recommendations present
1.2.1. Relevant process in
equipment and the galley
operational 1.4 Applying
processes analytical
1.2.2. Enterprise goals, techniques
targets and
measures
1.2.3. Enterprise quality,
OHS and
environmental
requirement
1.2.4. Enterprise
information
systems and data
collation
1.2.5. Industry codes
and standards
1.3. Normal operating
parameters and product
quality
1.4. Identifying and clarifying
the nature of problem
2. Determine 2.1 Possible causes are 2.1 Relevant equipment and 2.1 Analysis of
fundamental identified based on operational processes root causes
causes of the experience and the use 2.2 Enterprise goals, targets
problem of problem solving and measures

PERFORMANCE REQUIRED REQUIRED

ELEMENT CRITERIA KNOWLEDGE SKILLS
Italicized terms are elaborated
in the Range of Variables
tools / analytical 2.3 Enterprise quality, OHS
techniques. and environmental
2.2 Possible cause requirements
statements are 2.4 Enterprise information
developed based on systems and data
findings collation
2.3 Fundamental causes 2.5 Industry codes and
are identified per results standards
of investigation
conducted

3. Determine 3.1 All possible options are 3.1 Understanding the 3.1 Identifying
corrective action considered for resolution procedure in and
of the problem undertaking corrective clarifying
3.2 Strengths and action the nature
weaknesses of possible 3.2 Principles of decision of the
options are considered making strategies and problem
3.3 Corrective actions are techniques 3.2 Devising
determined to resolve 3.3 Enterprise information the best
the problem and systems and data solution
possible future causes collation 3.3 Evaluating
3.4 Action plans are 3.4 Action planning the solution
developed identifying 3.4 Implementi
measurable objectives, ng
resource needs and developed
timelines in accordance plan to
with safety and rectify the
operating procedures problem
3.5 Implementi
ng
corrective
and
preventive
actions
based on
root cause
analysis
4. Provide 4.1 Reports on 4.1 How to make a report 4.1 Writing
recommendation/s recommendations are and recommendation report and
to manager prepared according to recommen
procedures. dations
4.2 Recommendations are
presented to appropriate
personnel.
4.3 Recommendations are
followed-up, if required

RANGE OF VARIABLES

VARIABLE RANGE

1. Analytical techniques 1.1. Brainstorming

1.2. Cause and effect diagrams
1.3. Pareto analysis
1.4. SWOT analysis
1.5. Gant chart, Pert CPM and graphs
1.6. Scattergrams

2. Problem 2.1. Non – routine process and quality problems

2.2. Equipment selection, availability and failure
2.3. Teamwork and work allocation problem
2.4. Safety and emergency situations and
incidents

3. Action plans 3.1. Priority requirements

3.2. Measurable objectives
3.3. Resource requirements
3.4. Timelines
3.5. Co-ordination and feedback requirements
3.6. Safety requirements
3.7. Risk assessment
3.8. Environmental requirements

EVIDENCE GUIDE

1. Critical aspects of Assessment requires evidence that the candidate:

Competency
1.1. Identified the problem
1.2. Determined the fundamental causes of the problem
1.3. Determined the correct / preventive action
1.4. Provided recommendation to manager
These aspects may be best assessed using a range of
scenarios / case studies / what ifs as a stimulus with a
walk through forming part of the response. These
assessment activities should include a range of problems,
including new, unusual and improbable situations that may
have happened.
2. Resource 2.1. Assessment will require access to an operating
Implications plant over an extended period of time, or a suitable
method of gathering evidence of operating ability
over a range of situations. A bank of scenarios /
case studies / what ifs will be required as well as
bank of questions which will be used to probe the
reason behind the observable action.
3. Methods of Competency in this unit may be assessed through:
Assessment
3.1. Written Examination
3.2. Oral Questioning
3.3. Portfolio

4. Context for 4.1. In all workplace, it may be appropriate to assess

Assessment this unit concurrently with relevant teamwork or
operation units.

UNIT OF COMPETENCY: USE MATHEMATICAL CONCEPTS AND

TECHNIQUES

UNIT CODE : 500311113

UNIT DESCRIPTOR : This unit covers the knowledge, skills and attitudes required
in the application of mathematical concepts and techniques.

PERFORMANCE CRITERIA REQUIRED REQUIRED SKILLS

ELEMENT Italicized terms are elaborated in KNOWLEDGE
the Range of Variables
1. Identify 1.1 Problem areas are 1.1 Fundamental 1.1 Identifying and
operation selecting different
mathematical identified based on given (addition, measuring tools
tools and condition subtraction, 1.2 Applying different
division, formulas in solving
techniques to 1.2 Mathematical techniques multiplication) problems
solve problem are selected based on the 1.2 Units of 1.3 Describing the units
measurement and of measurement
given problem
its conversion and fundamental
1.3 Fundamental of units
units 1.4 Stating arithmetic
1.4 Standard formulas calculations
1.5 Basic measuring involving the
tools/devices following; addition,
1.6 Measurement subtraction, division,
system multiplication
1.7 Basic measuring 1.5 Stating arithmetic
tools/devices calculations
1.8 Steps in solving involving the
problem following: addition,
subtraction, division,
multiplication
1.6 Applying theory into
actual application on
shipboard catering
processes
2. Apply 2.1 Mathematical techniques 2.1 Problem-based 2.1 Solving
questions mathematical
mathematical are applied based on the 2.2 Estimation computations
procedure/ problem identified 2.3 Use of 2.2 Converting Metric to
mathematical English
solution 2.2 Mathematical tools and standard 2.3 Selecting and using
computations are formulas appropriate and
2.4 Mathematical efficient techniques
performed to the level of
techniques and strategies to
accuracy required for the solve problems
problem
2.3 Results of mathematical
computation is determined
and verified based on job
requirements

PERFORMANCE CRITERIA REQUIRED REQUIRED SKILLS

ELEMENT Italicized terms are elaborated in KNOWLEDGE
the Range of Variables
3. Analyze 3.1 Result of application is 3.1 Techniques in 3.1 Analyzing the result
analyzing the based on the
results reviewed based on results specified
expected and required 3.2 Process in requirements
reviewing the 3.2 Interpreting and
specifications and outcome results communicating the
3.2 Appropriate action is 3.3 Precision and results of the
accuracy analysis
applied in case of error
3.4 Four fundamental
operations
3.5 Steps in solving
problem
3.6 Standard formulas
3.7 Conversion
measurement

RANGE OF VARIABLES

VARIABLE RANGE
1. Mathematical techniques May include but are not limited to:
1.1 Four fundamental operations
1.2 Measurements
1.3 Use/Conversion of units of measurements
1.4 Use of standard formulas

2. Appropriate action 2.1 Review in the use of mathematical

techniques (e.g. recalculation, re-modeling)
2.2 Report error to immediate superior for proper
action

EVIDENCE GUIDE

1. Critical Aspects of Assessment requires evidence that the candidate:

Competency 1.1 Identified, applied and reviewed the use of
mathematical concepts and techniques to workplace
problems

2. Resource The following resources MUST be provided:

Implications 2.1 Calculator
2.2 Basic measuring tools
2.3 Case Problems

3. Methods of Competency may be assessed through:

Assessment 3.1 Authenticated portfolio
3.2 Written Test
3.3 Interview/Oral Questioning
3.4 Demonstration

4. Context for 4.1 Competency may be assessed in the work place or in

Assessment a simulated work place setting

UNIT OF COMPETENCY: USE RELEVANT TECHNOLOGIES

UNIT CODE : 500311114

UNIT DESCRIPTOR : This unit of competency covers the knowledge, skills, and
attitude required in selecting, sourcing and applying
appropriate and affordable technologies in the workplace.

