The American University HTH 2309 Reimbursement Methodologies

Introduces the student to different health insurances, managed care plans, and reimbursement methods. Students become familiar with the health insurance industry, physicians’ office billing practices, legal and regulatory issues, and proper billing codes assignment to complete claim forms. Eligibility requirements, claims processing and adjudication, collection, and computerized patient accounting procedures are also emphasized.

Learning outcomes

• Define basic health insurance, managed care terms, and abbreviations.
• Discuss the differences between managed care and government sponsored insurance plans.
• Interpret the legal, regulatory considerations involved in health care reimbursement.
• Use CPT and ICD-9 coding systems to complete claim forms.
• Analyze the components of revenue cycle management and its impact on the physician’s office.
• Analyze explanation of benefits (EOB) and remittance advice (RA).
• Apply reimbursement methodologies to calculate payer reimbursement.

Prerequisites

None