HITT 255 Alt Healthcare Settings Insurance
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.