10-530-120Intro to Medical Reimbursement
Course Information
Description
Investigates key trends that impact healthcare costs and reimbursement systems, including prospective payment methods and value-based purchasing. Learners compare government and non-government payers, explore payment methods, and apply systems to maximize reimbursement. Additionally, learners will gain skills in managing claim processes and advocating for patients navigating healthcare services.
Total Credits
2
Course Competencies
  1. INVESTIGATE trends that have an impact on healthcare costs and reimbursement systems
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    evaluate sociological and governmental trends that affect healthcare cost and reimbursement
    evaluate the trends in prospective payment and other cost-containing reimbursement methodologies
    evaluate the role of value-based purchasing and other quality of care initiatives that impact healthcare reimbursement

  2. COMPARE government and non-government payers and payment methodologies
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    compare eligibility
    compare benefits
    compare cost and utilization controls
    compare payment methodologies
    compare administration and oversight

  3. APPLY various prospective payment systems (e.g., MS-DRG, APC, RBRVS)
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    explain how codes affect groupings and reimbursement
    diagnostic /procedural grouping ensures optimal reimbursement
    diagnostic /procedural grouping selection process is articulated

  4. MANAGE the claim processes within the revenue cycle
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    prepare a claim for reimbursement
    assess a claim for accuracy
    resolve claim edits
    manage claim denials

  5. ADVOCATE for patients as they navigate healthcare systems and services
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    recognize when prior authorizations are required
    explain the availability of cost estimates
    recognize when ABN/Notices of Non-coverage etc. are required