College of Allied Health
Course Syllabus
HIM151 - Healthcare Reimbursement
4 Credit Hours
Course Description
This course provides the students with information about various
healthcare reimbursement programs, health insurance plans and the role
of health information technologists. Students apply their knowledge of
ICD-10-CM, ICD-10-PCS and CPT coding to the various healthcare
reimbursement programs.
Course Prerequisites
None
Required Text(s) and Resources
Casto, A. & White, S. (2021). Principles of healthcare reimbursement (8th ed.). Chicago, IL: AHIMA. ISBN:9781584269151
Student Learning Outcomes
Upon completion of this course, students will be able to:
- Compare and contrast the different types of healthcare reimbursement methodologies
- Evaluate commercial health insurance structure
- Compare and contrast the different Medicare/Medicaid offerings
- Explain evidence-based clinical guidelines
- Calculate MS-DRGs and evaluate the meaning
- Explain how coding management and clinical documentation relate to the revenue management cycle
- Analyze quality reporting programs
- Develop a plan for healthy outcomes
- Create a dashboard
HIM Associate Degree Entry Level Competencies
This course will focus on the following AHIMA competencies:
- IV.1 - Validate assignment of diagnostic and procedural codes and groupings in accordance with official guidelines
- IV.2 - Describe components of revenue cycle management and clinical documentation improvement
- IV.3 - Summarize regulatory requirements and reimbursement methodologies
- IV.2 (RM) - Evaluate revenue cycle processes
- IV.3 (RM) - Evaluate compliance with regulatory requirements and reimbursement methodologies
Assessment of Outcomes
Specified on the course schedule/outline
Grading System
| Letter Grade | Range | Definition |
|---|
| A |
90-100 |
Excellent |
| B |
80-89 |
Above Average |
| C |
70-79 |
Average |
| D |
60-69 |
Below Average |
| F |
0-59 |
Failing |
| W |
- |
Withdrawal during weeks 1 - 7 |
| WF |
- |
Withdrawal failing after week 7 |
| NF |
- |
Failing - Not actively engaged |
For more details about the Grading System, please see the current catalog.
Active Participation
Students must be actively engaged in the course. For a definition of active engagement, please see the current catalog.
Academic Integrity
Cheating and plagiarism are serious offenses against the
University's academic integrity and are consequently strictly
prohibited. All students must familiarize themselves with the
University policy on Academic Integrity.
Penalties for cheating and plagiarism are described in the
University policy on Academic Integrity in the catalog. They include
failure of the assignment, failure for the course, or dismissal from
the University. For the complete Cheating/Plagiarism policy, please see
the current catalog.
Students with Disabilities
Students who have disabilities that may impact their performance in
this course should follow the process described under the heading
Accommodations for the Disabled in the current catalog.
Discipline (Program) - Specific Information
None
Course Schedule
All courses in the HIM Program have a ten-day assignment cycle. Each
week's work is made available Friday at 5 p.m. and remains available
for ten days. The weekly assignments and discussions are due on the
Sunday night of the week following the week they were made available,
ten days later. For example, if the weekly assignments are made
available at 5 p.m. on Friday, January 8, the completed assignments are
due at midnight, on Sunday, January 17.
Note these two exceptions: Week 1 when the week's work is open from
the first day of the quarter at 8 a.m. to Sunday at 11:55 p.m. and the
last week when the final exam is available from Monday at 8 a.m. until
Thursday at 11:55 p.m. All times listed are EST/EDT.
This course requires a minimum of 70% (C) or higher for successful completion.