PERFORMANCE CRITERIA REQUIRED REQUIRED SKILLS

ELEMENT Italicized terms are elaborated in KNOWLEDGE
the Range of Variables
1. Study/select 1.1 Usage of different 1.1 Awareness on 1.1 Identifying
appropriate technologies is technology and relevant
technology determined based on job its function technology on
requirements 1.2 Communication job
1.2 Appropriate technology is techniques
selected as per work 1.3 Health and safety
specification procedure
1.4 Company policy
in relation to
relevant
technology
1.5 Machineries/
equipment and
their application
1.6 Software
programs

2. Apply 2.1 Relevant technology is 2.1 Knowledge on 2.1 Applying

relevant effectively used in operating relevant
technology carrying out function instructions technology
2.2 Applicable software and 2.2 Understanding 2.2 Communicating
hardware are used as software and skills
per task requirement hardware system 2.3 Using software
2.3 Management concepts 2.3 Communication applications
are observed and techniques skills
practiced as per 2.4 Health and safety 2.4 Conducting risk
established industry procedure assessment
practices 2.5 Company policy
in relation to
relevant
technology
2.6 Different
management
concepts
2.7 Technology
adaptability

3. Maintain/ 3.1 Maintenance of 3.1 Awareness on 3.1 Performing basic

enhance technology is applied in technology and troubleshooting
relevant accordance with the its function skills
technology industry standard 3.2 Repair and 3.2 Identifying failures
operating procedure, maintenance or defects
manufacturer’s procedure 3.3 Communication
operating guidelines 3.3 Health and safety skills
and occupational procedure 3.4 Applying
health and safety 3.4 Company policy corrective and
procedure to ensure its in relation to preventive
operative ability relevant maintenance
3.2 Updating of technology is technology
maintained through 3.6 Upgrading of
continuing education or technology
training in accordance 3.7 Organizational
with job requirement set-up/work flow
3.3 Technology failure/ defect
is immediately reported
to the
concern/responsible
person or section for
appropriate action

RANGE OF VARIABLES

VARIABLE RANGE
1. Technology May include but are not limited to:
1.1 Office technology
1.2 Industrial technology
1.3 System technology
1.4 Information technology
1.5 Training technology

2. Management concepts May include but not limited to:

2.1 Real Time Management
2.2 KAIZEN or continuous improvement
2.3 5s
2.1 Total Quality Management
2.2 Other management/productivity tools

3. Industry standard operating 3.1 Written guidelines relative to the usage of

procedure office technology/equipment
3.2 Verbal advise/instruction from the co-worker

4. Manufacturer’s operating 4.1 Written instruction/manuals of specific

guidelines/ instructions technology/ equipment
4.2 General instruction manual
4.3 Verbal advise from manufacturer relative to
the operation of equipment

5. Occupational health and 5.1 Relevant statutes on OHS

safety procedure 5.2 Company guidelines in using
technology/equipment

6. Appropriate action 6.1 Implementing preventive maintenance

schedule
6.2 Coordinating with manufacturer’s technician

EVIDENCE GUIDE

1. Critical aspects of Assessment requires evidence that the candidate:

Competency 1.1 Studied and selected appropriate technology
consistent with work requirements
1.2 Applied relevant technology
1.3 Maintained and enhanced operative ability of relevant
technology

2. Resource The following resources MUST be provided:

Implications 2.1 Relevant technology
2.2 Interview and demonstration questionnaires
2.3 Assessment packages

3. Methods of Competency must be assessed through:

Assessment 3.1 Interview
3.2 Actual demonstration
3.3 Authenticated portfolio (related certificates of
training/seminar)

4. Context for 4.1 Competency may be assessed in actual workplace or

Assessment simulated environment

COMMON COMPETENCIES

UNIT TITLE : APPLY QUALITY STANDARDS

UNIT CODE : ELC315202

UNIT DESCRIPTOR : This unit covers the knowledge, skills, (and) attitudes and
values needed to apply quality standards in the workplace. The
unit also includes the application of relevant safety procedures
and regulations, organization procedures and customer
requirements

PERFORMANCE CRITERIA REQUIRED REQUIRED SKILLS

ELEMENT Italicized Bold terms are elaborated KNOWLEDGE
in the Range of Variables
1.1. Work instructions are 1.1 Relevant 1.1. Reading skills
1. Assess
obtained and work is production required to
quality of
carried out in accordance processes, interpret work
received
with standard operating materials and instruction
materials or
procedures products 1.2. Critical thinking
components
1.2. Received materials or 1.2 Characteristics 1.3. Interpreting
component parts are work
of materials,
checked against instructions
software and
workplace standards and hardware used
specifications in production
1.3. Faulty material or processes
components related to
work are identified and 1.3 Quality checking
isolated procedures
1.4. Faults and any identified 1.4 Quality
causes are recorded Workplace
and/or reported to the procedures
supervisor concerned in 1.5 Identification of
accordance with faulty materials
workplace procedures related to work
1.5. Faulty materials or
components are replaced
in accordance with
workplace procedures
2.1. Documentation relative to 2.1 Safety and 2.1 Carry out work
2. Assess own
quality within the company environmental in accordance
work
is identified and used aspects of with OHS
2.2. Completed work is production policies and
checked against processes procedures
workplace standards 2.2 Fault
relevant to the task identification and
undertaken reporting
2.3. Errors are identified and 2.3 Workplace
isolated procedure in
2.4. Information on the quality documenting

PERFORMANCE CRITERIA REQUIRED REQUIRED SKILLS

ELEMENT Italicized Bold terms are elaborated KNOWLEDGE
in the Range of Variables
and other indicators of completed work
production performance is 2.4 Workplace
recorded in accordance Quality Indicators
with workplace procedures
2.5. Deviations from specified
quality standards,
causes are documented
and reported in
accordance with the
workplace’ standards
operating procedures
3.1. Process improvement 3.1 Quality 3.1 Solution
3. Engage in
procedures are improvement providing and
quality
participated in relation to processes decision-making
improvement
workplace assignment 3.2 Company 3.2 Practice
3.2. Work is carried out in customers company
accordance with process defined process
improvement procedures improvement
3.3. Performance of operation procedure
or quality of product or
service to ensure
customer satisfaction is
monitored

RANGE OF VARIABLES

VARIABLE RANGE
1. Materials/components 1.1. Materials may include but not limited to:
1.1.1. wires
1.1.2. cables, soldering lead
1.1.3. electrical tape
1.2. Components may include but not limited to:
1.2.1. ICs
1.2.2. Diodes

2. Faults Faults may include but not limited to:

2.1. Components/materials not according to
specification
2.2. Components/materials contain manufacturing
defects
2.3. Components/materials do not conform with
government regulation i.e., PEC, environmental
code
2.4. Components/materials have safety defect

3. Documentation 3.1. Organization work procedures

3.2. Manufacturer’s instruction manual
3.3. Customer requirements
3.4. Forms

4. Errors 4.1. Errors may be related but not limited to the

following:
4.1.1. Deviation from the requirements of the
Client
4.1.2. Deviation from the requirement of the
organization
5. Quality standards 5.1. Quality standards may relate but not limited
to the following:
5.1.1.materials
5.1.2.component parts
5.1.3.final product
5.1.4. production processes
5.1.5. customer service

6. Customer 6.1. Co-worker

6.2. Supplier
6.3. Client
6.4. Organization receiving the product or service

EVIDENCE GUIDE

1. Critical aspect of Assessment requires evidence that the candidate:

competency
1.1. Carried out work in accordance with the
company’s standard operating procedures
1.2. Performed task according to specifications
1.3. Reported defects detected in accordance with
standard operating procedures
1.4. Carried out work in accordance with the process
improvement procedures

2. Method of assessment 2.1. The assessor may select two (2) of the following
assessment methods to objectively assess the
candidate:
2.1.1. Observation
2.1.2. Questioning
2.1.3. Practical demonstration

3. Resource implication 3.1. Materials and component parts and equipment to

be used in a real or simulated electronic
production situation

4. Context of Assessment 4.1. Assessment may be conducted in the workplace

or in a simulated work environment.

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

PERFORMANCE CRITERIA REQUIRED REQUIRED SKILLS

ELEMENT Italicized Bold terms are elaborated in KNOWLEDGE
the Range of Variables
1. Plan and 1.1. Requirements of task are 1.1 Main types of 1.1. Reading and
prepare for determined according to job computers and comprehension
task to be specifications basic features of skills required to
undertaken 1.2. Appropriate hardware and different operating interpret work
software are selected systems instruction and
according to task assigned and 1.2 Main parts of a to interpret
required outcome computer basic user
1.3. Task is planned to ensure OH 1.3 Information on manuals.
& S guidelines and procedures hardware and 1.2. Communication
are followed software skills to identify
1.4. Client -specific guidelines and 1.4 Data security lines of
procedures are followed. guidelines communication,
1.5. Required data security
request advice,
guidelines are applied in
follow
accordance with existing
instructions and
procedures.
receive
feedback.
1.3 Interpreting user
manuals and
security
guidelines
2. Input data 2.1. Data are entered into the 2.1 Basic ergonomics 2.1 Technology
into computer using appropriate of keyboard and skills to use
computer program/application in computer user equipment
accordance with company safely including
2.2 Storage devices
procedures keyboard skills.
and basic
2.2. Accuracy of information is
categories of 2.2 Entering data
checked and information is
memory
saved in accordance with
standard operating procedures 2.3 Relevant types of
2.3. Inputted data are stored in software
storage media according to
requirements
2.4. Work is performed within
ergonomic guidelines
3. Access 3.1. Correct program/ application is 3.1 General security, 3.1 Accessing
information selected based on job privacy legislation information
using requirements and copyright 3.2 Searching and
computer 3.2. Program/application containing
3.2 Productivity browsing files
the information required is
Application and data
accessed according to

