OGEECHEE TECHNICAL COLLEGE One Joe Kennedy Boulevard Statesboro GA

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1 OGEECHEE TECHNICAL COLLEGE One Joe Kennedy Boulevard Statesboro GA SYLLABUS HIMT 2410 Revenue Cycle Management Course Information Course Date: Spring, 2014 Course Meeting Times: online course/angel Course Location: Course Type: Instructor: online course/angel online course/angel Priscilla Garrison, MHSA, RHIT Office hours: Monday, Wednesday, Thursday 9am-12p and Tuesday 9-10am Phone: Course Description: This course focuses on how the revenue cycle is impacted by various departments within the facility such as patient access/registration,case management/quality review, health information management, and patient accounting. Subjects include insurance plans, medical necessity, claims processing, accounts receivable, chargemaster, DRGs, APCs, edits, auditing and review. ICD and CPT coding as they relate to the billing function will be reviewed. The importance of revenue cycle management for fiscal stability is emphasized. Student Learning Outcome Upon successful completion of this course, the student will: Reimbursement System Define various payment methodologies used for inpatient and outpatient reimbursement. Interpret regulatory agency and payer-specific guidelines for use in the coding and reimbursement process. Select accurately diagnostic/procedural groupings such as diagnosis related group (DRG), MSDRGs, ambulatory payment classification (APC) systems, and Resource Utilization Groups (RUGs) based on coded data.

2 2 Define the data elements required for completing the industry-standard claim forms and computerized databases. Key Departments in the Revenue Cycle Diagram the flow of a patients charge and code data throughout a healthcare organizations revenue cycle. Define case mix index. Claims Processing Use applicable guidelines to comply with reimbursement and reporting requirements under the: Acute Inpatient PPS, Home Health PPS, Hospice, Inpatient Psychiatric Facilities PPS, Inpatient Rehabilitation Facilities PPS, Long-Term Care Hospital PPS, Skilled Nursing Facilities PPS, OPPS, RBRVS, managed care, and commercial payer contracts. Understand the health insurance query access (HIQA) process. Support accurate billing through coding, Charge-master, claims management, and bill reconciliation processes. Quality Management Compare and Contrast the differences in tools, auditing, communication and education for a clinical documentation improvement (CDI) program for an inpatient and outpatient setting. Outline the impact each of these regulatory entities or acts have on claims, coded data and supporting documentation: HIPAA, OIG, QIO, HEDIS, P4P, CDAC, and RAC. Evaluate a compliance programs communication methods and tools, policies and procedures, and training and education. Credit/Contact Hours: Prerequisites: GRADING AND EVALUATION 2 credits, 3 contact hours None Grading Scale: A B C D F 0-59 RHIT Competencies Domains and Subdomains Addressed in HIMT 2410 Domain Subdomain DSD# I. Healthcare Data Management D. Reimbursement Methodologies ID1. Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery. I. Healthcare Data D. Reimbursement ID2. Support accurate billing through coding, chargemaster, claims

