Health Information Technology - HIT 240

Course Description

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.

Prerequisites

(A requirement that must be completed before taking this course.)

Course Competencies

Upon successful completion of the course, the student should be able to:

• Explain the principles and applications of diagnostic and procedural coding grouping systems as the basis of prospective payment methodologies, such as MS-DRG’s, APC, RUG, CMG, HHRG.
• Apply policies and procedures for the use of clinical data required in reimbursement for inpatients, ambulatory services, post-acute care and outpatient services, including PPS, RBRVS, case mix indices, MSDRGs, healthcare insurance policies and Accountable Care Organizations.
• Illustrate policies and procedures to comply with the changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, commercial insurers and managed care.
• Examine coding compliance issues that influence reimbursement.
• 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.
• Evaluate revenue cycle processes.
• Characterize the models of value-based purchasing for various healthcare settings, payment systems and providers.
• Examine how report generation technologies and reimbursement data (OPPS, IPPS) can be used to support specific lines of business in healthcare.
• Identify current trends and future challenges in the exchange of healthcare data for the purpose of reimbursement.
• Access reimbursement and regulatory guidelines through the use of technology.

Course Schedule