Course Descriptions & Syllabi

Course Descriptions & Syllabi

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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 specific institutions and majors varies. Consult a counselor for this information.

Areas of Study | | HITT255 syllabus




COURSE NUMBER: HITT255
COURSE TITLE:Alternative Health Care Settings Insurance Procedures
DIVISION:Sciences
SEMESTER CREDIT HOURS:3
CONTACT HOURS:41
STUDENT ENGAGEMENT HOURS:139
DELIVERY MODE:Online

COURSE DESCRIPTION:
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.

NOTES: 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
  • Dialysis
  • Correctional Facilities
  • Mental Health
  • Substance Abuse
  • Facilities for Individuals with Intellectual or Developmental Disabilities
  • Long-Term Care
  • Home Health
  • Hospice
  • Rehabilitation
  • Dental Care Settings
  • Veterinary Settings
  • Consulting

Upon completion of this course, students will be able to:
  1. Apply diagnosis and procedure codes according to current guidelines using paper and electronic health records from multiple types of health care settings.
  2. Apply ethical coding and billing practice policies to create complete and accurate data.
  3. Describe regulatory issues, including licensure and accreditation standards for health care data in health records.
  4. Recognize documentation issues and describe how it would affect the reimbursement methodology in different settings.
  5. Summarize recommended retention periods for alternative site health records.
  6. Distinguish between the different types of reimbursement methodologies, payment, and other revenue issues used by each setting.
  7. 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).
  8. 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.
  9. Differentiate between claim forms utilized in the physician setting versus the facility setting, and the methods used to process an insurance claim.
  10. Verify the computing of RUG III, RVU, RBRVs used by third-party payers to determine the reimbursement for different settings.
  11. Discuss the role of HIM in the development and maintenance of a charge master.
  12. Explain issues in information management, including coding and classification, data and information flow, electronic information systems, and data sets for different settings.
  13. Adhere to the required and mandatory disclosure laws of the Health Insurance Portability and Accountability Act (HIPAA) in relation to insurance claims processing.
  14. Recognize claim denials to identify potential revenue issues and utilize appeal letters in response to claim denials.
  15. Summarize quality assessment, utilization management, and risk management activities that would be performed in the different settings.
  16. Differentiate the role of the health information management professional in different clinical settings.
  17. Describe trends affecting the practice areas and any other unique features of the practice area.

TEXTBOOK / SPECIAL MATERIALS:
See bookstore website for current book(s) at https://www.dacc.edu/bookstore

EVALUATION:
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.

LEARNING DOMAINS:
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

  1. n/a
  2. n/a
  3. Apply diagnostic/procedural groupings
  4. n/a
  Subdomain I.B. Health Record Content and Documentation
  1. n/a
  2. Verify the documentation in the health record is timely, complete, and accurate
  3. n/a
  4. n/a
  Subdomain I.C. Data Governance
  1. n/a
  Subdomain I.D. Data Management
  1. n/a
  2. Apply graphical tools for data presentations
  Subdomain I.E. Secondary Data Sources
  1. n/a
  2. n/a

Domain II. Information Protection: Access, Disclosure, Archival, Privacy & Security
  Subdomain II.A. Health Law

  1. n/a
  2. n/a
  3. Apply legal concepts and principles to the practice of HIM
  Subdomain II.B. Data Privacy, Confidentiality & Security
  1. n/a
  2. n/a
  3. n/a
  Subdomain II.C. Release of Information
  1. n/a

Domain III. Informatics, Analytics and Data Use
  Subdomain III.A. Health Information Technologies

  1. n/a
  2. n/a
  Subdomain III.B. Information Management Strategic Planning
  1. n/a
  2. Utilize health information to support enterprise wide decision support for strategic planning
  Subdomain III.C. Analytics and Decision Support
  1. n/a
  2. n/a
  Subdomain III.D. Health Care Statistics
  1. Utilize basic descriptive, institutional, and healthcare statistics
  2. n/a
  Subdomain III.E. Research Methods
  1. n/a
  Subdomain III.F. Consumer Informatics
  1. n/a
  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. Revenue Management
  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. Compliance
  Subdomain V.A. Regulatory

  1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
  2. n/a
  3. Adhere to the legal and regulatory requirements related to health information management
  Subdomain V.B. Coding
  1. n/a
  2. n/a
  Subdomain V.C. Fraud Surveillance
  1. n/a
  Subdomain V.D. Clinical Documentation Improvement
  1. n/a
  2. n/a

Domain VI. Leadership
  Subdomain VI.A. Leadership Roles

  1. Summarize health information related leadership roles
  2. n/a
  3. n/a
  Subdomain VI.B. Change Management
  1. n/a
  Subdomain VI.C. Work Design and Process Improvement
  1. n/a
  2. n/a
  3. n/a
  Subdomain VI.D. Human Resources Management
  1. n/a
  2. n/a
  3. n/a
  Subdomain VI.E. Training and Development
  1. n/a
  2. n/a
  Subdomain VI.F. Strategic and Organizational Management
  1. n/a
  2. n/a
  3. Describe the differing types of organizations, services, and personnel and their interrelationships across the healthcare delivery system
  4. n/a
  5. n/a
  Subdomain VI.G. Financial Management
  1. n/a
  2. n/a
  3. n/a
  Subdomain VI.H. Ethics
  1. n/a
  2. n/a
  3. n/a
  4. n/a
  Subdomain VI.I. Project Management
  1. n/a
  Subdomain VI.J. Vendor/Contract Management
  1. n/a
  Subdomain VI.K. Enterprise Information Management
  1. n/a

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.

REVISION:
Fall 2019

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