PERFORMANCE CRITERIA REQUIRED REQUIRED SKILLS

ELEMENT Italicized Bold terms are elaborated in KNOWLEDGE
the Range of Variables
company procedures 3.3 Business
3.3. Desktop icons are correctly Application
selected, opened and closed for
navigation purposes
3.4. Keyboard techniques are
carried out in line with OH & S
requirements for safe use of
keyboards
4. Produce/ 4.1. Entered data are processed 4.1 Computer 4.1 Computer data
output data using appropriate software application in processing
using commands printing, scanning 4.2 Printing of data
computer 4.2. Data printed out as required and sending
system using computer 4.3 Transferring files
facsimile
hardware/peripheral devices in and data
4.2 Types and function
accordance with standard
of computer
operating procedures
peripheral devices
4.3. Files, data are transferred
between compatible systems
using computer software,
hardware/ peripheral devices in
accordance with standard
operating procedures
5. Maintain 5.1. Systems for cleaning, minor 5.1 Computer 5.1 Removing
computer maintenance and replacement equipment/system computer
equipment of consumables are basic maintenance viruses from
and systems implemented procedures infected
5.2. Procedures for ensuring machines
5.2 Viruses
security of data, including
5. 3 OH & S principles 5.2 Making backup
regular back-ups and virus
and responsibilities files
checks are implemented in
accordance with standard 5.4 Calculating
operating procedures computer capacity
5.3. Basic file maintenance 5.5 System Software
procedures are implemented in 5.6 Basic file
line with the standard operating maintenance
procedures procedures

RANGE OF VARIABLES

VARIABLE RANGE
1. Hardware and 1.1. Personal computers
peripheral devices 1.2. Networked systems
1.3. Communication equipment
1.4. Printers
1.5. Scanners
1.6. Keyboard
1.7. Mouse
2. Software Software includes the following but not limited to:
2.1. Word processing packages
2.2. Data base packages
2.3. Internet
2.4. Spreadsheets
3. OH & S guidelines 3.1. OHS guidelines
3.2. Enterprise procedures
4. Storage media Storage media include the following but not limited to:
4.1. diskettes
4.2. CDs
4.3. zip disks
4.4. hard disk drives, local and remote
5. Ergonomic guidelines 5.1. Types of equipment used
5.2. Appropriate furniture
5.3. Seating posture
5.4. Lifting posture
5.5. Visual display unit screen brightness
6. Desktop icons Icons include the following but not limited to:
6.1. directories/folders
6.2. files
6.3. network devices
6.4. recycle bin
7. Maintenance 7.1. Creating more space in the hard disk
7.2. Reviewing programs
7.3. Deleting unwanted files
7.4. Backing up files
7.5. Checking hard drive for errors
7.6. Using up to date anti-virus programs
7.7. Cleaning dust from internal and external surfaces

EVIDENCE GUIDE

1. Critical aspect of Assessment requires evidence that the candidate:

competency
1.1. Selected and used hardware components
correctly and according to the task requirement
1.2. Identified and explained the functions of both
hardware and software used, their general
features and capabilities
1.3. Produced accurate and complete data in
accordance with the requirements
1.4. Used appropriate devices and procedures to
transfer files/data accurately
1.5. Maintained computer system

2. Method of assessment 2.1. The assessor may select two of the following
assessment methods to objectively assess
the candidate:
2.1.1. Observation
2.1.2. Questioning
2.1.3. Practical demonstration

3. Resource implication 3.1. Computer hardware with peripherals

3.2. Appropriate software

4. Context of Assessment 4.1. Assessment may be conducted in the workplace

or in a simulated environment

CORE COMPETENCIES

UNIT TITLE : ASSIGN MEDICAL CODES

UNIT CODE : ICT325301

UNIT DESCRIPTOR : This unit covers the skills, knowledge and attitude necessary to
assign codes for medical diagnoses, procedures, services,
supplies, equipment, and other services.

ELEMENT PERFORMANCE CRITERIA REQUIRED KNOWLEDGE REQUIRED SKILLS

Italicized terms are elaborated in
the Range of Variables
1. Prepare 1.1. Patient’s medical 1.1. Medical  Computer skills
requirements records/charts are Documentation  Analytical skills
for medical retrieved from client’s 1.2. Healthcare Laws  Reading and
coding system and Ethics comprehension
1.2. Coding tools/system to 1.3. Medical Coding skills
be used for medical Systems  Research skills
coding are prepared  Diagnosis Code  Communication
based on client’s Set skills
specification/coding  Procedure Code
guidelines Set
 Supplies code Set
1.4. 5S and 3Rs
1.5. I.T. Process
2. Evaluate 2.1. Medical information 2.1. Medical Terminology  Analytical skills
medical necessary for coding are  Systems of the  Reading and
reports analyzed for body (e.g., skeletal, comprehension
completeness based on respiratory, skills
client’s cardiovascular)  Research skills
specification/coding  Human anatomy  Communication
guidelines  Human physiology skills
2.2. Medical Report is  Fundamental  Computer skills
reviewed to determine nature of a disease
the appropriate process, signs,
diagnoses, procedures symptoms and
equipment & supplies methods of
based on client’s treatment
specification/coding  Common medical
guidelines. conditions
2.3. When necessary,  Medical
specific requirements of investigations and
insurance/ payor are procedures
considered  Injuries
2.4. Lacking data based on  Common
the initial screening abbreviations for
result are requested medical and
from the client pharmacological
terms (e.g., BCG,
HRT)

ELEMENT PERFORMANCE CRITERIA REQUIRED KNOWLEDGE REQUIRED SKILLS

Italicized terms are elaborated in
the Range of Variables
 Common
medications
 Commonly used
medical equipment
and instruments
 Laboratory testing
methods
 Diagnostic and
surgical procedures
 Laboratory values
and significance
 Medico-legal
terminology
2.2. Client’s specific
guidelines/ coding
standards
2.3. Medical
Documentation
2.4. Healthcare Laws
and Ethics
2.5. Essential of
healthcare insurance
2.6. Medical Coding
Systems

3. Assign codes 3.1 Medical terms to be 3.2 Medical  Analytical skills

reported are searched or Terminologies  Reading and
located in the Alphabetic 3.3 Medical comprehension
index of the appropriate Documentation skills
coding reference/s 3.4 Healthcare Laws  Research skills
3.2 Code numbers are and Ethics  Communication
verified using the tabular 3.5 Essential of skills
list of the coding manual healthcare insurance  Computer skills
3.3 Verified medical code  Diagnosis code
or codes are assigned set
to the highest level of  Procedure code
details in line with coding set
standards and guidelines  supplies code set
3.4 Unclear/Questionable 3.6 Client’s specific
cases are clarified with guidelines/coding
appropriate resource standards
person/s in line with 3.7 5S and 3Rs
enterprise procedures
3.5 Coding information/
requirements are verified
for completeness of data
based on the required
fields prior to submission

RANGE OF VARIABLES

VARIABLE RANGE

1. Coding tools May include but not limited to:

 electronic copy
 hard copy
2. Medical coding system Medical coding systems include but not
limited to:
 International Classification of Diseases
 Current Procedural Terminology
 Healthcare Common Procedure Coding
System
3. Completeness May include but not limited to:
 quantitative (completeness of data), and
 qualitative (consistency of data) analysis
4. Medical information May include but not limited to:
 Patient
 Provider
 Payor
5. coding references May include but not limited to:
 Electronic reference
o ICD codes
o CPT codes
o HCPCS
 Hard copy
o ICD codes
o CPT codes
o HCPCS
6. medical codes May include but not limited to:
 diagnoses codes
 codes for procedures and services
o ICD procedure codes
o CPT Procedure codes
 codes for supplies, equipment and others
services

EVIDENCE GUIDE

1. Critical aspects of Assessment may show that the candidate:

competency 1.1. Prepared requirements for medical coding
1.2. Evaluated medical reports
1.3. Assigned codes
2. Methods of The following may be used to objectively assess the
assessment candidate:
2.1. Demonstration with Oral Questioning (chart coding)
2.2. Written test
2.3. Portfolio assessment (international/DOH and DOH-
accredited training institution) with interview
3. Resource implication The following resources MUST be provided:
3.1. Diagnosis Coding manuals
3.2. Procedure/services and supplies coding manuals or
their equivalent
3.3. Mockup/Sample Medical documentation
3.4.
4. Context of Assessment 4.1. Assessment may be conducted in the workplace or
in a simulated environment.

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.

