HIM 282 : Reimbursement Systems

Transcript title

Reimbursement Systems

Credits

5

Grade mode

Standard letter grades

Contact hours total

80

Lecture hours

20

Other hours

60

Prerequisites

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

Description

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

Learning outcomes

1. Examine third party payer types and major developments over time.
2. Summarize current third party payers and health insurance model.
3. Describe managed health care models.
4. Compare/contrast managed health care models.
5. Describe commercial insurance and Blue Cross Blue Shield.
6. Describe government payers, Medicare, Medicaid, Tricare.
7. Describe Workers' Compensation programs.
8. Describe other liability payers, home, auto, general liability.
9. Identify coding compliance standards.
10. Utilize compliance standards for completion and submission of claims, including their electronic versions.

Content outline

1. Third party payer types and major developments over time.
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).

Grading methods

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

Outside of
expected

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