Principles of Healthcare Reimbursement MOA242 Winter 2012

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Principles of Healthcare Reimbursement

                                            MOA242

                                          Winter 2012
3 Credits Hours                                                         3 hours a week
                                   Tuesday Night 6- 8:54PM
Whiting Hall Room 101
Debra C Davisson, BS CPC
College Phone number 517-787-0800                                       Office Phone #, Ext #
Contact Phone 517-740-0184
Email Contact thebiller_2000@yahoo.com

Course Description
This course provides an introduction to the study of how reimbursement is calculated in the health
care industry. Focus is on different principles and applications of the business aspect of health
care. The student will explore different payment methodology is tied to billing and coding in a
variety of different health care settings.
Prerequisite (s)
MOA 241 and ACC216 or ACC231
Course Goals
This course will: describe the development, purpose, and general guidelines of health care
reimbursement; completion of CMS-1500 and UB-04 with basic CPT-4 and diagnosis coding for
the purpose of payment for the health care provider. Understanding payment methodology
through various fee schedules.
Performance Objectives
Assign procedure codes from the patient health record using CPT-4 coding.
Knowledgeable about the new coding system ICD-10, that will be implemented in the future.
Identify a UB-04 form and know its uses. Identify a CMS1500 and its uses.
Interpret types of insurance in direct correlation to how the claims are reimbursed.

Textbook (s)
Principles of Healthcare Reimbursement 3rd Edition. Authors Anne B. Casto and Elizabeth
Layman

Student Expectations
Come prepared for each class, having read the assigned material prior to arrival. Bring in any
necessary materials and turn in homework at the beginning of each class. Cell phones and lap tops
should not be utilized in any way during lecture.
Grading Scale
A distribution of grades across a percentage scale that will be used for assigning grades to course
work.


                                           Grading Scale
                                   4.0       =          94-100
                                  3.5        =          89-93
                                  3.0        =          84-99
                                  2.5        =          78-83
                                  2.0        =          72-77
                                  1.5        =          66-71
                                  1.0        =          60-65
                                  0.5        =          55-59
                                  0.0        =          0-54

Academic Honesty Policy
Academic honesty is expected of all students. It is the ethical behavior that includes producing
their own work and not representing other's work as their own, either by plagiarism, by cheating
or by helping other to do so. The Academic Honesty Policy is outlined in the Student Rights and
Responsibilities Handbook and on the JCC website.

Plagiarism
Plagiarism is the failure to give credit for the use of material from outside sources. Plagiarism
includes but is not limited to: Using data, quotations, or paraphrases from other sources without
adequate documentation; Submitting other's work as your own; Exhibiting other behaviors
generally considered unethical.

Cheating
Cheating is obtaining answers/material from an outside source without authorization. Cheating
includes, but is not limited to: plagiarizing in all forms; using notes/books without authorization;
copying; submitting other's work as your own or submitting your work for others; altering graded
work; falsifying data; exhibiting other behaviors generally considered unethical.

Collaboration
While JCC encourages students to collaborate in study groups, work teams, with class partners,
each student should take responsibility for accurately representing his/her own contribution.

Consequences/Procedures
Faculty members who suspect a student of academic dishonesty may penalize the student by
taking appropriate action up to and including assigning a failing grade for the paper, project,
report, exam, or the course itself. Instructors should document instances of academic dishonesty
in writing to the academic dean.

Help
Available learning services or opportunities for students seeking help with their course work.
Students may contact the Center for Student Success to obtain information about tutors, learning
centers, reserved library materials, open labs, counseling services.

Student Responsibilities
Homework is due at the beginning of each class and is worth 20% of grad

Quiz's and Test are worth10% of grade.

Mid Term and Final is worth 20% of grade each

Class attendance is 10% of grade.

Research Project is 20% of grade.

Attendance policy
Attendance and participation is mandatory. Attendance will be recorded at the beginning of each
class; if you are more than 10 minutes late you will be marked as absent. For each class you miss
your grade will be reduced by 10% participation is heavily weighted.

Calendar

___________________________________________________________________________
Week 1 January 10, 2012

Chapter 1: Healthcare Reimbursement Methodologies.

Key Term: Understand and apply terms in the healthcare business environment.

Understanding information on a patients insurance card/s

Application Exercises: Do in class Open or Group Discussion Problems 1-4

Review Quiz problems 1-10
Student Workbook Disc: Real-World Case answer Questions one and two

___________________________________________________________________________

Week 2- 3 January 17, 2012  January 24, 2012

Chapter 2 Clinical Coding and Coding Compliance
Key Term: Understand and apply terms in the healthcare business environment.

How are healthcare providers paid for their services? Understanding how CPT-4 and Diagnosis is
assigned to patients services, what is a modifier, what is a HCPC, how does a diagnosis code drive
reimbursements.
Understand basic concepts of how to assign a CPT to a patient utilizing CPT-4 and ICD-9 coding
books.

RAC? What is it and how does it affect the healthcare provider/industry

Student Workbook Disc: Review Quiz problems 1-10 (Same as back of chapter)

Coding assignments handed out in class

______________________________________________________________________________

Week 3-4 January 31, 2012- February 7, 2012

Test Chapters 1-2 January 31, 2012

Chapter 3 Voluntary Healthcare Insurance Plans

Key Term: Understand and apply terms in the healthcare business environment

Introduction to CMS-1500 and UB-04

Understanding what a commercial insurance is.

Third Party Administrators

Different BC/BS plans

Precertification and Prior approvals,

Student Workbook Disc Chapter 3: Review Quiz

______________________________________________________________________________

Week 5-6 February 14, 2012- February 21, 2012

Test chapter 3& 4 February 21, 2012

Chapter 4 Government Sponsored Healthcare programs

Key Term: Understand and apply terms in the healthcare business environment
Completing the CMS-1500 and UB-04 according to payer requirements for this insurance group.

Discussion of Medicare Secondary Payer and its rules

Understanding the different types of Medicare and how they are used.

Understanding what Medicare Advantage is.

Understanding Medicaid and different types of Medicaid products

Student Workbook Disc Chapter 4: Review Quiz and Application Exercises



Spring Break February 27, 2012  March 4, 2012

_______________________________________________________________________________

Week 7 Mid Term March 6, 2012__________________________________________________

Week 8-9 March 13, 2012  March 20, 2012

Chapter 5 Managed Care Plans

Key Term: Understand and apply terms in the healthcare business environment

Discussion of types of Managed Care Plans in the community Pros/Cons of having Managed Care
Plan from both a Provider and Subscriber Point of View. (Application Exercises from Workbook)
Commercial and Medicaid Managed Care Plans

Managed Care Fee Schedules and EOB's

Completing the CMS-1500 and UB-04 according to payer requirements for this insurance group.

Student Workbook Disc: Review Quiz
_____________________________________________________________________________

Week10 March 27, 2012

Chapter 6 Medicare-Medicaid Prospective Payment Systems for Inpatients.
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