| HIT 1203 - Healthcare Reimbursements |
This course prepares individuals to compare healthcare payers, illustrate the reimbursement cycle, and comply with regulations related to fraud and abuse of healthcare reimbursement services. Individuals will assign Diagnosis Related Groups (DRGs), Ambulatory Payment Classification (APCs) & Resource Utilization Groups (RUGs) with entry-level proficiency using computerized encoding & grouping software. Attention is given to the history of health insurance in the United States. A summary of insurance coverage is then provided. The impact of managed care on hospital and physician reimbursement is highlighted. The structure of Government payers, Medicare and Medicaid are explained and the stringent coding rules mandated by Medicare are discussed. Individuals will engage in simulations that illustrate the importance of negotiation and cooperation in providing services under different reimbursement scenarios. PREREQUISITE: HIT 1201 Healthcare Delivery Systems and HIT 1202 Healthcare Data Management or concurrent enrollment. |