HIT1400 Healthcare Reimbursement
This course introduces the student to reimbursement policies and procedures in the use of clinical data, organization of healthcare delivery system including managed care and capitation: issues and systems, including the compliance environment; and payers. The theory and use of reimbursement vocabulary and systems such as Diagnostic Related Groups (DRGs), Resource-Based Relative Value Scare (RBRVS) are applied, Ambulatory Payment Classifications (APCs) are applied. Revenue cycle discussions and analysis include data flow from admission to billing and the analysis of casemix. In addition, other external forces, such as Health Insurance Portability and Accountability Act and Recovery Audit Contractors are reviewed. Other topics covered/applied include, CMS 1500 and UB92 billing forms; charge masters, EDI, billing technologies, and application programs. Students will learn the value of using established guidelines to comply reimbursement and reporting requirements, to perform data quality reviews to validate code assignments.