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Reimbursement and Collections Methods

In this module, students will study the use of coded data and health information in reimbursement and payment systems appropriate to all healthcare as well as managed care settings. Contemporary prospective payment systems and charge master maintenance and evaluation of fraudulent billing practices will be covered. Capitation, fee-for-service, relative value unit (RVU), and usual, customary, and reasonable (UCR) reimbursement methods will be discussed. Students will learn to interpret an Explanation of Benefits (EOB) for purposes of collection and payment. Students will also learn anatomy and physiology of the digestive and urinary systems. Medical terminology, pathophysiology and pharmacology related to these systems will also be discussed. Medicine coding guidelines will be introduced. Students will learn identification and method of code assignments, coding, and classification systems in order to assign valid diagnostic and or procedure codes using ICD-9, ICD-10, CPT, and HCPCS manuals. Students will also become familiar with and improve their keyboarding skills. By the end of this module students should feel comfortable using coding manuals to locate and assign diagnostic and procedural codes relating to the digestive and urinary systems and the medicine section of the CPT manual.


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