Transcript title

Reimbursement Systems

Credits

4

Grading mode

Standard letter grades

Total contact hours

50

Lecture hours

30

Other hours

20

Prerequisites

Instructor approval required based on completion of first-year HIM curriculum.

Course Description

Provides an overview of third party payers in a variety of healthcare settings. Includes commercial health insurance, government payers, workman's comp, and liability. This course also addresses coding compliance, coding for medical necessity and completion and submission of claims, including their electronic versions.

Course learning outcomes

1. Examine third party payer types and health insurance models.
2. Compare and contrast managed health care models, commercial insurance, government payers and others.
3. Describe other liability payers, such as home, auto, and general liability insurance.
4. Identify coding compliance standards.
5. Utilize compliance standards for completion and submission of claims, including their electronic versions.

Content outline

1. History of third party payer types. 2. Current third party payers and health insurance model. 3. Managed health care models. 4. Commercial insurance and Blue Cross Blue Shield. 5. Medicare, Medicaid, Tricare. 6. Workers' Compensation programs. 7. Liability payers, home, auto, general liability. 8. Coding compliance standards. 9. Completion and submission of claims, including their electronic versions.

Required materials

Required textbook. Computer and reliable internet access. Portable storage device (ie. usb drive).