PERFORMANCE CRITERIA
ELEMENT Italicized terms are elaborated REQUIRED KNOWLEDGE REQUIRED SKILLS
in the Range of Variables
1. Prepare 1.1. Data are gathered 1.1. Medical Terminology  Analytical skills
requirements from patient’s record  Systems of the body  Reading and
for claims as provided by the (e.g., skeletal, comprehension
processing client. respiratory, skills
1.2. Patient’s medical cardiovascular)  Researching
record are created  Human anatomy skills
or updated based on  Human physiology  Basic
claims processing  Fundamental nature of mathematical
requirements a disease process, skills
1.3. Medical provider’s signs, symptoms and
 Communication
demographics are methods of treatment
skills
checked and  Common medical
 Computer skills
updated based on conditions
claims processing  Medical investigations
requirements 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
1.2. Medical Documentation
1.3. Medical claim process
1.4. Healthcare Laws and
Ethics
1.5. Essential of healthcare
insurance
1.6. Medical Coding Systems
 Diagnosis code set
 Procedure Code Set
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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TESDA-SOP-QSO-01-F08

PERFORMANCE CRITERIA
ELEMENT Italicized terms are elaborated REQUIRED KNOWLEDGE REQUIRED SKILLS
in the Range of Variables
 Supplies Code Set

1.7. Client’s specific

guidelines/ coding and
claims processing
standards
1.8. 5S and 3Rs
2. Screen 2.1. Claims are checked 2.1. Medical Terminologies  Analytical skills
claims for authorization, 2.2. Medical Documentation  Reading and
eligibility based on 2.3. Medical claim process comprehension
provider and/or 2.4. Healthcare Laws and skills
subscriber contract Ethics  Researching
with the payer 2.5. Essential of healthcare skills
2.2. Completeness of insurance  Basic
claims 2.6. Medical Coding Systems mathematical
documentation are  International skills
checked in Classification of  Communication
accordance with Diseases skills
payer requirements  Current Procedural
 Computer skills
2.3. Lacking data based Terminology
on the initial  Healthcare Common
screening result are Procedure Coding
requested from System
medical provider 2.7. Client’s specific
guidelines/ coding and
claims processing
standards

3. Process 3.1. Encode patient, 3.1 Medical Terminologies  Analytical skills

claims/billing provider and/or 3.2 Medical Documentation  Reading and
billing information 3.3 Medical claim process comprehension
3.2. Determine 3.4 Healthcare Laws and skills
reimbursable Ethics  Researching
procedures and/or 3.5 Essential of healthcare skills
services based on insurance  Basic
existing insurance 3.6 Medical Coding Systems mathematical
contract or provider include but not limited to: skills
contract or any 3.6.1 Diagnosis Code  Communication
existing Set skills
reimbursement 3.6.2 Procedure Code  Computer skills
guidelines Set
3.3. Billing information is 3.6.3 Supplies Code set
verified for 3.7 Client’s specific
completeness of guidelines/ coding and
data based on the claims processing
required fields. standards
3.4. Determine billing
address and facility
based on insurance
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TR - MEDICAL CODING AND CLAIMS PROCESSING NC III (Amended) Promulgated June 16, 2015 Page 35
TESDA-SOP-QSO-01-F08

PERFORMANCE CRITERIA
ELEMENT Italicized terms are elaborated REQUIRED KNOWLEDGE REQUIRED SKILLS
in the Range of Variables
contract

RANGE OF VARIABLES

VARIABLE RANGE
1. Data May include but not limited to:
 Patient information
 Patient medical records
 Record of medical provider
2. Claims processing May include but not limited to:
requirements  General guidelines
 Client-specific guidelines
3. Claims documentation May include:
1. medical report
2. supply documentation
4. Billing information May include but not limited to:
 Diagnosis Code
 Date of injury
 Date of service
 Place of service
 Procedure and other service codes
 Number of units
 Charges

EVIDENCE GUIDE

1. Critical aspects of Assessment must show that the candidate:

competency 1.1. Prepared requirements for claims processing
1.2. Screened medical claims
1.3. Processed medical claims
2. Methods of The following may be used to objectively assess the
assessment candidate:
2.1. Demonstration with Oral Questioning
2.2. Written test
-OR-
2.3. Portfolio (years of experience) with interview
2.4. Third-party report (COE)

3. Resource implication The following resources may be provided:

3.1. Diagnosis coding manuals
3.2. Procedures/Services and supplies coding Manuals
and/or their equivalent
3.3. Mockup/Sample Medical documentation
4. Context of 4.1. Assessment may be conducted in the workplace or
Assessment in a simulated environment.

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 REQUIRED KNOWLEDGE REQUIRED SKILLS

Italicized terms are elaborated in
the Range of Variables
1. Manage 1.1. Processed and 1.1. Medical Terminology  Analytical skills
account submitted claims are  Systems of the  Reading and
receivable tracked and monitored body (e.g., skeletal, comprehension
based on enterprise or respiratory, skills
client requirements cardiovascular)  Researching
1.2. Pending claims are  Human anatomy skills
followed-up from payer  Human physiology  Basic
and/or patient in  Fundamental mathematical
accordance with nature of a disease skills
enterprise policy process, signs,
 Communication
1.3. Supporting documents symptoms and
skills
are Identified and methods of
treatment  Computer skills
requested from the
medical provider based  Common medical
on payer requirements conditions
(when necessary)  Medical
1.4. Posting of payments investigations and
are performed in procedures
accordance with  Injuries
enterprise/client’s policy  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
1.2. Medical
Documentation
1.3. Medical claim

ELEMENT PERFORMANCE CRITERIA REQUIRED KNOWLEDGE REQUIRED SKILLS

Italicized terms are elaborated in
the Range of Variables
process
1.4. Healthcare Laws and
Ethics
1.5. Essential of
healthcare insurance
1.6. Medical Coding
Systems include but
not limited to:
 Diagnosis code set
 Procedure code set
 Supplies Code set
1.7. Client-specific
guidelines and
coding and claims
processing standards
1.8. 5S and 3Rs
2. Manage 2.1. Denied/ Rejected 2.1. Medical  Analytical skills
denied/ claims are reviewed Terminologies  Reading and
rejected based on the explanation 2.2. Medical comprehension
claims of benefits from the Documentation skills
insurance company. 2.3. Medical claim  Researching
2.2. Reasons for process skills
denial/rejections are 2.4. Healthcare Laws  Basic
verified with payer’s and Ethics mathematical
adjusters in line with 2.5. Essential of skills
enterprise policy. healthcare insurance  Communication
2.3. Necessary adjustments 2.6. Medical Coding skills
are made based on the Systems  Computer skills
explanation of benefits  Diagnosis Code set
from the insurance  Procedure Code set
company.  Supplies Code set
2.4. Supporting documents 2.7. Client’s specific
are Identified and guidelines / Coding
requested from the and claims
medical provider based standards
on the payer 2.8. 5S and 3Rs
requirements.
2.5. Adjusted claims are re-
submitted in compliance
with payer’s
requirements
3. Manage 3.1 Underpaid claims are 3.1 Medical  Analytical skills
underpaid reviewed based on the Terminologies  Reading and
claims explanation of benefits 3.2 Medical comprehension
from the insurance Documentation skills
company. 3.3 Medical claim  Researching
3.2 Reasons for process skills
underpayment are 3.4 Healthcare Laws and  Basic
verified with payer’s Ethics

ELEMENT PERFORMANCE CRITERIA REQUIRED KNOWLEDGE REQUIRED SKILLS

Italicized terms are elaborated in
the Range of Variables
adjusters in line with 3.5 Essential of mathematical
enterprise policy. healthcare insurance skills
3.3 Supporting documents 3.6 Medical Coding  Communication
are prepared based on Systems skills
payer requirements.  Diagnosis Code set  Computer skills
3.4 Underpaid claims are re-  Procedure Code Set
submitted together with  Supplies Code set
appeal request in line 3.7 Client’s specific
with enterprise/client’s guidelines / Coding
policy. and Claims
Standards
3.8 5S and 3Rs

RANGE OF VARIABLES

VARIABLE RANGE
1. 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
2. Posting of payments May be classified as:
 fully paid
 under paid
 rejected or denied
3. Rejected claims May be caused by but not limited to:
 Incomplete/incorrect patient information
 Illegible/unreadable documents
 Incorrect medical codes
 Incomplete/incorrect providers information
4. Reasons for May include but not limited to:
underpayment  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

1. Critical aspects Assessment must show that the candidate:

of competency 1.1. Managed account receivable
1.2. Managed rejection/denials
1.3. Managed underpayment
2. Methods of The following may be used to objectively assess the
assessment candidate:
2.1. Demonstration with oral Questioning
2.2. Written test
2.3. Portfolio with interview
3. Resource The following resources May be provided:
implication 5.1 diagnosis coding manuals
5.2 Procedures/Services and supplies coding Manuals and/or
their equivalent
5.3 Mockup/Sample Medical documentation

4. Context of Assessment may be conducted in the workplace or in a

Assessment simulated environment.

