HCM 3100: Reimbursement Methods in Health Care

Description

This course focuses on payment systems, including those for inpatient and ambulatory care settings, as well as those for psychiatric, hospice, and home health services. Topics include reimbursement and case mix management, revenue cycles, coding compliance requirements, charge-master maintenance, auditing processes, types of insurances, payment systems (e.g., prospective), and various Diagnosis Related Groups.

Objectives

1. Compare private health care and government-supplied health plans.
2. Apply development and assessment methods used in strategic planning and reimbursement within healthcare organizations.
3. Evaluate reimbursement methods used to efficiently appraise and oversee managed health care.
4. Explain critical issues in acute and long-term care reimbursement from the perspective of the insurance company and healthcare organization.
5. Interpret communal and global reimbursement issues that go beyond national borders and organizational culture.
6. Analyze the healthcare revenue cycle and medical claims process.
7. Define terms associated with health insurance and medical reimbursement (e.g., first party, second party, third party payers, capitation, fee-for-service, RBRVS, customary, reasonable and usual fees).

PreRequisites

1. HCM 3002

Textbook(s)

* Disclaimer: Textbooks listed are based on the last open revision of the course. Prior revisions and future revisions may use different textbooks. To verify textbook information, view the course syllabus or contact Student Services at students@waldorf.edu