HIM 182 : Introduction to Reimbursement and Classification Systems

Transcript title

Intro Reimbrsmt/Class Systems

Credits

4

Grade mode

Standard letter grades

Contact hours total

60

Lecture hours

20

Other hours

40

Prerequisites

Instructor approval.

Description

Provides an introductory survey of healthcare reimbursement methodologies: prospective payment systems, fee-for-service, resource-based relative value scale, and fee schedules. Provides an introductory survey of healthcare classification systems (coding systems): Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) Level II, International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Classification (ICD-10-CM/PCS), and others (DSM-5, ICD-O, ICF, NDC).

Learning outcomes

1. Demonstrate the concepts of reimbursement systems versus classification systems.
2. Identify and model prospective payment reimbursement systems.
3. Articulate reimbursement methodologies fee-for-service, capitation, pay for performance and others.
4. Examine and apply resource-based relative value scale (RBRVS) reimbursement system.
5. Identify fee schedule types and their application in various health care settings.
6. Explain the use of classification systems.
7. Differentiate the classification systems and their application in health care service reporting and claims for reimbursement.
8. Apply guidelines and conventions for Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) Level II, International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).
9. Illustrate other classification systems i.e. International Classification of Diseases, 10th Revision, Procedure Classification System (ICD-10-PCS), DSM-5, ICD-O, ICF, NDC.

Content outline

1. Concepts of reimbursement systems.
2. Concepts of classification systems.
3. Prospective payment reimbursement systems.
4. Reimbursement methodologies.
5. Resource-based relative value scale (RBRVS) reimbursement system.
6. Various fee schedules.
7. Classification systems: Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) Level II, International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Classification (ICD-10-CM/PCS), and others (DSM-5, ICD-O, ICF, NDC).

Required materials

Required textbook. CPT, HCPCS Level II, and ICD-10-CM coding resources provided. Computer and reliable internet access. Portable storage device (ie. usb drive).

Grading methods

This class requires a passing grade of 75% or better.

Outside of
expected

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