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Course Details

 

Course Details

Course Code: HIMA240 Course ID: 4902 Credit Hours: 3 Level: Undergraduate

This course provides students with a foundation of the basics of health insurance and public funding programs, managed care contracting, and payment for services. The content focuses on health insurance plans, government-sponsored healthcare programs, managed care plans, fee schedules, resource-based relative value system for physician payment and prospective payment for various inpatient settings. Students will examine various reimbursement methodologies, and the interconnection between clinical coding, compliance, and reimbursement. Within this, revenue life cycle management will be studied and its impact on provider financial stability.

Course Schedule

Registration Dates Course Dates Start Month Session Weeks
03/29/2022 - 09/02/2022 09/05/2022 - 10/30/2022 September Summer 2022 Session D 8 Week session
04/26/2022 - 09/30/2022 10/03/2022 - 11/27/2022 October Fall 2022 Session B 8 Week session
05/21/2022 - 11/04/2022 11/07/2022 - 01/01/2023 November Fall 2022 Session I 8 Week session
06/28/2022 - 12/02/2022 12/05/2022 - 01/29/2023 December Fall 2022 Session D 8 Week session
07/25/2022 - 12/30/2022 01/02/2023 - 02/26/2023 January Winter 2023 Session B 8 Week session

Current Syllabi

After successfully completing this course, candidates will be able to:
1. Distinguish among major health care payment methods in the United States.
2. Interpret health coverage statistics.
3. Analyze various managed care models.
4. Diagram the lifecycle of an insurance claim, including electronic data interchange.
5. Explain various terms as they relate to the insurance process.
6. Evaluate coding guidelines and the connection between compliance and reimbursement.

Forum
Please join the forums each week. Replies must be posted in the week due and replies after the end of each week will not be graded. The Forums are for student interaction and input should be submitted before the week ends in order to fully participate in the discussions. Students should demonstrate their own knowledge in the forums and avoid copying and pasting from websites.

Guidelines:
• Post the initial response to each forum by 11:55pm, ET, Thursday.
• Initial responses should be no less than 300 words and contains two references.
• Initial responses are to be original in content and demonstrate a thorough analysis of the topic.
• Reply to at least 2 of your classmates in each forum by 11:55pm, ET, Sunday.
• Replies to classmates should be no less than 200 words.
• Responses to classmates are significant to advance the forum.
• All forums can be accessed in the Forums section of the course.

NameGrade %
Discussions 20.00 %
Week 1: Introduction Coding Compliance Plans 2.50 %
Week 2: Healthcare Plans 2.50 %
Week 3: Compare and Contrast Medicare and Medicaid 2.50 %
Week 4: Origins of Managed Care 2.50 %
Week 5: Medicare and Medicaid Prospective Payment Systems 2.50 %
Week 6: Major Types of Medicare and Medicaid Reimbursement Systems 2.50 %
Week 7: Components of Revenue 2.50 %
Week 8: Reflection 2.50 %
Assignments 40.00 %
Week 1: Compliance and Leadership 5.00 %
Week 2: Creating a Claim 5.00 %
Week 3: CMS 1500 5.00 %
Week 4: Posting a Payment 5.00 %
Week 5: UHDDS 5.00 %
Week 6- Commercial Insurance and Capitation 5.00 %
Week 6 Assignmnet- Chargemaster and Cost Control 5.00 %
Week 7: Revenue Cycle Plan 5.00 %
Quizzes 20.00 %
Quiz 1 6.67 %
Quiz 2 6.67 %
Quiz 3 6.67 %
Comprehensive Final 20.00 %
Comprehensive Final 20.00 %

After successfully completing this course, candidates will be able to:
1. Distinguish among major health care payment methods in the United States.
2. Interpret health coverage statistics.
3. Analyze various managed care models.
4. Diagram the lifecycle of an insurance claim, including electronic data interchange.
5. Explain various terms as they relate to the insurance process.
6. Evaluate coding guidelines and the connection between compliance and reimbursement.

Book Title:Principles of Healthcare Reimbursement, 4th ed. - e-book available in the APUS Online Library.
ISBN:9781584263401
Publication Info:American Health Information Management Lib
Author:Casto, Anne
Unit Cost:$99.95
 
Book Title:To find the library e-book(s) req'd for your course, please visit http://apus.libguides.com/er.php to locate the eReserve by course #.
Author: No Author Specified
 
Book Title:EHR Go (aka Neehr Perfect) - Program Key & purchase instructions provided inside the classroom. Students will need access for the entire program. This material is not covered by the APUS Book Grant.
Author:No Author Specified
Electronic Unit Cost:$285.00
 

Previous Syllabi

Not current for future courses.