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HITM2263 – Reimbursement Systems pdf

Credits: 3 (2/1/0)
Description: This course covers the current reimbursement systems that are used in inpatient and outpatient settings in the health care industry. The revenue cycle management process will be covered, including the importance of clinical documentation improvement, chargemaster processes and procedures, compliance strategies, and fraud surveillance and reporting.
Prerequisites: HITM1150
Corequisites: (None)
  1. Apply and evaluate the accuracy of diagnostic and procedural groupings.
  2. Apply policies and procedures following provider contracts.
  3. Utilize software for grouping and billing.
  4. Apply policies and procedures for the use of data required in health care reimbursement.
  5. Evaluate the revenue cycle management processes.
  6. Identify discrepancies between supporting documentation and coded data.
  7. Comply with ethical standards of practice.
  8. Identify potential abuse or fraudulent trends through data analysis.
  9. Describe the differing types of organizations, services and personnel and their interrelationships across the health care delivery system.
  10. Utilize data for facility-wide outcomes reporting for quality management and performance improvement.
  11. Adhere to the legal and regulatory requirements related to health information management.
  12. Develop physician queries to resolve data and coding discrepancies.
MnTC goal areas: (N/A)

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