HITE 230 — Princpls Healthcare Reimbrsmnt
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 health 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. Students will also gain an understanding of the structure and determination of Diagnosis Related Groups (DRGs) and Ambulatory Payment Classifications (APCs). The course will include the billing processes and the billing forms (UB04 and CMS 1500) used to submit for reimbursement. Students will also learn the management of the revenue cycle.