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
4. Course Description:
This course provides additional training as it relates to medical billing and health insurance. Topics covered will be payment classification groups, fee schedules, exclusions lists, and wage indexes for accurate reimbursement. The course will explore the methods of government-sponsored, and commercial insurance payment systems along with the various types of healthcare cost-sharing and their affects on providers and consumers.
5. Placement Tests Required:
6. Prerequisite Courses:
HINS 2172 - Reimbursement Methodology
All Course(s) from the following...
Course Code | Course Title | Credits |
HINS 1163 | Medical Office Procedures | 3 cr. |
HINS 1150 | Intro to Diagnosis & Procedure Coding | 3 cr. |
9. Co-requisite Courses:
HINS 2172 - Reimbursement Methodology
There are no corequisites for this course.
III. Course Purpose
Program-Applicable Courses – This course fulfills a requirement for the following program(s):
Healthcare Administrative Specialist, AAS Degree
Healthcare Accounting, 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 ethical principles in decision-making |
Comply with federal and state laws while working with payer 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; and
- Describe the components of the revenue cycle and the importance of effective revenue cycle management for fiscal stability.