HITT217 Health Insurance and Reimbursement
Department of Health Sciences: 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
Course Learning Goals
- Analyze the impact medical insurance products and services have on the healthcare delivery system;
- Explain the role of healthcare providers, insurers, and integrated delivery systems in the medical insurance marketplace;
- Explain pay-for-performance systems and the Centers for Medicare and Medicaid Services model; and
- Discuss health insurance, public funding programs, managed care contracting, and how services are paid.
Planned Sequence of Topics and/or Learning Activities
- systems used for reimbursement of healthcare services
- the role of government in healthcare services
- historical development of healthcare reimbursement in the United States.
- current processes, forms, and support practices for healthcare reimbursement
- government-sponsored health programs
- Centers for Medicare and Medicaid Services
- prospective reimbursement system
- revenue cycle management
- diagnosis-related group (DRG)
- proper sequencing of codes
- major diagnostic category (MDC)
- case mix index (CMI)
- UB-92 (Universal Billing Form-92)
- resource-based relative value system
- outpatient prospective payment system
- resource utilization groups (RUGs)
- prospective payment methodology for reimbursement of ambulatory surgery
- federal fraud and abuse legislation and corporate compliance
Assessment Methods for Course Learning GoalsThe assessment of course learning goals will be based on classroom discussions, written exams, assignments, papers, and/or performance-based tasks and projects.
Reference, Resource, or Learning Materials to be used by Student:See course syllabus.
Revision/Approval Date: Approved 6/15/2011; New Core 8/2015; Revised 1/3/2022