2022-2023 Yavapai College Catalog 
    Jun 08, 2023  
2022-2023 Yavapai College Catalog [PREVIOUS CATALOG YEAR]

HIM 242 - Healthcare Reimbursement Methodology

Description: A comprehensive review of reimbursement systems used in professional and institutional healthcare settings. Emphasis on eligibility, health plans and programs, claims processing and third party payers. Review of HIPAA, federal billing guidelines, compliance, clinical coding and revenue cycle management.

Prerequisites: HIM 280  

Credits: 3
Lecture: 3
Course Content:

  1. Payment methodologies and systems, RBRVS
  2. Principles and applications of coding systems
  3. Commercial managed care and federal insurance plans
  4. Billing processes and claims procedures
  5. Regulatory guidelines
  6. Charge Description Master (CDM) maintenance
  7. Compliance strategies and reporting
  8. Reimbursement monitoring and reporting
  9. Value-Based Purchasing (VBP)

Learning Outcomes:
  1. Discuss application of diagnosis/procedure codes according to current nomenclature. (2) Domain I.C.2
  2. Distinguish and apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in health care delivery. (3) Domain I.D.2
  3. Break down billing by using resources from coding, the Chargemaster, claims management, and bill reconciliation processes. (4,6,8) Domain I.D.3
  4. Use established guidelines to comply with reimbursement and reporting requirements. (5) Domain I.D.4
  5. Apply policies and procedures to comply with the changing regulations among various payment systems for healthcare services. (1,7,9) Domain I.D.2
  6. Compare and contrast existing and emerging CMS (Centers for Medicare and Medicaid Services) quality initiatives. (9) Domain I.D.1, I.D.2

*Domains listed refer to CAHIIM Curriculum Requirements