PAGE 3 VERNON COLLEGE SYLLABUS COURSE NUMBER AND TITLE: HITT 2340 Advanced Medical Billing and Reimbursement

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1 VERNON COLLEGE SYLLABUS DIVISION: Allied Health and Human Services DATE: CREDIT HRS: HRS/WK LEC: 2 HRS/WK LAB: 2 LEC/LAB COMB: 4 I. VERNON COLLEGE GENERAL EDUCATION PHILOSOPHY STATEMENT General education at Vernon College reflects the institution s deep conviction that successful, satisfying lives require a wide range of skills and knowledge. Through the Texas Core Curriculum and through support and reinforcement in all non-core courses, students will gain a foundation of knowledge of human cultures and the physical and natural world, develop principles of personal and social responsibility for living in a diverse world, and advance intellectual and practical skills that are essential for all learning. CORE OBJECTIVES (GENERAL EDUCATION OUTCOMES) Critical Thinking Skills to include creative thinking, innovation, inquiry and analysis, evaluation and synthesis of Communication Skills to include effective development, interpretation, and expression of ideas through written, oral, and visual communication Empirical and Quantitative Skills to include the manipulation and analysis of numerical data or observable facts resulting in informed conclusions Teamwork - to include the ability to consider different points of view and to work effectively with others to support a shared purpose or goal Personal Responsibility to include the ability to connect choices, actions and consequences to ethical decision making Social Responsibility to include intercultural competence, knowledge of civic responsibility, and the ability to engage effectively in regional, national, and global communities II. CATALOG DESCRIPTION: Prerequisites: HITT 141 and HITT 2. Skill development in coding to prepare reimbursement forms in various health care settings for submission to payors. Lab Fee: $24.00; Special Fee: $0.00 III. REQUIRED BACKGROUND: Prerequisites: HITT 141 and HITT 2 IV. TEXTS, OTHER REFERENCE MATERIALS: Rowell, Green Understanding Health Insurance, w/cd. Delmar Publishing, Tenth Edition, 2012 REQUIRED HARDWARE: Computer with Internet Access V. METHOD OF INSTRUCTION: This course will use a variety of methods of instruction. Lecture, videos, class discussion, case studies will all be used. Course will be taught in either PSI or group instruction, depending on student needs.

2 PAGE 2 VERNON COLLEGE SYLLABUS Students desiring auxiliary aids and services for this course should make their requests to the instructor and the PASS Department Director/Office for Students with Disabilities Coordinator. VI. COURSE CONTENT: 1. Role of the insurance billing specialist 2. Legal aspects of insurance billing. Introduction to health insurance 4. Introduction to diagnostic and procedural coding. Patient registration and patient accounting procedures 6. HCFA-100 claim form completion guidelines 7. Electronic Data Interchange (EDI) 8. Managed care 9. Blue Cross/Blue Shield 10. Medicare 11. Medicaid 12. Tricare/CHAMPVA 1. Workers Compensation Curriculum Competencies and Knowledge Clusters for Health Information Management (HIM) Education at the Associate Degree Level Subdomain I.A Classification Systems 1. Apply diagnosis/procedure o ICD/CPT, HCPCS, SNOMED, DSM codes according to current guidelines o Healthcare data sets (OASIS, HEDIS, UHDDS, DEEDS) o SNOMED 2. Evaluate the accuracy of diagnostic and procedural coding. Apply diagnostic/procedural groupings 4. Evaluate the accuracy of diagnostic/procedural groupings terminologies, clinical vocabularies, auditing pplications of diagnostic and procedural grouping Domain IV. Revenue Management Definition: Healthcare reimbursement; revenue cycle; chargemaster; DOES NOT INCLUDE COMPLIANCE regulations and activities related to revenue management (coding compliance initiatives, fraud and abuse, etc.) AS THESE ARE COVERED IN DOMAIN V. Subdomain IV.A. Revenue Cycle and Reimbursement 1. Apply policies and procedures for the use of data required in healthcare reimbursement o Capitation, PPS, RBRVS, case mix, indices, MSDRGs, healthcare insurance policies, Accountable Care Organizations o Case management

