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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. (2024). 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

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

This course requires a minimum of 70% (C) or higher for successful completion.

Late work is not accepted.

The use of AI in the course is prohibited.

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 - Explaining the Revenue Cycle to New Employees Assignment 1.2 - Reflection	Sunday
Lesson 2: Commercial Healthcare 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	Wednesday

Grading Criteria

Assignment	Weight
Reflection Papers	10%
Assignments	40%
Midterm Project	20%
Final Project	30%
Total	100%

Date of last review: 04/04/2024