Reimbursement

Module Eight: Course Reflection

HCM 345

• Understand the role of reimbursement in the revenue cycle and reimbursement • Determine the key departments or organizational entities that contribute to the

revenue cycle • Explain quality measures for improvement and the relationship to

revenue cycle management

• Summarize financial reporting

Module One Review: Healthcare Finance and the Revenue Cycle

• Understand the importance of standard billing and coding systems as a universal healthcare language

• Identify the compliance issues for healthcare coding • Evaluate how reimbursement data is used in fi nancial and managerial

accounting • Assess how coding impacts reimbursement

Module Two Review: Financial Management and Coding

• Analyze third-party policies to determine payer-mix and reimbursement • Assess claims processing and the appeals process to achieve timely

reimbursement • Evaluate governmental payer types for compliance with rules and

regulations

Module Three Review: Claims Processing and the Government

• Compare and contrast the prospective payment systems • Assess the impact of payment systems on operations

Module Four Review: Prospective Payment Systems

• Differentiate among the managed care plans offered in healthcare • Assess the ACA and the impact on healthcare insurance negotiations • Evaluate how reimbursement data can be used for performance

incentives

Module Five Review: Affordable Care Act (ACA), Managed Care, and Pay Incentives

• Assess RAC and its impact on case management • Evaluate RAC and its impact on pay for performance incentives • Analyze the Promoting Interoperability regulation for electronic

health records

Module Six Review: Additional Regulations

•  Critique legal and ethical practices to prevent fraud and abuse •  Create a document that educates about key reimbursement concepts

and processes

Module Seven Review: Fraud and Abuse

Module Eight continues the discussion on reimbursement by reviewing the course content and allowing the students to reflect.

Conclusion