SECTION 3 TRAINING ARRANGEMENTS

This set of standards provides Technical and Vocational Education and Training
(TVET) providers with information and other important requirements to consider when
designing training programs for Medical Coding and Claims Processing NC III.

This includes information on curriculum design; training delivery; trainee entry

requirements; tools and equipment; training facilities; and trainer’s qualification and
institutional assessment.

3.1 CURRICULUM DESIGN

TESDA shall provide the training on the development of competency-based

curricula to enable training providers develop their own curricula with the components
mentioned below.

Delivery of knowledge requirements for the basic, common and core units of
competency specifically in the areas of mathematics, science/technology,
communication/language and other academic subjects shall be contextualized. To this
end, TVET providers shall develop a Contextual Learning Matrix (CLM) to accompany
their curricula.

Course Title: MEDICAL CODING AND CLAIMS PROCESSING NC Level: NC III

Nominal Training Hours: 32 Hours (Basic)
+ 18 Hours (Common)
160 Hours (Core)
---------------------------------------
210 Hours - TOTAL

Course Description:

This course is designed to develop knowledge, desirable attitudes, and skills

in assigning medical codes to medical conditions and procedures and services from
medical reports made by physicians and other health care professional for reporting
and billing/claims purposes. It covers specialized competencies such as assigning
medical codes, processing and managing of medical claims.

To obtain this, all units prescribed for this qualification must be achieved:

BASIC COMPETENCIES
32 hrs

Unit of Learning Learning Content Practical Activities Assessment Nominal

Methodology
Competency Outcomes (Required Knowledge) (Required Skills) Approach Duration
1. Lead 1.1 Communicate  Method of communication  Expressing One self  Group  Written Test 2 hours
workplace information  Communication skills  Practice on Public speaking discussion  Interview
communication about  Communication tools  Written activities on  Role Play  Observation
workplace  Questioning techniques workplace process  Brainstorming
processes.  Demonstration
.

1.2 Lead  Method/technique of  Written and Electronic  Self-paced  Written Test 2 hours
workplace discussion communication activities handout/  Demonstration
discussions  How to lead discussion  Debate Exercises module
 How to solicit response  Discussion
 Role Play

1.3 Identify and  Identify problems and  Resolving conflict in the  Brainstorming  Interviews 2 hours
communicate issues workplace  Self-paced  Written exam
issues arising  Organizing information on  Making a report about handout/  Demonstration
in the problem and issues problem and issues module
workplace  Relating problems and  Practice communication  Role Play
issues model  Self-paced
 Communication barriers handout/
affecting workplace module
discussions

Unit of Learning Learning Content Practical Activities Assessment Nominal

Methodology
Competency Outcomes (Required Knowledge) (Required Skills) Approach Duration
2. Lead small 2.1 Provide team  Communication skills  Evaluate the success factors  Self-paced  Written 2 hours
teams leadership. required for leading small in the contribution of the handout/  Oral
team personnel in the module Questioning
 Skills and techniques in implementation of the safety,  Role Play  Demonstration
promoting team building quality and environmental  Case Study
 Negotiating skills objectives of the company
 Up to date dissemination of  Practice leadership activities
instruction and  Teambuilding activities
requirements to members  Write simple negotiation
 Art of listening and treating strategy on workplace issues
individual team members  Role play on communication
concern model and the art of listening

2.2 Assign  Duties and responsibilities  Planning session regarding  Role Play  Case studies 2 hours
responsibilities of each team member duties and responsibilities of  Workshop  Interview
among  Skills in identifying each team member  Demonstration  Demonstration
members individual skills, knowledge  Writeshop of interpersonal
and attitude as basis for abilities, attitude and
allocating responsibilities knowledge
 Knowledge in identifying  Identification of team
each team member duties members responsibilities thru
and responsibilities simulation
2.3 Set  Knowledge and skills in  Develop /implement an  Group  Written exam 1 hour
performance setting individual appraisal document for the discussion  Demonstration
expectation for performance worker  Writeshop  Written Exam
team target/expectation  Workshop on setting  Multimedia
members.  Team members duties and individual performance target presentation
responsibilities  Writeshop on team members
 Employee policies and duties and responsibilities
procedures  Video presentation regarding
 Defining performance employees performance role
expectations criteria and expectation towards
work

Unit of Learning Learning Content Practical Activities Assessment Nominal

Methodology
Competency Outcomes (Required Knowledge) (Required Skills) Approach Duration
2.4 Supervise  Knowledge and skills in  Practice monitoring skills  Role Play  Written Test 1 hour
team monitoring team member  Design monitoring scheme  Writeshop  Demonstration
performance performance for team operation as well as  Discussions  Written Test
 Monitoring team operation client satisfaction and needs  Self-paced  Demonstration
to ensure client needs and  Evaluate performance of handout/
satisfaction worker module
 Methods of monitoring  Group
performance Dynamics
 Informal/formal counseling
skills
3. Develop and 3.1 Identify  Background information on  Perform Data gathering  Direct  Interview 2 hours
practice relevant other parties to the regarding relevant observation  Written exam
negotiation skills information in negotiation information related to  Self-paced  Demonstration
planning  Observing differences negotiation handout/
negotiations between content and  Designing a negotiation module
process process  Discussion
 Identifying bargaining  Practice negotiation  Workshop
information strategies and manage the
 Applying strategies to process
manage process
3.2 Participate in  Applying steps in  Writeshop on identifying  Simulation/  Written exam 2 hours
negotiations negotiating process negotiation process role playing  Practical/
 Strategies to manage  Perform background  Writeshop performance
conflict information gathering  Discussion test
 Steps in negotiating process
3.3 Document  Procedure in documenting  Practice documentation  Case studies  Written exam 1 hour
areas for negotiations techniques/minutes of  Role play  Practical/
agreement  Managing information meeting performance
 Filing documents  Practice recording of test
agreement
 Keeping of records

Unit of Learning Learning Content Practical Activities Assessment Nominal

Methodology
Competency Outcomes (Required Knowledge) (Required Skills) Approach Duration
4. Solve workplace 4.1 Explain the  Observation, investigation &  Conduct investigation and  Direct  Written test 2 hours
problem related analytical analytical techniques root cause analyses and observation  Demonstration
to work activities techniques  Brainstorming implement corrective actions  Simulation
 Cause and effect diagrams  Perform analytical skills in
solving problem related to
work
4.2 Identify the  Normal operating  Evaluate the present status  Simulation/  Written exam 1 hour
problem parameters & product of the performance against role playing  Practical/
quality the established safety,  Discussion performance
 Identifying & clarifying the quality and environmental  Simulation test
nature of problem policies of the workplace  Demonstration
 Application of analytical  Discussion in identifying and
techniques clarifying the nature of
problem
4.3 Determine the  Non-routine process and  Implement corrective or  Case studies  Written exam 1 hour
possible quality problems preventive actions based on  Multimedia  Interviews
cause/s of the  Teamwork and work root cause analyses presentation  Written Test
problem allocation problem  View video presentation on  Writeshop
 Safety and emergency possible cause of problem in
situations and incidents the workplace
 Writeshop on the
determining problems in the
workplace
5. Use 5.1 Identify Measurement system  Practice mathematical  Direct  Written exam 1 hour
mathematical mathematical Basic measuring concepts to solve problem in observation  Practical/
concepts and tools and tools/devices the workplace  Demonstration performance
techniques techniques to test
solve problem
5.2 Apply Fundamental operation  Practice linear  Simulation/  Written exam 2 hours
mathematical (addition, subtraction, measurements and role playing  Practical/
procedures/ division, multiplication) conversion  Demonstration performance
solution  Practice mathematical test
calculation on workplace
situation

Unit of Learning Learning Content Practical Activities Assessment Nominal

Methodology
Competency Outcomes (Required Knowledge) (Required Skills) Approach Duration
5.3 Analyze Precision and accuracy  Compare the results against  Case studies  Written exam 2 hours
results the new requirements and  Demonstration  Interviews
identify gaps
 Analysis of result
6. Use relevant 6.1 Identify Awareness on technology  Film Viewing regarding  Direct  Written exam 2 hours
technologies appropriate and its function technology and its benefits observation  Demonstration
technology Communication techniques  Identify different technology  Multimedia
applicable to workplace presentation
6.2 Apply relevant Study different relevant  Conduct risk assessment for  Direct  Written exam 2 hours
technology technology in the workplace a routine or non-routine task observation  Demonstration
Relate 5s to technology in the workplace using the  Simulation/
established systems role playing
 Application of relevant
technology to the workplace
6.3 Maintain/ Corrective and preventive Identify monthly maintenance  Case studies  Interviews 2 hours
enhance maintenance tasks based on the Planned  Simulation/  Demonstration
relevant Upgrading of technology Maintenance System role playing
technology Communication Skills Application of corrective and
Organizational set–up / work preventive maintenance to
flow workplace

32
hours
Note: Basic competencies may be embedded in the core competencies.

