HDIM 2050 - Healthcare Reimbursement and Revenue Cycle Management

4.5 Credits

Students examine in depth healthcare reimbursement methodologies, bill reconciliation, and revenue cycle management including the charge master. Students apply the principles and application of diagnostic and procedural grouping. Students gain an understanding of Recovery Audit Contractor (RAC) audits, the Office of Inspector General (OIG) audits, case mix, interpreting explanation of benefits (EOB), and remittance advice.

Recommended: HDIM 2432

Lecture Hours: 4.5
Lab Hours: 0.0
Internship Hours: 0.0
Clinical or Practicum Hours: 0.0

Course Objectives

Identify types of healthcare reimbursement methodologies and their place of service used
Explain various Medicare improper payment review entities such as RAC audits
Analyze EOBs and RAs
Explain and demonstrate knowledge related to ambulatory payment classifications, physician quality reporting system, relative value units as well as resource-based relative value scale
Differentiate Medicare and Medicaid prospective payment systems for healthcare services delivered to patients in post-acute care as well as Medicare’s prospective payment systems for long-term care hospitals and inpatient rehabilitation facilities.
Differentiate the specialized collection instruments; standardized base rates, and case mix groups that exist in post-acute care.
Demonstrate knowledge in regards to revenue cycle management
Describe the origins and evolution of value-based purchasing and pay for performance
Analyze MSDRGs

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