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Note: some or all of the courses in the subjects
marked as "Transfer" can be used towards a transfer degree: Associate of Science
and Arts or Associate of Engineering Science at DACC. Transferability for
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Areas of Study
| HITT255 syllabus
|COURSE NUMBER: ||HITT255|
|COURSE TITLE:||Alternative Health Care Settings Insurance Procedures|
|SEMESTER CREDIT HOURS:||3|
|STUDENT ENGAGEMENT HOURS:||139|
This course addresses medical services, health record systems, regulatory agencies, reimbursement methodologies, and insurance for non-acute care settings. Topics include regulatory issues, documentation requirements, reimbursement, information management, quality improvement, risk management, and current trends for services provided in places such as nursing homes, home health, correctional facilities, hospice, and rehabilitation facilities. Basic concepts of healthcare reimbursement are covered along with types of payers, and types of insurance plans. The terminology, rationale and methodology, such as Resource Utilization Group Version Three (RUG III), Relative Value Unit (RVU), Resource-Based Relative Value Scales (RBRVs), Diagnosis-Related Groups (DRGs), Ambulatory Payment Classifications (APCs), Insurance Investment in Cash Deposit (IVCD), Local Medical Review Policy (LMPR), Advance Beneficiary Notice (ABN), and Explanation of Benefits (EOB)
used by third-party payers to determine the reimbursement for health care providers will be examined. Proper completion of the 1500 billing form and legal issues related to reimbursement will be discussed, as well as the role Health Information Management (HIM) plays in the Charge Description Master, Reimbursement Monitoring, Revenue Cycle, Compliance and Case-Mix Management. An overview of hospital and nursing home billing systems including proper submission of Uniform/Universal Billing Form 92s (UB-92s) will also be covered.
This course is available for web registration.
STUDENT LEARNING OUTCOMES:
*With regard to the following practice areas,
- Hospital-Based Care
- Freestanding Ambulatory Care
- Managed Care
- Correctional Facilities
- Mental Health
- Substance Abuse
- Facilities for Individuals with Intellectual or Developmental Disabilities
- Long-Term Care
- Home Health
- Dental Care Settings
- Veterinary Settings
Upon completion of this course, students will be able to:
TEXTBOOK / SPECIAL MATERIALS:
- Apply diagnosis and procedure codes according to current guidelines using paper and electronic health records from multiple types of health care settings.
- Apply ethical coding and billing practice policies to create complete and accurate data.
- Describe regulatory issues, including licensure and accreditation standards for health care data in health records.
- Recognize documentation issues and describe how it would affect the reimbursement methodology in different settings.
- Summarize recommended retention periods for alternative site health records.
- Distinguish between the different types of reimbursement methodologies, payment, and other revenue issues used by each setting.
- Explain the appropriate healthcare data set against a given setting with sets such as Outcome & Assessment Information Set (OASIS), Healthplan Employer Data Information Sets (HEDIS), and Data Elements for Emergency Department Systems (DEEDS).
- Describe major methods of payment for U.S. healthcare, commercial and government-sponsored healthcare insurance plans with special attention paid to the terms associated with healthcare insurance and the clauses of healthcare insurance policies.
- Differentiate between claim forms utilized in the physician setting versus the facility setting, and the methods used to process an insurance claim.
- Verify the computing of RUG III, RVU, RBRVs used by third-party payers to determine the reimbursement for different settings.
- Discuss the role of HIM in the development and maintenance of a charge master.
- Explain issues in information management, including coding and classification, data and information flow, electronic information systems, and data sets for different settings.
- Adhere to the required and mandatory disclosure laws of the Health Insurance Portability and Accountability Act (HIPAA) in relation to insurance claims processing.
- Recognize claim denials to identify potential revenue issues and utilize appeal letters in response to claim denials.
- Summarize quality assessment, utilization management, and risk management activities that would be performed in the different settings.
- Differentiate the role of the health information management professional in different clinical settings.
- Describe trends affecting the practice areas and any other unique features of the practice area.
