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HIM 200 Healthcare Reimbursement
Credit Hours:  2
Effective Term: Fall 2017
SUN#: None
AGEC: None  
Credit Breakdown: 2 Lectures
Times for Credit: 1
Grading Option: A, B, C, D, F

Description: Principles of health insurance relating to private, state, and government programs, and managed care contracting within the U.S. healthcare payment systems are evaluated. Emphasis is placed on payment methodologies and systems within the revenue cycle management.

Prerequisites: HIM 158 CPT Coding

Corequisites: None

Recommendations: None

Measurable Student Learning Outcomes
Domain I. (Application Level) Data Content, Structure & Standards (Information Governance) (CSLO 2)

Subdomain I.A Classification Systems

3. Apply diagnostic/procedural groupings
4. Evaluate the accuracy of diagnostic/procedural groupings

Domain II. (Application Level) Information Protection: Access, Disclosure, Archival, Privacy & Security (CSLO 2)

Subdomain II.A. Health Law
1. Apply healthcare legal terminology
2. Identify the use of legal documents
3. Apply legal concepts and principles to the practice of HIM

Subdomain II.B. Data Privacy, Confidentiality & Security
1. Apply confidentiality, privacy and security measures and policies and procedures for internal and external use and exchange to protect electronic health information
2. Apply retention and destruction policies for health information
3. Apply system security policies according to departmental and organizational data/information standards

Subdomain II.C. Release of Information
1. Apply policies and procedures surrounding issues of access and disclosure of protected health information

Domain III. (Application Level) Informatics, Analytics and Data Use (CSLO 2)

Subdomain III.A. Health Information Technologies
2. Explain policies and procedures of networks, including intranet and Internet to facilitate clinical and administrative applications

Subdomain III.F. Consumer Informatics
1. Explain usability and accessibility of health information by patients, including current trends and future challenges

Subdomain III.G. Health Information Exchange
1. Explain current trends and future challenges in health information exchange

Subdomain III.H. Information Integrity and Data Quality
1. Apply policies and procedures to ensure the accuracy and integrity of health data both internal and external to the health system

Domain IV. (Analysis Level) Revenue Management (CSLO 2)

Subdomain IV.A. Revenue Cycle and Reimbursement
1. Apply policies and procedures for the use of data required in healthcare reimbursement
2. Evaluate the revenue cycle management processes

Domain V. (Analysis Level) Compliance (CSLO 2)

Subdomain V.A. Regulatory
1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
3. Adhere to the legal and regulatory requirements related to the health information management

Subdomain V.C. Fraud Surveillance
1. Identify potential abuse or fraudulent trends through data analysis

Domain VI. (Comprehension Level) Leadership (CSLO 2)

Subdomain VI.F. Strategic and Organizational Management

3. Describe the differing types of organizations, services, and personnel and their interrelationships across the health care delivery system

Subdomain VI.H. Ethics
1. Comply with ethical standards of practice
2. Evaluate the consequences of a breach of healthcare ethics

Internal/External Standards Accreditation