HITT217 Health Insurance and Reimbursement

Department of Professional Studies: Health Information Technology

I. Course Number and Title
HITT217  Health Insurance and Reimbursement
II. Number of Credits
3 credits
III. Number of Instructional Minutes
IV. Prerequisites
HITT190 (C or better)
V. Other Pertinent Information
VI. Catalog Course Description
This course covers health insurance products and managed care approaches to the financing and delivery of healthcare services. Students explore reimbursement and payment methodologies. Students examine forms, processes, practices, and the roles of health information professionals. Students discuss concepts in insurance, third-party and prospective payments, and managed care organizations.
VII. Required Course Content and Direction
  1. Course Learning Goals

    Students will:

    1. identify and comprehend medical insurance products and services and the impact they have on the healthcare delivery system;
    2. demonstrate an understanding of the role of healthcare providers, insurers, and integrated delivery systems in the medical insurance marketplace;
    3. demonstrate an understanding of pay for performance systems and the Centers for Medicare and Medicaid Services model; and
    4. demonstrate an understanding of the basics of health insurance, public funding programs, managed care contracting, and how services are paid.
  2. Planned Sequence of Topics and/or Learning Activities

    1. systems used for reimbursement of healthcare services
    2. the role of government in healthcare services
    3. historical development of healthcare reimbursement in the United States.
    4. current processes, forms, and support practices for healthcare reimbursement
    5. government-sponsored health programs
    6. Centers for Medicare and Medicaid Services
    7. prospective reimbursement system
    8. revenue cycle management
    9. diagnosis-related group (DRG)
    10. proper sequencing of codes
    11. major diagnostic category (MDC)
    12. case mix index (CMI)
    13. UB-92
    14. resource-based relative value system
    15. outpatient prospective payment system
    16. resource utilization groups (RUGs)
    17. prospective payment methodology for reimbursement of ambulatory surgery
    18. federal fraud and abuse legislation and corporate compliance
    19. chargemaster
  3. Assessment Methods for Course Learning Goals

    The assessment of course learning goals will be based on classroom discussions, written exams, assignments, papers, and/or performance-based tasks and projects.
  4. Reference, Resource, or Learning Materials to be used by Student:

    See course syllabus.

Revision/Approval Date: Approved 6/15/2011; New Core 8/2015