FOR NYANYA (ONLY) - HLTH245 Principles of Reimbursement Mgmt

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HLTH245  Principles of Reimbursement Management

Course Description

This course introduces the student to the role of health care reimbursement systems. Students gain an understanding of third party payers, payment methodologies, how charges are developed and maintained, and financial implications of reimbursement management.  Students acquire knowledge of health claims processing policies and procedures, regulatory guidelines, compliance, and reimbursement's impact on the revenue cycle.

Learning Outcomes

Upon successfully completing this course, the student will be able to:

1. Describe healthcare billing and reimbursement processes with an emphasis on billing policies/procedures practiced across the continuum of care.

2. Compare and contrast commercial, managed care and federal insurance plans.

3. Analyze payment methodologies and systems and appraise impact of third-party payment and reimbursement.

4. Discuss the implication of fraudulent activities within various health care organizations and the role of Office of the Inspector General (OIG).

5. Compare and contrast various ethical dilemma-solving methods utilized in reimbursement management and describe potential positive and negative outcomes along with potential unexpected consequences related to each one.

6. Discuss, interpret and apply regulatory guidelines to billing and reimbursement processes.

7. Describe and analyze various reimbursement monitoring and reporting techniques.

8. Discuss auditing and reporting including coding quality monitors.

Required Textbooks and Additional Materials

978-0-07-752051-9

Integrated Claims Process Approach

Valerius, Joanne / Bayes, Nenna / Newby, Cynthia

6TH / McGraw-Hill Publishing Company / Purchase as New only

978-0-07-351371-3

Medical Insurance

Valerius, Joanne

6TH / McGraw-Hill Publishing Company