HITT 2105 - Healthcare Reimbursement Systems

Credit Hours: 3.00

Objectives:

1. Monitor coding and revenue cycle processes.
2. Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery.
3. Support accurate billing through coding, charge master, claims management, and bill reconciliation processes.
4. Use established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative.
5. 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:

1. Collect and maintain health data (such as data elements, data sets, and databases).
2. Verify timeliness, completeness, accuracy, and appropriateness of data and data sources for patient care, management, billing reports, registries, and/or databases.
3. Design and generate reports using appropriate software.

Outcome 3: Upon completion of this course, students will be able to apply clinical classification systems.

Objectives:

1. Ensure accuracy of diagnostic/procedural groupings such as DRG, APC, and so on.
2. Demonstrate the ability to evaluate data quality, case‐mix analysis, severity of illness, and coding policies and procedures as required.
3. Compile patient data and perform data quality reviews to validate code assignment and compliance with reporting requirements such as outpatient prospective payment systems.

• Communication: The graduate can communicate effectively for the intended purpose and audience.
• Critical Thinking: The graduate can make informed decisions after analyzing information or evidence related to the issue.
• Global Literacy: The graduate can analyze human behavior or experiences through cultural, social, political, or economic perspectives.
• Information Literacy: The graduate can responsibly use information gathered from a variety of formats in order to complete a task.
• Quantitative Reasoning: The graduate can apply quantitative methods or evidence to solve problems or make judgments.
• Scientific Literacy: The graduate can produce or interpret scientific information presented in a variety of formats.

1. Healthcare Reimbursement Methodologies
2. Clinical Coding and Coding Compliance
3. Voluntary Healthcare Insurance Plans
4. Government-sponsored Healthcare Programs
5. Managed Care Plans
6. Medicare-Medicaid Prospective Payment Systems for Inpatients
7. Ambulatory and Other Medicare-Medicaid Reimbursement Systems
8. Medicare-Medicaid Prospective Payment systems for Post-acute Care
9. Revenue Cycle Management
10. Value-Based Purchasing