3 Management Methodologies management, and bill reconciliation processes. I. Healthcare Data Management I. Healthcare Data Management D. Reimbursement Methodologies D. Reimbursement Methodologies ID3. Use established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative. ID4. Compile patient data and perform data quality review to validate code assignment and compliance with reporting requirements such as outpatient prospective payment systems. 3 III. Health Services Organization and Delivery A. Healthcare Delivery Systems IIIA3. Apply policies and procedure to comply with the changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, managed care, and so forth. IV. Information Technology & Systems A. Information and Communication Technologies IVA3. Use specialized software in the completion of HIM processes such as record tracking, release of information, coding, grouping, registries, billing, quality improvement, and imaging. HIMT Knowledge Clusters and Competencies (1) = Awareness (introductory recall and recognition) (2) = Literacy (knowledge of framework and content) (3) = Concept (comprehension, translation, extrapolation, and interpretation of meaning) (4) = Detailed understanding (appropriate application of knowledge in a structured or controlled context) (5) = Skilled use (applications using analysis, synthesis, and evaluation in new situations) Online Information Knowledge Cluster Health record monitoring and compliance reporting (5)-Chapter 2 Classifications, taxonomies, nomenclatures, terminologies, and clinical vocabularies (4)-Chapter 6; Chapter 7; Chapter 8 Principles and applications of coding systems (ICD, CPT, DSM, etc.) (5)-Chapter 6; Chapter 7; Chapter 8 Diagnostic and procedural groupings (DRGs, APCs, SNOMED, etc.) (5)-Chapter 6; Chapter 7; Chapter 8 Case-mix analysis and indexes (4)-Chapter 6 Severity-of-illness systems (4)-Chapter 2; Chapter 6 Coding compliance strategies, auditing, and reporting (5)-Chapter 2 Coding quality monitors and reporting (5)-Chapter 2 Commercial, managed care, and federal insurance plans (4)-Chapter 1; Chapter 3; Chapter 4; Chapter 5 Payment methodologies and systems (capitation, PPS, etc.) (4)-Chapter 1; Chapter 4 Billing processes and procedures (4)-Chapter 3; Chapter 9 Charge-master maintenance (5)-Chapter 9 Reimbursement monitoring and reporting (5)-Chapter 1; Chapter 3 Compliance strategies and reporting (4)-Chapter 2 Payment and reimbursement systems (4)-Chapter 1; Chapter 3; Chapter 4; Chapter 5; Chapter 6 Health information specialty systems (ROI, coding, registries) (5)-Chapter 2 Application of systems and policies to HIS and functions and data requests (5)-Chapter 2 Revenue cycle monitors (4)-Chapter 9

4 4 Orientation: Instructor turnaround: All students who intend to register for online classes are required to complete and pass an online orientation prior to registering for classes. To access the online orientation module, students must connect to the college website ( select Current Students and then select Online Orientation. Mrs. Garrison will routinely check ANGEL s during the work week with an expected turn-around time of 24 hours, M- R and 48 hours on the week-ends, F-Su. If you have any problems with ANGEL, please Mr. John Locke, jlocke@ogeecheetech.edu. LIBRARY RESOURCES The Ogeechee Technical College Library provides students access to books, periodicals, e-books, GALILEO, and other electronic resources. Students are encouraged to use the Library for class research projects. Help with research and projects is available within the Library. Computers are available for student use. A student ID is required in order to check out any materials from the Library or to use a computer. A self-service, black and white copier is also available. Hours of operation are Monday-Thursday from 7am until 9:30pm. Copyright Notice: The materials for this course are only for the use of students enrolled in this course for purposes associated with this course and may not be retained or further disseminated. Textbook & Materials Casto, Anne B. and Layman, Elizabeth; Principles of Healthcare Reimbursement, 3 rd Ed., AHIMA, ISBN: Materials: Medical Dictionary (Stedman s or Merriam Webster or access to a good one online). APA 6 th edition for your paper. One online site is You may also go to to access to this bibliography information if you re on campus. If you are unable to get to campus, please contact me and we will have an account set up for you. GALILEO Password for Fall Semester: phrase Microsoft Office Suite (Word, PowerPoint, Access, and Excel) Internet Access

5 5 Proctoring Policy In order to comply with accreditation requirements for the validation of student identity for all online courses, all students enrolled in online courses at Ogeechee Technical College (OTC) are required to have at least one proctored event (a major exam or assignment). The proctored event will count a minimum of 20% of the course grade, and will be reflected as such on the course syllabus. Proctored events must be completed prior to the end of the semester. The proctored event will be administered on the instructor s home campus and will be monitored by the instructor or another OTC employee. Students must attend the proctored session as scheduled on the Lesson Plan/Course Calendar. Students living farther than 50 miles from campus who cannot come to OTC for the event must secure an approved proctoring site. The site and the proctor must meet OTC s requirements. The off-campus proctored event must occur on the same day as the on-campus event unless approved by the course instructor. Students who do not complete the proctored event as scheduled must submit to the instructor a valid, documented excuse within three business days after the scheduled event. If the excuse is approved, students must make arrangements with the instructor to makeup/reschedule the missed event. Any penalty and makeup directions will be at the instructor s discretion. Students who do not complete the proctored event will receive a WF in the course. Assessment Distribution of Grades: Quizzes... 30% Mid-Term..20%... 20% Final... 20% Discussion Boards 10% Grading Scale: A B C D F 59 and below Chapter Quizzes: Quizzes should be taken after you have read the Chapter and studied it. They are timed at 10 minutes for ten questions, and are to be taken closed book. They will be available from Thursday 8am-Sunday midnight at the end of the week and beginning of the next week. For instance, week one quiz will be open from Thursday 8am-Sunday 11:55 pm, and so forth.