See bookstore website for current book(s) at https://www.dacc.edu/bookstoreEVALUATION:
A point system will be used to determine student's grades. Three sources of point values will be used to calculate the student’s final grade: homework 45%, tests 45%, and a final exam worth 10%.
90 - 100 = A
80 - 89 = B
70 - 79 = C
60 - 69 = D
59 & below = F
Note: Must receive C or better to pass.
This course addresses the following domains of knowledge identified by the
American Health Information Management Association as indicators of entry-level
competency for Health Information Technology. See the student handbook for a
complete list of domains and subdomains.
Domain I. Data Content Structure and Standards
Subdomain I.A Classification Systems
- Apply diagnostic/procedural groupings
Subdomain I.B. Health Record Content and Documentation
- Verify the documentation in the health record is timely, complete, and
Subdomain I.C. Data Governance
Subdomain I.D. Data Management
- Apply graphical tools for data presentations
Subdomain I.E. Secondary Data Sources
Domain II. Information Protection: Access, Disclosure, Archival, Privacy &
Subdomain II.A. Health Law
- Apply legal concepts and principles to the practice of HIM
Subdomain II.B. Data Privacy, Confidentiality & Security
Subdomain II.C. Release of Information
Domain III. Informatics, Analytics and Data Use
Subdomain III.A. Health Information Technologies
Subdomain III.B. Information Management Strategic Planning
- Utilize health information to support enterprise wide decision support for
Subdomain III.C. Analytics and Decision Support
Subdomain III.D. Health Care Statistics
- Utilize basic descriptive, institutional, and healthcare statistics
Subdomain III.E. Research Methods
Subdomain III.F. Consumer Informatics
Subdomain III.G. Health Information Exchange
- Explain current trends and future challenges in health information exchange
Subdomain III.H. Information Integrity and Data Quality
- Apply policies and procedures to ensure the accuracy and integrity of
health data both internal and external to the health system
Domain IV. Revenue Management
Subdomain IV.A. Revenue Cycle and Reimbursement
- Apply policies and procedures for the use of data required in healthcare
- Evaluate the revenue cycle management processes
Domain V. Compliance
Subdomain V.A. Regulatory
- Analyze policies and procedures to ensure organizational compliance with
regulations and standards
- Adhere to the legal and regulatory requirements related to health information
Subdomain V.B. Coding
Subdomain V.C. Fraud Surveillance
Subdomain V.D. Clinical Documentation Improvement
Domain VI. Leadership
Subdomain VI.A. Leadership Roles
- Summarize health information related leadership roles
Subdomain VI.B. Change Management
Subdomain VI.C. Work Design and Process Improvement
Subdomain VI.D. Human Resources Management
Subdomain VI.E. Training and Development
Subdomain VI.F. Strategic and Organizational Management
- Describe the differing types of organizations, services, and personnel and
their interrelationships across the healthcare delivery system
Subdomain VI.G. Financial Management
Subdomain VI.H. Ethics
Subdomain VI.I. Project Management
Subdomain VI.J. Vendor/Contract Management
Subdomain VI.K. Enterprise Information Management
|STUDENT CONDUCT CODE:||Membership in the DACC community brings both rights and responsibility. As a student at DACC, you are expected to exhibit conduct compatible with the educational mission of the College. Academic dishonesty, including but not limited to, cheating and plagiarism, is not tolerated. A DACC student is also required to abide by the acceptable use policies of copyright and peer-to-peer file sharing. It is the student’s responsibility to become familiar with and adhere to the Student Code of Conduct as contained in the DACC Student Handbook. The Student Handbook is available in the Information Office in Vermilion Hall and online at: https://www.dacc.edu/student-handbook|
|DISABILITY SERVICES:||Any student who feels s/he may need an accommodation based on the impact of a disability should contact the Testing & Academic Services Center at 217-443-8708 (TTY 217-443-8701) or stop by Cannon Hall Room 103. Please speak with your instructor privately to discuss your specific accommodation needs in this course.|