3 PAGE VERNON COLLEGE SYLLABUS 2. Evaluate the revenue cycle management processes o Claims, EOB, ABN, electronic data interchange, coding, chargemaster, bill reconciliation process; hospital inpatient and outpatient, physician office and other delivery settings Subdomain V.D. Clinical Documentation Improvement 1. Identify discrepancies between supporting documentation and coded data monitoring 2. Develop appropriate physician queries to resolve data and coding discrepancies 6 improvements o Physician Role, HIM Role in CDI Commercial, managed care and federal insurance plans (Analyzing, 4) Compliance strategies and reporting (Applying, ) Payment methodologies and systems (such as capitation, prospective payment systems, RBRVS) (Analyzing, 4) Billing processes and procedures (such as claims, EOB, ABN, electronic data interchange) (Analyzing, 4) Chargemaster maintenance (Evaluating, ) Regulatory guidelines (NCDs and QIOs) () Reimbursement monitoring and reporting (Evaluating, ) Taxonomy Level Category Definition Verbs 1 Remember Recall facts, terms, basic concepts of previously learned material 2 Understand Determine meaning and demonstrate clarity of facts and ideas Apply Use differing methods, techniques and to acquire knowledge Choose, Define, Find Collect, Depict, Describe, Explain, Illustrate, Recognize, Summarize Adhere to, Apply, Demonstrate, Discover, Educate, Identify, Implement, Model, Organize, Plan, Promote, Protect, Report, Utilize, Validate

4 PAGE 4 VERNON COLLEGE SYLLABUS and/or solve problems 4 Analyze Contribute to the examination of in part or aggregate to identify motives and causes Evaluate Make judgments in support of established criteria and/or standards 6 Create Generate new knowledge through innovation and assimilation of data and Analyze, Benchmark, Collaborate, Examine, Facilitate, Format, Map, Perform, Take part in, Verify Advocate, Appraise, Assess, Compare, Comply, Contrast, Determine, Differentiate, Engage, Ensure, Evaluate, Interpret, Leverage, Manage, Mitigate, Oversee, Recommend Build, Compile, Conduct, Construct, Create, Design, Develop, Forecast, Formulate, Govern, Integrate, Lead, Master, Propose VII. COURSE OUTCOMES: The Course Outcomes for this course meet SCANS Competencies: F1(1a), 2(1b),F(1c), C(2b),C6(2c) F1(1a) 1-6 Foundation Skills: Basic Skills: read, write, perform arithmetic and mathematical operations, listen, and speak effectively F2(1b) 7-1 Foundation Skills: Thinking Skills: think creatively, make decisions, solve problems, visualize, know how to learn, and reason effectively F(1c) 1-17 Foundation Skills: Personal Qualities: display responsibility, self-esteem, sociability, self-management, integrity, and honesty C (2b) -10 Workplace Competencies: Interpersonal skills: deal with others effectively C6 (2c) Workplace Competencies: Information: acquire and use By the end of this course each student should be able to: 1. Code health records using various classification systems* 2. Execute reimbursement forms*. Apply revenue cycle management procedures*

5 PAGE VERNON COLLEGE SYLLABUS 4. Describe and explain the differences and similarities among insurance plans.. Accurately bill patients and insurance carriers for visits and procedures. 6. Use medical procedure and diagnosis codes. 7. Define various health care delivery systems. 8. Describe responsibilities of an insurance billing specialist. 9. Identify components of an authorization to release. 10. Compare the difference between direct pay, indirect pay, and third-party reimbursement methods. 11. List and discuss three third-party reimbursement methods. *WORKFORCE EDUCATION COURSE MANUAL (WECM) VIII. ASSESSMENT: Students will be evaluated on their ability to: 1. Examinations will be administered after each predetermined unit is complete. 2. Evaluation of all work handed in by student as a requirement.. See the Course Outline, Information, and Instruction sheet for further. Vernon College does not discriminate on the basis of color, race, gender, age, religion, national origin, or disability.