I. General Information

1. Course Title:
Reimbursement Methodology

2. Course Prefix & Number:
HINS 2172

3. Course Credits and Contact Hours:

Credits: 2

Lecture Hours: 2

Lab Hours: 0

4. Course Description:

This course provides training as it relates to medical billing and health insurance. Topics covered will be statement preparation in the medical office, types of medical insurance companies, types of coverage, the claim process from beginning to end (includes generated the claim, clearing house, and getting reimbursed), and related ethical and legal issues. Topics such as rejection of claims and filing appeals will be discussed.

5. Placement Tests Required:

6. Prerequisite Courses:

9. Co-requisite Courses:

There are no corequisites for this course.

II. Transfer and Articulation

III. Course Purpose

1. Program-Applicable Courses – This course is required for the following program(s):

Health Informatics Coordinator, Diploma
Health Informatics Specialist, AAS Degree

IV. Learning Outcomes

1. College-Wide Outcomes

College-Wide Outcomes/Competencies	Students will be able to:
Analyze and follow a sequence of operations	Obtain correct reimbursement using federal and state guidelines
Apply abstract ideas to concrete situations	How to solve correct appeals.
Apply ethical principles in decision-making	Comply with federal and state laws while working with payors regulations.

2. Course Specific Outcomes - Students will be able to achieve the following measurable goals upon completion of the course:

•  Define RVU and DRG
• Explain the different codes sets approved by the HIPAA Act of 1996,
• Define basic language associated with reimbursement under Medicare and Medicaid healthcare payment systems
• Explain common models and policies of payment for Medicare and Medicaid healthcare payment system for physicians in an outpatient setting.
• Describe models of pay-for-performance
• Describe the components of the revenue cycle and the importance of effective revenue cycle management for fiscal stability.
• Describe types of managed care plans.

V. Topical Outline

Listed below are major areas of content typically covered in this course.

1. Lecture Sessions

I.  Healthcare Reimbursement Methodologies

II. Clinical Coding and Coding Compliance

III. Voluntary Healthcare Insurance Plans

IV.  Government - Sponsored Healthcare Programs

V.  Managed Care Plans

VI.  Medicare-Medicaid prospective payment systems for inpatients

VII.  Ambulatory and Other Medicare-Medicaid Reimbursement Systems

VIII.  Medicare-Medicaid prospective payment systems for Postacute care

VIV.  Revenue Cycle Management

X.  Value-based purchasing