| Course Title: | Health Insurance and Reimbursement |
|---|---|
| Course Number: | HIT230 |
| Course Description: | Students explore reimbursement and payment methodologies applicable to healthcare provided in various settings in the United States. Forms, processes, practices, and the roles of health information professionals are examined. Concepts related to insurance products, third party, and prospective payment and managed care capitation are explored. Issues of data exchange among patient, provider, and insurer are analyzed in terms of organizational policy, regulatory issues, and information technology operating systems. Management of the chargemaster and the importance of coding integrity are emphasized. |
| Course Prerequisites: | HIT141 |
Syllabus
Course Information
Course Specific Requirements
Readings and Assignments
Each class will have reading assignments. The readings and assignments section each week provides specifics on text chapter readings, special notations on tables, exhibits, websites, and other materials on which you should concentrate. This listing provides details for each week’s activities and, where required, due dates and references to your papers, project, and exams.
Participation
Classroom participation, homework assignments, and discussions online are important elements of this class and are key to your learning. Discussion topics will be drawn from text readings, practical applications, and other areas designed to further the learning experience.
Discussions
Discussion participation will take place in the Discussion area. Discussions are a whole class forum—the online equivalent of class attendance. Discussion topics will be posted weekly, drawn from text readings, practical applications, and related areas designed to further your learning experience. Each student is expected to participate in the discussion a minimum of 3 days per week. See the detailed course expectations and grading guidelines outlined below. Also, review posted course policies.
Discussion Expectations and Grading Guidelines
Your active online participation grade (20% of the course grade) will be based on quantity, quality, and timeliness of your contributions to the posted discussion topics in Weeks 1–7, supplemented by your contributions to the course Webliography. You should strive to be in the discussion every other day to ensure that your fellow students are able to review your postings, respond, and share thoughts within the class week. The instructor will take great interest in your online time and participation in these discussions. Failure to effectively participate will have a notable impact on your perception of value for the course and your ultimate grading outcome.
For grading purposes, discussion participation will be evaluated in the week in which it is due; you must participate for that week to receive points. Grades will be posted the following week in the online Gradebook.
In general, grades will be based on the following guidelines.
(Insert specific instructor expectations and grading guidelines for participation in this course, consistent with material covered, availability of an online component, and current DeVry Online policy.)
Webliography
Additionally, each student will be expected to add a minimum of three topic-relevant websites to the course Webliography during the term to add to the discussion. The Webliography is accessed from the Course Home
Software Citation Requirements
This course uses open-source software, and as the end users of this software, students are required to cite the software for any student work, such as assignments, labs, or projects, where the software has been utilized. Open-source software does have end-user license agreements, and all students should read the entire agreement for a software prior to installation or usage. In order to use the software in this course, software citations have been created for students and can be located on the Open Source Applications page. These software citations must be included in all student work submissions that have used the software.
Textbooks and Resources
Required Textbooks
The following books are required for this course:
E-book Details
If you are a Chamberlain student, you must purchase your books through the bookstore before the eBook links above will function.
First Time Using VitalSource?
Step 1: View the VitalSource Video
Step 2: Register with VitalSource Bookshelf Online
- Click the cover or title of your eBook. A new window will open.
- Enter email address and password. Bookshelf Online will open.
Step 3: Access the Desktop and Mobile Versions
You must complete Step 2 prior to using the desktop or mobile versions.
Already Registered? 3 Ways to Access Your eBooks
Online
Access your eBook by clicking on the book cover or title in the syllabus page. Bookshelf Online will open.
Desktop
Download your eBooks and use them whether you're connected to the Internet or not.
Mobile
Download the app and get your eBooks on your iPhone, iPad, or Android device.
Campus Additional Information
Enter content here, if necessary.
Terminal Course Objectives
DeVry University course content is constructed from curriculum guides developed for each course that are in alignment with specific Terminal Course Objectives. The Terminal Course Objectives (TCOs) define the learning objectives that the student will be required to comprehend and demonstrate by course completion. The TCOs that will be covered in detail each week can be found in the Objectives section for that particular week. Whenever possible, a reference will be made from a particular assignment or discussion back to the TCO that it emphasizes.
1
Given an example of a reimbursement methodology, trace its development along a historical timeline, and relate to HIM practices.
2
Given state Medicaid eligibility requirements, relate examples of covered services to the coding, billing, and payment process.
3
Given the False Claims Act, compare and contrast examples of fraud and abuse in relation to coding and billing practices.
4
Given an example of individuals or groups seeking healthcare insurance in the United States, analyze available payment methods.
