Health Information Technology
Healthcare Reimbursement Methodologies
The course is designed to provide the student knowledge of the diverse reimbursement methodologies utilized by governmental and private insurance entities in the payment for healthcare delivery services. The course will present third-party payer and compliance/auditing issues, correct coding policy and government prospective payment systems. The terminology and principles for managed care, revenue cycle management and other healthcare plans will be covered.
(A requirement that must be completed before taking this course.)
Upon successful completion of the course, the student should be able to:
- Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery.
- Apply policies and procedures to comply with the changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, commercial insurers, managed care and so forth.
- Support accurate billing through coding, chargemaster, claims management and bill reconciliation processes.
- Use established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative.
- Compile patient data and perform data quality reviews to validate code assignment and compliance with reporting requirements such as outpatient prospective payment systems.
- Ensure accuracy of diagnostic/procedural groupings such as APC.
- Utilize the internet resources for accurate coding and reimbursement practices.
- Monitor coding and revenue cycle processes.
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