6 6 Quizzes & Mid-Term: Proctored Mid-term Final Exam: The Chapter Quizzes and the Mid-term Exam will be timed exams. The Mid-Term exam will be held on the OTC campus. The date, time and location will be announced as soon as the schedule is released to Mrs. Garrison. May 12, 2014, online 8 AM to 11:55pm, timed, nonproctored. Classroom Policies Attendance: Attendance for Online Classes Ogeechee Technical College has a mandatory attendance policy for all online courses. Students are required to attend an online course through completion of an academically related activity at least one time during each 7 day period. One academically related activity (defined below) per week is required to be considered present; however, much more than the minimum requirement will be required in order to pass the course. Per the attendance policy, all students are required to attend at least 90% of the scheduled class time. Any student who does not attend an online class for 11 or more consecutive days (10% of the class) will be withdrawn from the course. A student who does not complete an academically related activity in any 7 day period will be considered absent from class for that week. Any student who accrues two absences, either consecutive or nonconsecutive, in an online course may be withdrawn from the course. Academically Related Activities: Participating in weekly discussion boards Submitting a quiz or an exam Submitting a dropbox assignment Completing an interactive tutorial Note: Logging into the class without participating in an academically related activity is NOT considered attending. Course Withdrawal: Students may withdraw from a course without academic penalty until the midpoint of the term (as stated in the Academic Calendar and in the OTC Catalog and Student

7 Handbook). By withdrawing before the midpoint of the term, the student is automatically assigned a grade of W, which does not affect term or cumulative grade point average. Grades of W will affect satisfactory academic progress for financial aid purposes. Students who stop attending online class without formally withdrawing risk earning a final grade of F, which will appear on the academic transcript. Refer to the OTC Catalog and Student Handbook for further details. 7 Food and Drink: Food and beverages (other than water) are not allowed in classrooms/labs. Dress Code: Ogeechee Technical College strives to train honest, hardworking professionals of good character in a secure environment. That is why appropriate dress and clear display of student ID is expected of every student. On page 32 of the student handbook, the current OTC dress code reads as follows: Dress requirements vary in classrooms, laboratory, and shop areas. Students enrolled in internships and clinical courses are required to dress appropriately according to the requirements of the work for which they are being trained. Student shall not dress, groom, wear, or use emblems, insignias, badges, or other symbols or lewd or vulgar words where the effect thereof is offensive to a reasonable person or otherwise causes disruption or interference with the orderly operations of the college. The supervising administrator shall determine if the particular mode of dress results in disruptions or interference. Student shall at all times observe rules governing body cleanliness and not wear short or tight shorts, swimsuits, tank tops, bare midriffs, or have bare feet. Note: Possible sanctions appear on page 33 of the OTC Catalog & Student Handbook. Late Work: Readings and assignments will be given throughout the course and will have corresponding due dates that must be adhered to unless otherwise notified by the instructor. Late assignments will not be accepted without prior arrangement and approval of the instructor. All assignments are due on the assigned date at 11:55pm.

8 8 Students will be required to participate in one or two discussions each week. You are required to post a reply to both discussion questions by the third day (Wednesday) 11:55pm of each week and respond to at least two other learners replies by Saturday at 11:55pm. Missed Exams: Absences: Extra Credit: Cheating/Plagiarism: Safety The School of Health Sciences allows one day for make-up exams that have been missed during the quarter, including online courses. If an exam is missed for any reason by a student taking an online course, it will not be reset by the instructor during the quarter and no requests should be made of the instructor to do so. Only those students who contacted the instructor on the day of the exam with a valid excuse will be allowed to take the make-up exam. Per the attendance policy, all students are required to attend at least 90% of the scheduled class time. Any student who does not attend an online class for 11 or more consecutive days (10% of the class) will be withdrawn from the course. A student who does not complete an academically related activity in any 7 day period will be considered absent from class for that week. Any student who accrues two absences, either consecutive or non-consecutive, in an online course may be withdrawn from the course. There is no extra credit available in this course. Academic honesty is expected at all times. Any student found to have engaged in academic misconduct such as cheating, plagiarism, or collusion is subject to disciplinary sanctions as outlined in the Student Code of Conduct detailed in the OTC Catalog and Student Handbook. The term plagiarism includes, but is not limited to, the use, by paraphrase or direct quotation, of the published or unpublished work of another person without full and clear acknowledgment. The term collusion includes, but is not limited to, the unauthorized collaboration with any other person in preparing work offered for academic credit. Students are advised that faculty routinely use turnitin.com both to prevent plagiarism and to assist in verifying when/if it has occurred. In case of emergency while on campus, please refer to the Emergency Operations and Safety Plan and the Blood Borne Pathogen Exposure Control Plan found by the door of all classrooms and labs on the OTC campus. A copy of the OTC