5
Given a Medicare payment process, compare and contrast the billing and payment steps under (a) fee-for-service and (b) managed care delivery models.
6
Given patient diagnosis and treatment in a managed care organization, inventory the steps required for the development, submission, review, and payment of a claim that has been submitted by the healthcare provider.
7
Given a skilled nursing facility prospective payment system (PPS) environment, relate requirements for medical necessity to the billing and payment process.
8
Given patient service and clinical data in an ambulatory healthcare office setting, relate the process of assuring its accuracy and integrity to the responsibilities of the health information professional.
9
Given the major steps in the billing cycle for an acute care hospital setting, relate the central role of the chargemaster to the requirements for billing and claims payment processing.
10
Given the role and function of medical peer review, examine the processes involved in establishing appropriate billing practices and assuring the appropriate use of healthcare resources.
11
Given an example of employer-sponsored healthcare plan, relate the role of the health information professional to steps in the healthcare reimbursement process for a contracted provider.
12
Given an example of a national data standard, examine the impact of standardized forms and formats for electronic data transmission on the efficiency and quality of the reimbursement process.
Lab Schedule
Week 1
None
Citrix
RKON
Skillsoft
Toolwire
WebServer
ACC COMAT
ACC NonCOMAT
CWP
EDUPE (MySQL)
Week 2
None
Citrix
RKON
Skillsoft
Toolwire
WebServer
ACC COMAT
ACC NonCOMAT
CWP
EDUPE (MySQL)
Week 3
None
Citrix
RKON
Skillsoft
Toolwire
WebServer
ACC COMAT
ACC NonCOMAT
CWP
EDUPE (MySQL)
Week 4
None
Citrix
RKON
Skillsoft
Toolwire
WebServer
ACC COMAT
ACC NonCOMAT
CWP
EDUPE (MySQL)
Week 5
None
Citrix
RKON
Skillsoft
Toolwire
WebServer
ACC COMAT
ACC NonCOMAT
CWP
EDUPE (MySQL)
Week 6
None
Citrix
RKON
Skillsoft
Toolwire
WebServer
ACC COMAT
ACC NonCOMAT
CWP
EDUPE (MySQL)
Week 7
None
Citrix
RKON
Skillsoft
Toolwire
WebServer
ACC COMAT
ACC NonCOMAT
CWP
EDUPE (MySQL)
Week 8
None
Citrix
RKON
Skillsoft
Toolwire
WebServer
ACC COMAT
ACC NonCOMAT
CWP
EDUPE (MySQL)
Course Schedule
| Week, TCOs, and Topics | Readings and Class Preparation | Activities and Assignments |
|---|---|---|
Week 1 TCO 1 Healthcare Reimbursement Methodologies | Chapter 1--Healthcare Reimbursement Methodologies | Graded Discussion Topics Quiz |
Week 2 TCOs 3, 4 and 11 Clinical Coding and Compliance and Voluntary Healthcare Insurance Plans | Chapter 2--Clinical Coding and Coding Compliance Chapter 3--Voluntary Healthcare Insurance Plans | Application Assignment Graded Discussion Topics Quiz |
Week 3 TCOs 2 and 5 Government Sponsored Healthcare Programs | Chapter 4--Government-Sponsored Healthcare Programs | Graded Discussion Topics Quiz |
Week 4 TCO 6 Managed Care Plans | Chapter 5--Managed Care Plans | Application Assignment Graded Discussion Topics Quiz |
Week 5 TCO 9 Medicare-Medicaid Prospective Payment Systems for Inpatients | Chapter 6--Medicare-Medicaid Prospective Payment Systems for Postacute care | Application Assignment Graded Discussion Topics Quiz |
Week 6 TCOs 7 and 8 Ambulatory, Post-Acute, and Other Medicare-Medicaid Reimbursement Systems | Chapter 7--Ambulatory and Other Medicare-Medicaid Reimbursement Systems Chapter 8--Medicare-Medicaid Prospective Payment Systems for Postacute Care | Graded Discussion Topics Quiz |
Week 7 TCOs 10 and 12 Revenue Cycle Management and Value-Based Purchasing | Chapter 9--Revenue Cycle Management Chapter 10--Value-Based Purchasing | Application Assignment Graded Discussion Topics Quiz |
Week 8 All TCOs | Final Exam | |
Blended E-Learning
This course is an 8-week, intensive course that includes both classroom-based and e-learning activities. Your participation in both areas is essential to your success in this course. You should expect to spend time each week participating in the prescribed activities both before and after our class meeting.
Participation before, during, and after class meetings is critical to your success in this intensive environment.
