This course will focus on the basic concepts and principles of healthcare reimbursement and medical coding. The current healthcare insurance programs, commercial and government sponsored, will be described in the context of the United States healthcare 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 healthcare. Prospective payment systems will be differentiated between healthcare 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.
Prereq: HIT135; HIT216 or concurrent enrollment in HIT216.