HIM 2223 - Introduction to Coding and Reimbursement Systems

College of Health Sciences

Credit(s): 2
Contact Hours: 32
Effective Term Fall 2020 (580)

Requisites

Admission to Health Services Administration (Bachelor of Applied Science) (HSA-BAS) or
Admission to Health Information Technology (Associate in Science) (HIT-AS) or
Admission to Health Sciences (Associate in Science) (HSA-AS) or
Admission to Medical Coding and Revenue Management (Certificate with Financial Aid Eligibility) (MEDCD-CT) or
Admission to Health Care Services (Certificate with Financial Aid Eligibility) (HSA-CT) or
Admission to Health Sciences (Transfer Plan) (HSA-TR)

Course Description

This course gives learners an overview of healthcare reimbursement systems, and the impact on the US healthcare delivery system and economy. Concepts of this course include reimbursement terminology, methodologies, as well as the impact of health insurance, coding, billing, and compliance.

Learning Outcomes and Objectives

  1. Students will apply the principles of healthcare reimbursement by:
    1. discussing the influence of the federal government in the United States healthcare sector.
    2. describing types of healthcare reimbursement methodologies.
    3. exploring health insurance plans, government sponsored programs, and managed care plans.
  2. Students will apply the concepts of payment methodologies by:
    1. examining Medicare-Medicaid Prospective Payment Systems for Inpatient and Postacute care.
    2. explaining the origin and evolution of value-based purchasing and pay for performance.
    3. exploring other pay for performance models in other healthcare settings.
  3. Students will apply the concepts of revenue cycle management by:
    1. applying healthcare practices that impact reimbursement.
    2. defining medical necessity and utilization management.
    3. discussing coding issues that influence reimbursement.
    4. applying coding guidelines and adhering to clinical and coding compliance.
    5. identifying fraud, waste, and abuse.

Criteria Performance Standard

Upon successful completion of the course the student will, with a minimum 78% accuracy, demonstrate mastery of each of the above stated objectives through classroom measures developed by individual course instructors.

History of Changes

C&I 7/10/07, BOT 8/21/07 Effective 20072(0390) C&I 9/11/07, BOT 10/16/07, Effective 20072(0390). Was 2XX2; approved as 2223. “C” grade added eff 20081(0400). prereq prefix & # changed effective 20091. Prereq # change: CGS 1060 chg to CGS 1070 Effective 20102(0435). C&I Approval: 05/31/2013, BOT Approval: 08/05/2013, Effective Term: Spring 2014 (480). C&I Approval: , BOT Approval: , Effective Term: Fall 2017 (535). C&I Approval: , BOT Approval: , Effective Term: Spring 2019 (555).
C&I Approval: , BOT Approval: , Effective Term: Fall 2020 (580)

Related Programs

  1. Health Care Services (HSA-CT) (595) (Active)
  2. Health Information Technology (HIT-AS) (640) (Active)
  3. Health Sciences (HSA-TR) (670) (Active)
  4. Health Sciences: Dental Hygiene Focus (HSA-DENHY-AS) (640) (Active)
  5. Health Sciences: Emergency Medical Services Focus (HSA-EMS-AS) (640) (Active)
  6. Health Sciences: General Health Sciences Focus (HSA-GEN-AS) (640) (Active)
  7. Health Sciences: Health Information Technology Focus (HSA-HIT-AS) (640) (Active)
  8. Health Sciences: Nursing Focus (HSA-NURSE-AS) (640) (Active)
  9. Health Sciences: Physical Therapist Assistant Focus (HSA-PTA-AS) (640) (Active)
  10. Health Sciences: Radiography Focus (HSA-RAD-AS) (640) (Active)
  11. Health Sciences: Respiratory Care Focus (HSA-RESC-AS) (640) (Active)
  12. Health Sciences: Surgical Services Focus (HSA-SURG-AS) (640) (Active)
  13. Health Sciences: Veterinary Technology Focus (HSA-VETTC-AS) (640) (Active)
  14. Health Services Administration (HSA-BAS) (655) (Active)
  15. Medical Coder/Biller Applied Technical Diploma (MEDATD-AR) (590) (Active)
  16. Medical Coder/Biller PTC (MEDCDTC-AR) (635) (Active)
  17. Medical Coding and Revenue Management (MEDCD-CT) (595) (Active)