9 Safety Plan can be found online at: ety.html. The Campus Safety & Security Director contact information is as follows: Stan York, phone: (912) ; address: 9 Disability Statement Warranty Statement Communication Students with disabilities who believe that they may need accommodations in this class based on the impact of the disability are encouraged to contact Penny Hendrix in the Support Services Office, Room 171E, Kennedy Bldg., , to coordinate reasonable accommodations. The Technical College System of Georgia guarantees employers that graduates of State Technical Colleges shall possess skills and knowledge as prescribed by State Curriculum Standards. Should any graduate employee within two years of graduation be deemed lacking in said skills, that student shall be retrained in any State Technical College at no charge for instructional costs to either the student or the employer. Important communication about this course will be transmitted through the Ogeechee Tech student system. Students should check their student accounts before each class in order to receive the most up-to-theminute information about classes and assignments. Ogeechee Tech sends vital information about financial aid, registration, and college news through the student system. Students should check their student accounts periodically for this information. Student may be accessed through the college website, under the Current Students tab. OTC Alert Disclaimer Students are encouraged to sign up for OTC Alert, a system designed to notify students of any emergency on campus. Alerts are sent by text messaging and/or by . To subscribe to OTC Alert, a student can go to and click on Current Students Banner Web OTC Alert Information. The instructor reserves the right to amend or edit any portion of this syllabus at any time.

10 10 HIMT 2410 Revenue Cycle Management DATE WEEK 1 January 13-19, 2014 WEEK 2 January 20-26, 2014 MLK Holiday 1/20/2014 WEEK 3 Jan. 27- Feb.2, 2014 WEEK 4 Feb. 3-9, 2014 WEEK 5 Feb , 2014 WEEK 6 Feb Winter Break WEEK 7 Feb. 24-Mar. 2, 2014 WEEK 8 Mar. 3-9, 2014 WEEK 9 Mar , 2014 WEEK 10 Mar , 2014 ASSIGNMENTS Chapter 1 Discussion Board () Quiz on Chapter 1 (All quizzes open Th. 8am-Sun. 11:55pm) Chapter 2 Quiz on Chapter 2 Chapter 3 Quiz on Chapter 3 Chapter 4 Quiz on Chapter 4 Chapter 5 Quiz on Chapter 5 NO ASSIGNMENTS Chapter 6, A Quiz on Ch. 6, A Mid-Term exam Proctored, on OTC campus. Details will be sent out as time approaches. Covers all of 1 st half of semester material, Ch. 1-6A. Chapter 6, B Quiz on Ch. 6, B Chapter 7, Part A

11 11 WEEK 11 Mar , 2014 WEEK 12 Mar. 31-Apr. 6, 2014 WEEK 13 Apr. 7-13, 2014 SPRING BREAK! NO CLASSES! WEEK 14 Apr , 2014 WEEK 15 Apr. 28-May 4, 2014 WEEK 16 May 5-8, 2013 FINAL Quiz on Chapter 7, Part A Chapter 7, Part B Quiz on Chapter 7, Part B Chapter 8, Part A Quiz on Chapter 8, Part A Chapter 8, Part B Quiz on Chapter 8, Part B April 14-17, 2014 Chapter 9 Quiz on Chapter 9 Chapter 10 Quiz on Chapter 10 Study and prepare for Final Exam. FINAL EXAM, May 12, 2014, 8 AM-11:55 PM, Online, Non-Proctored. JEH 12/11/13