Course Abstract Details

HIT-223, Reimbursement Methodologies

Credits: 3

Course Description

HIT-223, Reimbursement Methodologies, explores the private and government-sponsored financial systems that exist today within the healthcare environment. The course will provide an overview of various types of health plans including managed care, prospective payment systems, and other reimbursement methodologies employed in various healthcare settings. Other areas such as coding, billing, claims processing, and chargemaster maintenance will be covered in additional detail. Current issues affecting reimbursement such as revenue cycle management, regulatory compliance, coding compliance, and role of quality improvement organizations will also be explored. Prerequisite: exemption/completion of HIT-222 with a "C" grade or better. Three hours lecture each week. Three credits. Three billable hours.

Course Objectives and Grading Information

MAJOR COURSE OBJECTIVES:  On completion of this course, the student will be able to: 

1. Identify and describe the key elements of private and government-funded sources of health care in the United States. (PG.6) 

2. Indicate how the specific inpatient and outpatient prospective payment systems function. Identify the methodologies utilized and the variables unique to each of the individual systems. (PG.6) 

3. Describe the impact of current reimbursement methodologies on payers, providers, consumers, and policy makers. (PG.6) 

4. Outline the revenue cycle management process, including the role that coding staff play in that process. (PG.6) 

5. Demonstrate an understanding of terms and basic concepts related to coding, billing, and claims processing for physicians and hospitals. (PG.2) 

6. Restate key initiatives and issues (such as Medicare?s Pay-For-Performance) that affect future reimbursement and describe how organizations are addressing them. (PG.2, PG.6) 

Learning Goals

The abbreviations in parentheses represent Learning Goals which have been identified for this course and program of study:

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