To get the most out of our weekly class meetings, it is essential that you come to class prepared. The weekly readings listed in the Course Schedule will prepare you for class. Our class meetings, in turn, will prepare you for upcoming exams and assignments.
Through the DeVry e-learning platform, you will be able to
- review the Syllabus and weekly assignment information;
- submit completed work for grading;
- take quizzes and exams;
- obtain copies of class handouts and notes;
- e-mail the instructor and other students; and
- participate in online discussion of class material.
Due Dates for Assignments & Exams
Unless otherwise specified, the following applies.
- Access to most weeks begins on Sunday at 12:01 a.m. mountain time (MT).
- All assignments are to be submitted on or before Sunday at the end of the specified week that they are due, by 11:59 p.m. (MT).
- All quizzes and exams are to be completed on or before Sunday at the end of the specified week that they open, by 11:59 p.m. (MT).
Week 8 opens at 12:01 a.m. (MT) on the ending Sunday of Week 7. Any assignments or exams must be completed by 11:59 p.m. (MT) Saturday of the eighth week.
Due Dates for Assignments & Exams
All assignments, quizzes, and exams are to be completed per the schedule indicated by your instructor.
Assignment Values and Letter Grades
The maximum score in this class is 1,000 points. The categories, which contribute to your final grade, are weighted as follows.
| Assignment | Points | Weighting |
|---|---|---|
| Discussions | 140 | 14% |
| Quizzes | 210 | 21% |
| Application Assignments (Week 2, Week 4, Week 5, Week 7)-100 points each | 400 | 40% |
| Final Exam | 250 | 25% |
| Total Points | 1,000 | 100% |
All of your course requirements are graded using points. At the end of the course, the points are converted to a letter grade using the scale in the table below.
Final grades are based on the percentage equivalent in the chart below and are not rounded to the next higher letter grade.
| Letter Grade | Points | Percentage |
|---|---|---|
| A | 900–1,000 | 90% to 100% |
| B | 800–899 | 80% to 89.9% |
| C | 700–799 | 70% to 79.9% |
| D | 600–699 | 60% to 69.9% |
| F | 599 and below | Below 60% |
DeVry Graduate Academic Policy and Relevant Resources
DeVry Undergraduate Academic Policy and Relevant Resources
Frequently Asked Questions
When are grades calculated, and how can I view my grades?
- You must complete any quizzes and post your written assignments (if necessary) to the weekly Dropbox by Sunday 11:59 p.m. (MT) each week, except Week 8 which closes at 11:59 p.m. (MT) Saturday.
- Once your work is reviewed, you should see comments and total points for each assignment in the Gradebook. Instructors should have Discussion work graded by the following Tuesday and all other assignments by the following Friday.
- You may check your progress at any time by going to the Gradebook, selecting the week and then your name.
- Click on the points earned for each assignment in the Gradebook to see any instructor comments.
What should I do if a discrepancy is found with my grade?
- Double-check the error and try to determine what caused it.
- Send your instructor an email explaining your findings.
- Trust that any error in grading will be corrected quickly
What if I cannot get my work submitted on time?
- If you have an emergency that will cause your work to be late, please contact your instructor in advance of the due date so that arrangements can be made. Your instructor may reserve the right to deduct points for work turned in late based on the reason and the timeliness of notice.
- If a technical problem prevents you from meeting the scheduled due date, please contact the Help Desk at 1-800-594-2402 and immediately email your instructor about the situation.
How can I get extra credit?
Extra credit is not an option.
Questions and Concerns
Please feel free to contact me for help with coursework or other areas that may impact your progress. Here are some examples.
- Do you have general questions about attendance, deadlines regarding your courses, student financial aid, or other areas?
- Are you a member of the military service? Do you need to adjust your schedule due to active duty, or do you have questions about your GI Bill® benefits or have other unforeseen military and veteran-related issues that have developed?
- Do you need supplementary student assistance? Please let me know if you are having academic difficulty and would like an ADA accommodation. Although I can talk with you about getting assistance, an excellent point of contact is the Office of Student Disability Services. You can reach the Office by calling 877-496-9050, option 3, or by e-mailing adaofficer@devry.edu or adaofficer@keller.edu.
Regardless of your situation, please feel free to contact me for assistance in whatever area of concern you might have. I will do everything I can to assist you or put you in contact with University colleagues who are trained to assist you in whatever area of concern you might have.
"GI Bill® is a registered trademark of the U.S. Department of Veterans Affairs (VA). More information about education benefits offered by the VA is available at the official U.S. government website: www.benefits.va.gov/gibill.”