HIM 222 Reimbursement Methodologies

This course will introduce the student to different reimbursement methodologies in medical office, hospital, long term, and other settings. The course will analyze different reimbursement methodologies including fee-for- service, MCO’s, managed care, MS- DRG’s, and HCC’s.

Credits

5

Prerequisite

HIM 120 and HIM 160

Course Learning Outcomes

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

1. Apply knowledge of the methods of healthcare reimbursement

2. Describe Clinical Coding and Coding Compliance

3. Describe Voluntary Healthcare Insurance Plans

4. Define the key concepts of Government-Sponsored Healthcare Programs

5. Articulate the key concepts of Managed Care Plans

6. Describe the Medicare-Medicaid Prospective Payment System for Inpatients

7. Differentiate between the non-acute Medicare/Medicaid reimbursement systems for ambulatory, other, and prospective payment systems for Post-Acute Care

8. Explain the important role of Revenue Cycle Management and Value-Based Purchasing in healthcare reimbursement