COMMON COMPETENCIES
18 hrs

Unit of Learning Assessment Nominal

Learning Contents Practical Activities Methodologies
Competency Outcomes Methods Duration
1. Apply 1.1 Assess quality 1.1 Relevant production  Checking quality of  Field trip  Written test 3 hours
Quality of received processes, materials and materials or  Symposium  Demonstration &
Standards materials products component parts as  Video clips questioning
1.2 Characteristics of per manufacturer’s  Simulation/ Role  Observation &
materials, software and standards playing questioning
hardware used in  Interpreting  On the job training
production processes specifications or
1.3 Quality checking symbols
procedures
1.4 Quality Workplace
procedures
1.5 Identification of faulty
materials

1.2 Assess own 2.1 Safety and environmental  Observing safety  Field trip  Demonstration & 3 hours
work aspects of production and environmental  Symposium questioning
processes aspects of  Film showing  Observation &
2.2 Fault identification and production  Simulation questioning
reporting processes  On the job training  Third party report
2.3 Workplace procedure in  Preparing technical
documenting completed reports
work  Performing
2.4 Workplace Quality procedures in the
Indicators workplace

1.3 Engage in 3.1 Quality improvement  Implementing  Field trip  Demonstration & 2 hours
quality processes continuous  Symposium questioning
improvement a. IEC/ISO standards improvement  Film showing  Observation &
b. Environmental and  Simulation questioning
safety standards  On the job training  Third party report

Unit of Learning Assessment Nominal

Learning Contents Practical Activities Methodologies
Competency Outcomes Methods Duration
2. Perform 2.1 Plan and 2.1 Main types of computers  Planning and  Modular  Demonstration & 3 hours
Computer prepare for and basic features of preparing computer  Film showing questioning
Operations task to be different operating operation activity  Computer based  Observation &
undertaken systems training (e-learning) questioning
2.2 Main parts of a computer  Project method  Third party report
2.3 Information on hardware  On the job training  Assessment of
and software output product
2.4 Data security guidelines  Portfolio
2.5 Different Computer  Computer- based
specifications assessment

2.2 Input data into 2.1 keyboard and computer  Encoding of data  Modular  Demonstration & 1 hour
computer user  Saving encoded  Film showing questioning
data  Computer based  Observation &
2.2 Storage devices and
training (e-learning) questioning
basic categories of
 Project method  Third party report
memory
 On the job training  Assessment of
2.3 Relevant types of output product
software  Portfolio
 Computer- based
assessment

2.3 Access 3.1 General security, privacy  Accessing computer  Modular  Demonstration & 2 hours
information legislation and copyright data/files  Film showing questioning
using computer 3.2 Productivity Application  Performing data  Computer based  Observation &
 Microsoft office encoding training (e-learning) questioning
applications  Creating  Project method  Third party report
3.3 Business Application presentation  On the job training  Assessment of
 Introduction to Basic materials output product
Programming software  Drafting office  Portfolio
communication and  Computer- based
documents assessment

Unit of Learning Assessment Nominal

Learning Contents Practical Activities Methodologies
Competency Outcomes Methods Duration
2.4 Produce/ output 4.1 Computer application in  Printing and  Modular  Demonstration & 2 hours
data using printing, scanning and scanning of office  Film showing questioning
computer sending facsimile documents  Computer based  Observation &
system 4.2 Types and function of and materials training (e-learning) questioning
computer peripheral  Sending of  Project method  Third party report
devices office/business  On the job training  Assessment of
documents output product
 Saving of  Portfolio
documents in  Computer- based
storage devices assessment
a. CD/DVD
b. USB drives
c. Hard disk
drives
2.5 Maintain 5.1 Computer  Performing cleaning  Modular  Demonstration & 2 hours
computer equipment/system basic of PC  Film showing questioning
equipment and maintenance procedures parts/hardware  Computer based  Observation &
systems 5.2 Different types of components training (e-learning) questioning
computer viruses  Scanning/Debugging  Project method  Third party report
5.3 Basic file maintenance of computer  On the job training  Assessment of
procedures software and output product
applications  Portfolio
 Performing cleaning  Computer- based
and defragmentation assessment
of computer files
 Performing backup
of computer files

CORE COMPETENCIES
160 hrs
Unit of Learning Assessment Nominal
Learning Contents Practical Activities Methodologies
Competency Outcomes Methods Duration
1. Assign 1.1 Prepare  Types and contents of  Analyzing the completeness of a  Lecture  Written exam 16
Medical requirements medical record medical record  Discussion  Demonstration
Codes for medical  Different type and uses of  Demonstration  Interview
 Identifying different types of
coding Medical Codes medical codes and its uses
 Identification of types and
 Identifying types of Coding Tools
uses Coding Tools
 Format and Organization of  Familiarizing on the format and
Coding Tools organization of different coding
tools
 Healthcare Data Security
and Privacy  Understanding HIPAA and its
 Medical terminology importance in Healthcare Coding
and Claims Processing
 Anatomy and Physiology
1.2 Evaluate  Information/Data set  Identifying and gathering  Lecture  Written exam 24
medical necessary in Coding necessary information or Data  Discussion  Demonstration
reports sets in Coding  Demonstration  Interview
 Data management
 Coding Guidelines and  Identifying and understanding all
Conventions the appropriate Coding
conventions and guidelines.
 Current Coding practices
 Identifying standard coding
practices
1.3 Assign codes  Basic Coding steps  Knowing the basic coding steps.  Lecture  Written exam 80
 Discussion  Demonstration
 Classification of Diagnoses  Assigning appropriate diagnoses
 Demonstration  Interview
Codes codes
 Classification of Procedure  Assigning appropriate procedure
and Supply codes and supply codes
 Best Practices in Coding  Applying best practices in coding
activities

Unit of Learning Assessment Nominal

Learning Contents Practical Activities Methodologies
Competency Outcomes Methods Duration
2. Process 2.1 Prepare  Medical terminology  Perform data gathering of  Discussion  Written exam 4
Medical requirements requirements for claims  Demonstration  Demonstration
 Medical documentation and
Claims/ for claims processing  Case study  Interview
billing forms
Billing processing
 Claims processing  Identify the appropriate claims
requirements processing requirement by
medical providers
 Medical provider
requirements  Evaluate completeness of claims
documents for processing
 Third-party payers
 Patient Information
2.2 Screen  Healthcare Laws and Ethics  Checking claim eligibility and  Discussion  Written exam 12
claims authorization  Demonstration  Demonstration
 Healthcare Insurance and
 Project type  Direct
Plans  Performing research activities to
observation
 Government Insurance screen claims
 Clearinghouse  Practicing mathematical concept
to process claims
 Medical billing software
 Identifying and analyzing
 Basic mathematical tools
variances and discrepancies in
 Precision and accuracy claims
 Communication skills  Creating report log to
communicate with client
2.3 Process  Healthcare Laws and Ethics  Identify correct billing information  Brain storming  Written exam 12
claims/billing  Discussion  Demonstration
 Medical Coding Systems  Maintain data confidentiality and
 Demonstration  Interview /
 Client-specific guidelines and security
questioning
claims processing standards  Demonstrate research capability
 Apply appropriate guidelines
when processing claims
3.1 Manage  Basic mathematical  Record the appropriate  Lecture  Written exam 4
3. Manage account tools/accounting process payments and balances  Discussion  Demonstration
medical receivable  Create report log to  Demonstration  Interview
 Communication skills
claims communicate action items for  Project type
 Research skills
payers and providers re
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TR - MEDICAL CODING AND CLAIMS PROCESSING NC III (Amended) Promulgated June 16, 2015 Page 53
TESDA-SOP-QSO-01-F08

Unit of Learning Assessment Nominal

Learning Contents Practical Activities Methodologies
Competency Outcomes Methods Duration
 Medical documentation documentation
 Computer operation  Checks various payer portals for
payment status and reasons for
non-payment
 Performs data entry to post
payment
3.2 Manage  Explanation of Benefits  Identifying the components of an  Lecture  Written exam 4
denied/ Explanation of Benefits  Demonstration  Demonstration
 Insurance Policies
rejected  Interpreting Explanation of  Case study  Interview/
claims  Common Reason for Claim questioning
Benefits of a denied claim
denials
 Interpreting an Explanation of
 Measure to Prevent Denied Benefits of a rejected claims
Claims  Identifying common reason for
 Communication Skills claim rejection
 Common Reason for Claim  Identifying solution for identified
Rejection reason for rejection
 Rebilling Process for
Rejected Claims
3.3 Manage  Common Reason for  Identifying common reason for  Brain storming  Written exam 4
underpaid Underpaid claims claims underpayment  Discussion  Demonstration
claims  Identifying measures to prevent  Demonstration  Interview
 Measure to Prevent
underpayment of claims  Case study
underpaid Claims
 Providing possible solution for
 Rebilling process for
identified reason for
underpaid claims
underpayment
 Review and Appeal process  Performing Rebilling of
underpaid Claims
 Performing Review and Appeal
for underpaid Claims
160
hours

3.2 TRAINING DELIVERY

1. The delivery of training shall adhere to the design of the curriculum. Delivery shall be
guided by the principles of competency-based TVET.

a. Course design is based on competency standards set by the industry or

recognized industry sector; (Learning system is driven by competencies
written to industry standards)

b. Training delivery is learner-centered and should accommodate individualized

and self-paced learning strategies;

c. Training can be done on an actual workplace setting, simulation of a workplace

and/or through adoption of modern technology.

d. Assessment is based in the collection of evidence of the performance of work to

the industry required standards;

e. Assessment of competency takes the trainee’s knowledge and attitude into

account but requires evidence of actual performance of the competency as the
primary source of evidence.

f. Training program allows for recognition of prior learning (RPL) or current

competencies;

g. Training completion is based on satisfactory performance of all specified

competencies.

