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Apr 19, 2024
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HITC 155 - Reimbursement Methodologies(2,2) 3 Credits
Prerequisite(s): HITC 152 - Basic ICD Coding , HITC 154 - Basic CPT Coding .
This course provides students the opportunity to learn the history, rationale, and methodology of the systems used by third-party payers to determine the reimbursement that health care providers will receive. Reimbursement concepts include fee-for-service, managed care, capitation systems, Diagnosis-Related Groups (DRGs), Resource Based Relative Value Scale (RBRVS), Ambulatory Payment Classifications (APCs), and related concepts. The use of the charge description master (chargemaster) in reimbursement will be discussed. The importance of compliance with regulations and the related issues of fraud and abuse will also be addressed.
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