Reimbursement Systems (HIT 218)
3.0 Semester Hours
This course will focus on the basic concepts and principles of health care reimbursement and medical coding. The current health care insurance programs, commercial and government sponsored, will be described in the context of the United States health care delivery system. The structure and management of a coding compliance program to meet the internal and external requirements will be described and analyzed. The origins, evolution and principles of managed care will be analyzed as a cost effective approach to deliver and finance health care. Prospective payment systems will be differentiated between health care settings including inpatient, hospital ambulatory services, physician offices, skilled nursing facilities and home care. The structure and determination of Diagnosis Related Groups and Ambulatory Payment Classifications are analyzed as well as the billing processes and the billing forms used to submit for reimbursement. The management of the revenue cycle is examined.