2. The competency-based TVET system recognizes various types of delivery modes,

both on-and off-the-job as long as the learning is driven by the competency standards
specified by the industry. The following training modalities and their
variations/components may be adopted singly or in combination with other modalities
when designing and delivering training programs:

2.1. Institution- Based:

 Dual Training System (DTS)/Dualized Training Program (DTP) which contain

both in-school and in-industry training or fieldwork components. Details can be
referred to the Implementing Rules and Regulations of the DTS Law and the
TESDA Guidelines on the DTP;

 Distance learning is a formal education process in which majority of the

instruction occurs when the students and instructor are not in the same place.
Distance learning may employ correspondence study, audio, video, computer
technologies or other modern technology that can be used to facilitate learning
and formal and non-formal training. Specific guidelines on this mode shall be
issued by the TESDA Secretariat.

 The traditional classroom-based or in-center instruction may be enhanced

through use of learner-centered methods as well as laboratory or field-work
components.

2.2 Enterprise-Based:

 Formal Apprenticeship – Training within employment involving a contract

between an apprentice and an enterprise on an approved apprenticeable
occupation.

 Enterprise-based Training- where training is implemented within the company

in accordance with the requirements of the specific company. Specific
guidelines on this mode shall be issued by the TESDA Secretariat.

3.3 TRAINEE ENTRY REQUIREMENTS

The trainees who wish to enter the course should possess the following
requirements:
 Graduate of 12-years Basic education;
 Can communicate in English, both oral and written;
 Have pass the trainability/aptitude test of the institution*
___________
Note: * Optional

This list does not include specific institutional requirements such as

educational attainment, appropriate work experience, and others that may be
required of the trainees by the school or training center delivering the TVET
program.

3.4 LIST OF TOOLS, EQUIPMENT AND MATERIALS

Recommended list of equipment and materials for the training in Medical

Coding and Claims Processing NC III

MATERIALS
At least 5 sets Coding Manuals (latest edition or at least 2-years of publication)
 Coding Resources Diagnosis code set
 Procedures/Services and Supplies code set
Claims Processing Manuals / Handouts
1:1 Training/Student manual (optional)
At least 2 pcs Latest Medical Dictionary
At least 2 sets Computers with internet (optional)

3.5 TRAINING FACILITIES

The building must be in compliance with occupational health and safety

guidelines. The space requirements for the teaching/learning and circulation areas
are as follows:
TEACHING/LEARNING SIZE IN AREA IN SQ. QTY. TOTAL AREA
AREAS METERS METERS IN SQ. METERS

Lecture /Laboratory Room* 8x5 40 1 40

Learning Resource Area / 4X5 20 1 20

Repository of references/
manuals, etc. (may be
located inside the lecture /
laboratory room)

Wash ,Toilet & Locker Room 1x2 2 2 4

Total 64

Facilities / Equipment / Circulation** 19

Total Area 83

Note: Maximum required ratio of trainer to students = 1: 25

* The above specification for the lecture room space requirement assumes a maximum of 25 students.
The area size may vary depending on the number of students at a given class.
** Area requirement is equivalent to 30% of the total teaching/learning areas

3.6 TRAINERS QUALIFICATIONS

MEDICAL CODING AND CLAIMS PROCESSING – NC III

Trainer’s Qualification I (TQ I)

 Must be a holder of National TVET Trainer’s Certificate (NTTC) I

o Must be a holder of Medical Coding and Claims Processing NC III
o Must have completed training and passed the assessment for Trainer’s
Methodology course

 With at least two (2) years of relevant industry experience as medical coding
and claims specialist or with international certification in medical coding, billing
and/or claims

3.7 INSTITUTIONAL ASSESSMENT

Institutional assessment is undertaken by trainees to determine their

achievement of units of competency. A certificate of achievement is issued for
each unit of competency.

The result of the institutional assessment may be considered as evidence for

the assessment for national certification.

SECTION 4. ASSESSMENT AND CERTIFICATION ARRANGEMENTS

Competency Assessment is the process of collecting evidence and making

judgments whether competency has been achieved. The purpose of assessment is to
confirm that an individual can perform to the standards expected at the workplace as
expressed in relevant competency standards.
The assessment process is based on evidence or information gathered to prove
achievement of competencies. The process may be applied to an employable unit(s) of
competency in partial fulfillment of the requirements of the national qualification.

4.1 NATIONAL ASSESSMENT AND CERTIFICATION ARRANGEMENTS

4.1.1 To attain the National Qualification of Medical Coding and Claims

Processing NC III, the candidate must demonstrate competence in all
units listed in Section 1. Successful candidates shall be awarded a
National Certificate signed by the TESDA Director General.

4.1.2 The qualification of Medical Coding and Claims Processing NC III may
be attained through:

4.1.2.1 Accumulation of Certificates of Competency (COCs) in the

following competencies:

4.1.2.1.1 Assign medical codes

4.1.2.1.2 Perform medical claims/billing work
 Process medical claims/billing
 Manage medical claims

Successful candidates shall be awarded a Certificate of

Competency (COC) in each of the core units.

4.1.2.2 Demonstration of competence through project-type assessment

covering all the units required in the qualification.

4.1.3 Accumulation and submission of all COCs acquired for the relevant units
of competency comprising a qualification, an individual shall be issued the
corresponding National Certificate.

4.1.4 Assessment shall focus on the core units of competency. The basic and
common units shall be integrated or assessed concurrently with the core
units.

4.1.5 The following are qualified to apply for assessment and certification:

4.1.5.1 Graduate of formal, non-formal, and informal including enterprise-

based training programs and e-learning/online/distance learning
programs;
4.1.5.2 Experienced workers (wage employed or self-employed).

4.1.5.3 Those who are included in the national ICD10 Training Registry of
DOH/WHO

4.1.5.4 Those with international medical coding training certification

4.1.6 The conduct of assessment and issuance of certificates shall follow the
procedures manual and implementing guidelines developed for the
purpose.

4.2 COMPETENCY ASSESSMENT REQUISITE

4.2.1 Self-Assessment Guide. The self-assessment guide (SAG) is accomplished

by the candidate prior to actual competency assessment. SAG is a pre-
assessment tool to help the candidate and the assessor determine what
evidence is available, where gaps exist, including readiness for
assessment.
This document can:

a. Identify the candidate’s skills and knowledge

b. Highlight gaps in candidate’s skills and knowledge
c. Provide critical guidance to the assessor and candidate on the
evidence that need to be presented
d. Assist the candidate to identify key areas in which practice is needed or
additional information or skills that should be gained prior `
4.2.2 Accredited Assessment Center. Only Assessment Center accredited by
TESDA is authorized to conduct competency assessment. Assessment
centers undergo a quality assured procedure for accreditation before they
are authorized by TESDA to manage the assessment for National
Certification.
4.2.3 Accredited Competency Assessor. Only accredited competency assessor is
authorized to conduct assessment of competence. Competency assessors
undergo a quality assured system of accreditation procedure before they
are authorized by TESDA to assess the competencies of candidates for
National Certification.

