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HIMA240 - Healthcare Reimbursement Methodologies

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. (Prerequisite: HIMA110)





Prerequisites

Course Schedule

Registration Dates Course Dates Session Weeks
12/31/18 - 05/31/19 06/03/19 - 07/28/19 Spring 2019 Session D 8 Week session
03/25/19 - 08/30/19 09/02/19 - 10/27/19 Summer 2019 Session D 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.

Required Course Textbook:

Casto, A., & Forrestal, E. (2013). Principles of Healthcare Reimbursement (4th ed.). Chicago:
AHIMA Press.

NeehrPerfect Practice EHR Software

Recommended Text(s):

Mosby, I. (2009). Mosby's dictionary of medicine, nursing & health professions (8th ed.). St.
Louis, Mo.: Mosby/Elsevier.

ICD-9-CM 2014 for Hospitals, Volumes 1, 2 & 3 Standard Edition HCPCS 2014 Level II
Standard CPT 2014 Standard Edition. (2014). W B Saunders.
Required Textbook for the degree program:
Candidates are expected to adhere to APA style throughout the program. The Publication manual of the American Psychological Association (Currently 6th ed.) should be purchased and used in all courses.

Web Sites

In addition to the required course texts, the following public domain web sites are useful. Please abide by the university’s academic honesty policy when using Internet sources as well. Note web site addresses are subject to change.

AHIMA Home - American Health Information Management Association. (n.d.). Retrieved
December 2, 2014, from http://www.ahima.org/

HIMSS - Healthcare Information and Management Systems Society. (n.d.). Retrieved December
2, 2014, from http://www.himss.org/

Book Title:Principles of Healthcare Reimbursement, 4th ed. - e-book available in the APUS Online Library.
ISBN:9781584263401
Publication Info:American Health Information Management
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 #. You must be logged in to eCampus first to access the links.
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.