HITM2210

This course provides a study of the entire revenue cycle process, from the scheduling of the appointment to the receipt of payment. Students will explore numerous health insurance plans, reimbursement methodologies, and compliance strategies. Students will learn about the current healthcare reimbursement systems used in outpatient and inpatient settings. Students will adhere to current regulations and guidelines for insurance coverage, claim submission, and denial management. Student Learning Outcomes

• Distinguish how different Reimbursement Methodologies operate, including applicable regulations, transmittals, payment procedures and documentation.
• Compare the purpose and benefits of different third-party payers, including government-sponsored health programs.
• Apply revenue cycle management processes to support reimbursement for patient services.
• Evaluate the accuracy of diagnostic/procedural groupings for medical necessity.
• Identify procedures for obtaining patient demographic information, insurance verification, authorizations, and collecting time-of-service payments.
• Interpret reimbursement monitoring reports, to identify trends and patterns of Fraud and Abuse, Discharged but Not Billed, and Denied Claims.
• Demonstrate the ability to correctly complete various medical insurance billing forms.