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HIMT 2305 (formerly HIT 2221) Syllabus

Course Syllabus

HIMT 2305 (formerly HIT 2221) - Revenue Cycle Management

3 Credit Hours

Course Information

Course Description:

This course focuses on advanced topics in healthcare reimbursement. The course includes an introduction to claims filing and processing, third party payers, and physician office management.

The course focuses on:

  • principles of healthcare reimbursement including health insurance plans
  • government-sponsored healthcare programs
  • managed care plans
  • fee schedules
  • resource-based relative value system for physician payment
  • prospective payment for various inpatient settings
Course Outcomes:

At the conclusion of this course, the student will be able to:

  • Explain the historical development of healthcare reimbursement in the United States.
  • Complete a CMS claim form for professional services accurately.
  • Review a UB04 claim form for hospital services and identify errors.
  • Identify various third party payers and regulations specific to each.
  • Explain the basics of healthcare claims process.
  • Define terminology and abbreviations associated with healthcare reimbursement and prospective payment systems.
  • Review documentation for information that substantiates the principal and secondary diagnoses as well as complications and/or comorbidities.
  • Define the purpose and content of the UB-92 and CMS-1500 claim forms fields.
  • Apply medical knowledge in review of documentation substantiate medical necessity of services provided.
  • Differentiate between different government sponsored healthcare programs including services covered and eligibility requirements.
  • Identify components of the revenue cycle.
  • Explain the importance of revenue cycle management
  • Describe the purpose and principles of utilization management and relationship between utilization management and health information management.
  • Define case mix and importance of case mix management.
  • Define fraud and abuse and discuss regulations as they relate to fraud and abuse.
  • Identify the steps of the medical review process and importance of medical necessity
  • Describe the origins and evolution of value-based purchasing and pay for performance. 
Prerequisites & Co-requisites:

Admission to HIMT program at CAHIIM accredited home school OR permission of local HIMT program director; BIOL 2010, HIMT 1300, HIMT 1301, HIMT 1302, HIMT 1303, HIMT 1305.

Course Topics:
 Course Topics
Module 1

Development of United States healthcare reimbursement systems for physician office services.
Medicare-Medicaid Prospective Payment Systems for Inpatients
Ambulatory and Other Medicare-Medicaid Reimbursement Systems

Module 2

Clinical Coding and Coding Compliance
Quality Issues 

Module 3

Voluntary Healthcare Insurance Plans
Government Sponsored Healthcare Programs
Managed Care Plans 

Module 4

Healthcare claims process
Content of claim forms-UB-92 and CMS-1500 

Module 5

Revenue Cycle Management 

HIM Associate Degree Entry Level Competencies: Domains, Subdomains, and Tasks

  • I. B. 2. Apply policies and procedures to assure organizational compliance with regulations and standards
  • I. C. 1. Use and monitor applications and work processes to support clinical classification and coding
  • I. C. 4. Ensure accuracy of diagnostic/procedural groupings (e.g. APC;DRG;IPS)
  • I. C. 5. Adhere to current regulations and established guidelines in code assignment
  • I. C. 6. Validate coding accuracy using clinical information found in the health record
  • I. C. 7. Identify discrepancies between coded data and supporting documentation
  • I. D.1. Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery.
  • I. D.2 Support accurate billing through coding, chargemaster, claims management, and bill reconciliation processes.
  • I. D.3 Use established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative.
  • I.D.4 Compile patient data and perform data quality reviews to validate code assignment and compliance with reporting requirements such as outpatient prospective payment systems.
  • III. A. 3. Apply policies and procedures to comply with the changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, managed care, and so forth.
  • III. B. 7. Demonstrate and promote legal and ethical standards of practice 
Specific Course Requirements:

Textbooks, Supplementary Materials, Hardware and Software Requirements

Required Textbooks:

Please visit the Virtual Bookstore to obtain textbook information for this course. Move your cursor over the "Books" link in the navigation bar and select "Textbooks & Course Materials." Select your Program, Term, Department, and Course; then select "Submit."

Supplementary Materials:
Hardware and Software Requirements:

Minimum hardware requirements can be found here.

Minimum software requirements can be found here.

