HIT 240 - Healthcare Reimbursement Methodologies

1. Explain the principles and applications of diagnostic and procedural coding grouping systems as the basis of prospective payment methodologies, such as MS-DRG’s, APC, RUG, CMG, HHRG.
2. Apply policies and procedures for the use of clinical data required in reimbursement for inpatients, ambulatory services, post-acute care and outpatient services, including PPS, RBRVS, case mix indices, MSDRGs, healthcare insurance policies and Accountable Care Organizations.
3. Illustrate policies and procedures to comply with the changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, commercial insurers and managed care.
4. Examine coding compliance issues that influence reimbursement.
5. Support accurate billing through coding, chargemaster, claims management and bill reconciliation processes.
6. Use established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative.
7. Evaluate revenue cycle processes.
8. Characterize the models of value-based purchasing for various healthcare settings, payment systems and providers.
9. Examine how report generation technologies and reimbursement data (OPPS, IPPS) can be used to support specific lines of business in healthcare.
10. Identify current trends and future challenges in the exchange of healthcare data for the purpose of reimbursement.
11. Access reimbursement and regulatory guidelines through the use of technology.