| Assignments |
Due
View Dates
|
| Lesson 1: Healthcare Reimbursement and Revenue Cycle |
- Read textbook Chapter 1 and the lecture
- Answer the "Check Your Understanding 1.1" questions
- Review the
"Chapter 1 Review Quiz"
- Read Chapter 1 PowerPoint presentation (link provided in lesson)
|
Sunday |
- Discussion 1.1 - Introductions
| Sunday |
- Assignment 1.1 - Models of Healthcare Delivery
- Assignment 1.2 - Reflection
|
Sunday |
|
Lesson 2: Commercial Healcare Insurance Plans
|
- Read textbook Chapter 2 and the lecture
- Answer the "Check Your Understanding 2.1" questions
- Answer the "Check Your Understanding 2.2" questions
- Review the
"Chapter 2 Review Quiz"
- Read Chapter 2 PowerPoint presentation
|
Sunday |
- Assignment 2.1 - Explanation of Benefits (EOB)
- Assignment 2.2 - Reflection
|
Sunday |
| Lesson 3: Government-Sponsored Healthcare Programs |
- Read textbook Chapter 3 and the lecture
- Answer the "Check Your Understanding 3.1" questions
- Answer the "Check Your Understanding 3.2" questions
- Review the
"Chapter 3 Review Quiz"
- Read Chapter 3 PowerPoint presentation
|
Sunday |
- Assignment 3.1 - Medicare Cost Sharing
- Assignment 3.2 - Reflection
|
Sunday |
| Lesson 4: Medicare Cost Sharing |
- Read textbook Chapter 4 and the lecture
- Answer the "Check Your Understanding 4.1" questions
- Answer the "Check Your Understanding 4.2" questions
- Review the
"Chapter 4 Review Quiz"
- Read Chapter 4 PowerPoint presentation
|
Sunday |
- Assignment 4.1 - Contract Matrix
- Assignment 4.2 - Reflection
|
Sunday |
| Lesson 5: Medicare Hospital Inpatient and Skilled Nursing Services Payment Systems |
- Read textbook Chapters 5 and the lecture
- Answer the "Check Your Understanding 5.1" questions
- Answer the "Check Your Understanding 5.2" questions
- Review the
"Chapter 5 Review Quiz"
- Read Chapter 5 PowerPoint presentation
- Read textbook Chapters 6 and the lecture
- Answer the "Check Your Understanding 6.1" questions
- Answer the "Check Your Understanding 6.2" questions
- Review the
"Chapter 6 Review Quiz"
- Read Chapter 6 PowerPoint presentation
|
Sunday |
- Assignment 5.1 - MS-DRG Calculations
- Assignment 5.2 - Midterm Project
- Assignment 5.3 - Reflection
|
Sunday (5.1, 5.3)
Thursday (5.2)
|
| Lesson 6: Medicare Hospital Outpatient and Physician Payment Systems |
- Read Chapter 7 of the textbook
- Answer the "Check Your Understanding 7.1" questions
- Answer the "Check Your Understanding 7.2" questions
- Review the "Chapter 7 Review Quiz"
- Read Chapter 7 PowerPoint presentation
- Read Chapter 8 of the textbook
- Answer the "Check Your Understanding 8.1" questions
- Answer the "Check Your Understanding 8.2" questions
- Review the "Chapter 8 Review Quiz"
- Read Chapter 8 PowerPoint presentation
|
Sunday |
- Assignment 6.1 - Medicare Provisions
- Assignment 6.2 - Reflection
|
Sunday |
| Lesson 7: Prospective Payment Systems for Post-Acute Care |
- Read Chapter 9 of the textbook
- Answer the "Check Your Understanding 9.1" questions
- Answer the "Check Your Understanding 9.2" questions
- Review the "Chapter 9 Review Quiz"
- Read Chapter 9 PowerPoint presentation
- Read Chapter 10 of the textbook
- Answer the "Check Your Understanding 10.1" questions
- Answer the "Check Your Understanding 10.2" questions
- Review the "Chapter 10 Review Quiz"
- Read Chapter 10 PowerPoint presentation
|
Sunday |
- Assignment 7.1 - Patient Care Decision
- Assignment 7.2 - Reflection
|
Sunday |
- Assignment 11.1 - Final Project assigned
| Lesson 11 |
| Lesson 8: Revenue Cycle – Claims Production and Revenue Collection |
- Read Chapter 11 of the textbook
- Answer the "Check Your Understanding 11.1" questions
- Answer the "Check Your Understanding 11.2" questions
- Review the "Chapter 11 Review Quiz"
- Read Chapter 11 PowerPoint presentation
|
Sunday |
- Assignment 8.1 - Dashboards
- Assignment 8.2 - Reflections
|
Sunday |
| Lesson 9: Revenue Cycle – Claims Production and Revenue Collection |
- Read Chapter 12 of the textbook
- Answer the "Check Your Understanding 12.1" questions
- Answer the "Check Your Understanding 12.2" questions
- Review the "Chapter 12 Review Quiz"
- Read Chapter 12 PowerPoint presentation
|
Sunday |
- Assignment 9.1 - Computer-Assisting Coding
- Assignment 9.2 - Reflection
|
Sunday |
| Lesson 10: Revenue Compliance |
- Read Chapter 13 of the textbook
- Answer the "Check Your Understanding 13.1" questions
- Review the "Chapter 13 Review Quiz"
- Read Chapter 13 PowerPoint presentation
|
Sunday |
- Assignment 10.1 - Recovery Audit Program
- Assignment 10.2 - Reflection
|
Sunday |
| Lesson 11: Finals Week |
- Assignment 11.1 - Final Project
|
Thursday |
Grading Criteria
| Assignment |
Weight |
| Reflection Papers |
10% |
| Assignments |
40% |
| Midterm Project |
20% |
| Final Project |
30% |
| Total |
100% |
Date of last review: 4/04/2024