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Apr 25, 2024
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HITT 2105 - Healthcare Reimbursement Systems Credit Hours: 3.00
Prerequisites: Admission into the Health Information Technology Program; HITT 1201, HITT 1209, HITT 1210, and HITT 1211 all with grade C or better
Corequisites: HITT 2108 and HITT 2109
(formerly HITT 2102)
This course covers the complex financial systems in today’s healthcare environment. The student will obtain insight into how reimbursement systems have made an impact on providers, payers, and consumers. Students will develop skills in coding compliance, revenue cycle management and case mix management.
Location: Online only
When Offered: Fall semester only
Contact Hours: 3
Billable Contact Hours: 3
OUTCOMES AND OBJECTIVES
Outcome 1: Upon completion of this course, students will be able to distinguish between the various aspects of reimbursement.
Objectives:
- Monitor coding and revenue cycle processes.
- Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery.
- Support accurate billing through coding, charge master, claims management, and bill reconciliation processes.
- Use established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative.
- Apply policies and procedures to comply with the changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, managed care, and so forth.
Outcome 2: Upon completion of this course, students will be able to integrate health data structure, content, and standards.
Objectives:
- Collect and maintain health data (such as data elements, data sets, and databases).
- Verify timeliness, completeness, accuracy, and appropriateness of data and data sources for patient care, management, billing reports, registries, and/or databases.
- Design and generate reports using appropriate software.
Outcome 3: Upon completion of this course, students will be able to apply clinical classification systems.
Objectives:
- Ensure accuracy of diagnostic/procedural groupings such as DRG, APC, and so on.
- Demonstrate the ability to evaluate data quality, case‐mix analysis, severity of illness, and coding policies and procedures as required.
- Compile patient data and perform data quality reviews to validate code assignment and compliance with reporting requirements such as outpatient prospective payment systems.
COMMON DEGREE OUTCOMES
(Bulleted outcomes apply to the course)
- 1. The graduate can integrate the knowledge and technological skills necessary to be a successful learner.
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- 2. The graduate can demonstrate how to think competently.
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- 3. The graduate can demonstrate how to employ mathematical knowledge.
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- 4. The graduate can demonstrate how to communicate competently.
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- 5. The graduate is sensitive to issues relating to a diverse, global society.
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COURSE CONTENT OUTLINE
- Healthcare Reimbursement Methodologies
- Clinical Coding and Coding Compliance
- Voluntary Healthcare Insurance Plans
- Government-sponsored Healthcare Programs
- Managed Care Plans
- Medicare-Medicaid Prospective Payment Systems for Inpatients
- Ambulatory and Other Medicare-Medicaid Reimbursement Systems
- Medicare-Medicaid Prospective Payment systems for Post-acute Care
- Revenue Cycle Management
- Value-Based Purchasing
Primary Faculty
Dunsmore, Kristin
Secondary Faculty
Associate Dean
Primeau, Paula
Dean
Mirijanian, Narine
Official Course Syllabus - Macomb Community College, 14500 E 12 Mile Road, Warren, MI 48088
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