ANNEX A - COMPETENCY MAP

Medical Coding and Claims Processing NC III

BASIC COMPETENCIES
Receive and Respond Practice basic
Demonstrate work Participate in Workplace
to Workplace Work with Others housekeeping
values Communication
Communication procedures
Practice occupational
Work in a Team Practice career Lead Workplace
health and safety Lead Small Team
Environment professionalism Communication
procedures
Solve Problems Use mathematical
Develop and practice Use relevant Utilize Specialist
Related to Work concepts and
negotiation skills technologies Communication Skills
Activities techniques
Apply Problem Solving
Develop Team and Collect, analyze and Promote environmental
Techniques in the Plan and Organize Work
Individuals organize information protection
Workplace

COMMON COMPETENCIES
Perform Mensuration Prepare and Interpret Apply Quality Perform Computer
Use Hand Tools
and Calculation Technical Drawing Standards Operations

CORE COMPETENCIES
Provide specialized
Communicate
Render quality Utilize enterprise/ Conduct contact center support and
effectively in a customer
customer service company technology campaign assistance to
contact center
customers
Manage the activities of Use medical
Lead a contact center Use business Produce text from
a contact center work technology to carry out
work team technology audio transcription
team task
Lead a team in Produce cleaned-up
Manage the activities Create 2D models
Review/edit documents delivering quality and in-between
of a work team and images
service drawings
Produce key Produce over-all
Produce 2D colored Produce background Composite and edit
drawings for designs for
animation designs animation sequence
animation animation
Coordinate the
Create 3D models and Produce storyboard
production of
images for animation
animation
Process medical Manage medical
Assign medical codes
claims/billings claims

DEFINITION OF TERMS

GENERAL

1) Certification - is the process of verifying and validating the competencies of a

person through assessment

2) Certificate of Competency (COC) – is a certification issued to individuals who

pass the assessment for a single unit or cluster of units of competency

3) Common Competencies - are the skills and knowledge needed by all people
working in a particular industry

4) Competency - is the possession and application of knowledge, skills and

attitudes to perform work activities to the standard expected in the workplace

5) Competency Assessment - is the process of collecting evidence and making

judgments on whether competency has been achieved

6) Competency Standard (CS) - is the industry-determined specification of

competencies required for effective work performance

7) Context of Assessment - refers to the place where assessment is to be

conducted or carried out

8) Core Competencies - are the specific skills and knowledge needed in a particular
area of work - industry sector/occupation/job role

9) Critical aspects of competency - refers to the evidence that is essential for

successful performance of the unit of competency

10)Elective Competencies - are the additional skills and knowledge required by the
individual or enterprise for work

11)Elements - are the building blocks of a unit of competency. They describe in

outcome terms the functions that a person performs in the workplace.

12)Evidence Guide - is a component of the unit of competency that defines or

identifies the evidences required to determine the competence of the individual. It
provides information on critical aspects of competency, underpinning knowledge,
underpinning skills, resource implications, assessment method and context of
assessment

13)Level - refers to the category of skills and knowledge required to do a job

14)Method of Assessment - refers to the ways of collecting evidence and when,

evidence should be collected

15)National Certificate (NC) – is a certification issued to individuals who achieve all

the required units of competency for a national qualification defined under the
Training Regulations. NCs are aligned to specific levels within the PTQF

16)Performance Criteria - are evaluative statements that specify what is to be

assessed and the required level of performance

17)Qualification - is a cluster of units of competencies that meets job roles and is

significant in the workplace. It is also a certification awarded to a person on
successful completion of a course in recognition of having demonstrated
competencies in an industry sector

18)Range of Variables - describes the circumstances or context in which the work is

to be performed

19) Recognition of Prior Learning (RPL) – is the acknowledgement of an individual’s

skills, knowledge and attitudes gained from life and work experiences outside
registered training programs

19)Resource Implication - refer to the resources needed for the successful

performance of the work activity described in the unit of competency. It includes
work environment and conditions, materials, tools and equipment

20)Basic Competencies - are the skills and knowledge that everyone needs for work

21)Training Regulations (TR) – refers to the document promulgated and issued by

TESDA consisting of competency standards, national qualifications and training
guidelines for specific sectors/occupations. The TR serves as basis for
establishment of qualification and certification under the PTQF. It also serves as
guide for development of competency-based curricula and instructional materials
including registration of TVET programs offered by TVET providers

22)Underpinning Knowledge - refers to the competency that involves in applying

knowledge to perform work activities. It includes specific knowledge that is
essential to the performance of the competency

23)Underpinning Skills - refers to the list of the skills needed to achieve the elements
and performance criteria in the unit of competency. It includes generic and
industry specific skills

24)Unit of Competency – is a component of the competency standards stating a

specific key function or role in a particular job or occupation; it is the smallest
component of achievement that can be assessed and certified under the PTQF

SECTOR SPECIFIC

1. Anatomy – the branch of morphology concerned with the structure of animals or

plants.
2. Browser – a software package that provides the user interface for accessing
Internet, intranet and extranet Web sites.
3. Claims processing - is the fulfillment by an insurer of its obligation to receive,
investigate and act on a claim filed by an insured. It involves multiple
administrative and customer service layers that includes review, investigation,
adjustment (if necessary), remittance or denial of the claim.
4. Computer – a device that has the ability to accept data; internally store and
execute a program of instructions; perform mathematical, logical, and
manipulative operations on data; and report the results.
5. Computer Terminal – any input/output device connected by
telecommunications links to a computer.
6. Data - objective measurements of the attributes (characteristics) of entities such
as people, places, things, and events.
7. Documentation – a collection of documents or information.
8. Edit – to modify the form or format of data
9. Encryption – to scramble data or convert it, prior to transmission, to a secret
code that masks the meaning of he data to unauthorized recipients.
10. End user – anyone who uses an information system or the information it
produces.
11. Ergonomics - the science and technology emphasizing the safety, comfort,
and ease of use of human-operated machines. The goal of ergonomics is to
produce systems that are user-friendly: safe, comfortable and easy to use.
12. Information – data placed in a meaningful and useful context for an end user.
13. Information and Communication Technology (ICT) - refers to technologies
associated with the transmission and exchange of data in the form of sound,
text, visual images, signals or any combination of those forms through the use
of digital technology. It encompasses such services as telecommunications,
posts, multimedia, electronic commerce, broadcasting, and information
technology.
14. Keyboarding – using the keyboard of a microcomputer or terminal.
15. Knowledge workers – people whose primary work activities include creating,
using, and distributing information.
16. Local Area Network (LAN) – a communications network that typically
connects computers, terminals, and other computerized devices within a limited
physical area such as an office, building, manufacturing plant and other work
sites.
17. Medical billing - is the process of submitting and following up on claims
with health insurance companies in order to receive payment for services
rendered by a healthcare provider. It is an interaction between a health care
provider and the insurance company (payer).The same process is used for
most insurance companies, whether they are private companies or government
sponsored programs.
18. Medical claims processor - manages and processes insurance claims. When
healthcare providers treat patients, they file a medical claim to receive payment

from the patient's insurance company. The medical claims processor then
reviews and assesses the claim, remitting payment to the doctor if a claim is
covered by the patient's insurance policy. Due to the nature of the work, it is
vital that the processor be knowledgeable about the health insurance industry.
19. Outsourcing – turning over all or part of an organization’s information systems
operation to outside contractors, known as systems integrators or facilities
management companies.
20. Physiology – the branch of biology concerned with the functions of living
things.
21. Protocol – a set of rules and procedures for the control of communication in a
communications network.
22. Quality Assurance – methods for ensuring that information systems are free
from errors and fraud and provide information products of high quality.
23. Software – computer programs and procedures concerned with the operation
of an information system.
24. Standards – measures of performance developed to evaluate the progress of
a system toward its objectives
25. System – an assembly of methods, procedures, or techniques unified by
regulated interaction to form an organized whole
26. 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) PETER A. EDU, MD

MYLA ROSE M. REYES (SPI Global) LINA LIZA A. ALCANCES, MD
MA. CRISTINA G. CORONEL (Pointwest) Teledevelopment Services Inc.
JEANETTE S. CARRILLO
Healthcare Information Management Outsourcing
Association of the Philippines (HIMOAP)

THERESA D. TIMBANG JONATHAN MICHAEL ELE, MD

FLORINDA G. TUVILLO Philippine Health Insurance Corp.
Department of Health - Standards & Monitoring Department
Technical Working Group on ICD - 10

 THE PARTICIPANTS IN THE NATIONAL VALIDATION OF THIS TRAINING REGULATION

 Healthcare Information Management Outsourcing Association of the Philippines, Inc.

(HIMOAP)
 SPI – Global
 American Academy of Medical Transcription
 Teledevelopment Services Inc.
 Pointwest Technologies
 Total Transcriptions Solutions
 Center for Technical Excellence Integrated Schools, Inc.

 THE TESDA BOARD - STANDARDS SETTING AND SYSTEMS DEVELOPMENT

COMMITTEE

 THE MANAGEMENT AND STAFF OF TESDA SECRETARIAT

Qualifications and Standards Office (QSO)

Name Company/industry Email Address
Luz Victoria G. Amponin TESDA [email protected]
Zoilo C. Galang TESDA [email protected]
Mercedes Javier TESDA [email protected]
Samuel E. Calado Jr. TESDA [email protected]
Fortunata L. Baco TESDA [email protected]

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