Common applications you might need:

Web Resources:

Purdue OWL Online Writing Lab (for APA, MLA, or Chicago style)

The Writing Center Online Writer's Handbook

Student Resources:
  • Technical support information can be found on the TN eCampus Help Desk page.
  • Smarthinking virtual tutoring is available FREE of charge. to access Smarthinking, visit the course homepage and select Smarthinking under Course Resources. You also view sample sessions to see what Smarthinking offers and how it works.
  • Information on other student issues or concerns can be located on the TN eCampus Student Resources page.

Instructor Information

Please see "Instructor Information" in the Getting Started Module for instructor contact information, virtual office hours, and other communication information. You can expect to receive a response from the instructor within 24-48 hours unless notified of extenuating circumstances.

Participation, Assessments, & Grading

Testing Procedures:

All testing will occur online. It is the student's responsibility to remember to click "save" for each question when taking a quiz or test. If you do not save your answers, the test will not be reset for you. Your score will be based on what is submitted. 

Grading Procedures:

The course will be graded using a point system. The final grade will be computed using the following components for learning assessment: 

Description Total Points
Review QuizzesChapter 630
 Chapter 730
 Chapter 830
 Chapter 230
 Chapter 330
 Chapter 430
 Chapter 930
 Chapter 1030
DiscussionIntroduction10
 Module Three Chapter 5 Application Exercise
#1-Discussion
25
 Module Three Chapter 5 Application Exercise
#1-Response to two other students' posting
25
Article ReviewModule 2-Developing a Coding Compliance Policy Document30
 Module 4-Key Points of UB-0430
 Module 5-The Care and Maintenance of Charge Masters30
AssignmentsModule 1-Chapter 1 Real World Case15
 Module 2-Chapter 2 Application Exercise #325
 Module 3 Real World Case15
 Module 4-MedLearn Assignment Basics CMS-150025
 Module 5-Chapter 9 Application Exercise 230
MidtermWill Cover Modules 1 & 250
Final ExamWill Cover Modules 3, 4, 550
TOTAL POINTS 600

 

Grading Scale:
GradePercentagePoints Required
A93%-100%555-600
B85%-92%507-554
C77%-84%459-506
D70%-76%417-458
F69%-0%0-416

 

Assignments and Projects:

See detailed list under Grading Procedures above. Also within D2L you may use the Checklist; the link is found on the right side navigation bar. 

Class Participation:

Students must communicate with the instructor regarding any issues they have regarding the course, schedule and assignments. If a student is having difficulty with any concept being taught it is the student's responsibility to contact the instructor for assistance. To be successful the student should make regular contact with the instructor. Students must check the course discussions for discussion topics/questions. Students should check course announcements and updates on a regular basis. Students must actively participate in discussion events 

Late Policy:

Attending class and being punctual in an online environment should be treated with the same importance as a face-to-face class. Students are expected to logon to the course site at least once a day between Monday and Friday. Late submission of assignments may be allowed based on extenuating circumstances at the instructor's discretion and are subject to grade reduction. It is the responsibility of the student to contact the instructor about late submissions or circumstances interfering with the ability to complete course work on schedule. 

Course Ground Rules

The following two statements (1., 2.) were derived from the TBR System-wide Student Rules document, released January 2012:

RULES OF THE TENNESSEE BOARD OF REGENTS STATE UNIVERSITY AND COMMUNITY COLLEGE SYSTEM OF TENNESSEE SYSTEMWIDE STUDENT RULES CHAPTER 0240-02-03 STUDENT CONDUCT AND DISCIPLINARY SANCTIONS

Read the document in its entirety here.

1. Standards of Conduct:

  • Students are required to adhere to the same professional, legal and ethical standards of conduct online as on campus. In addition, students should conform to generally accepted standards of "netiquette" while sending e-mail, posting comments to the discussion board, and while participating in other means of communicating online. Specifically, students should refrain from inappropriate and/or offensive language, comments and actions.

2. Review the TN eCampus Academic Integrity/Academic Honesty Policy:

  • In their academic activities, students are expected to maintain high standards of honesty and integrity. Academic dishonesty is prohibited.

Such conduct includes, but is not limited to:

  • an attempt by one or more students to use unauthorized information in the taking of an exam
  • to submit as one's own work, themes, reports, drawings, laboratory notes, computer programs, or other products prepared by another person,
  • or to knowingly assist another student in obtaining or using unauthorized materials.

Plagiarism, cheating, and other forms of academic dishonesty are prohibited.

Students guilty of academic misconduct, either directly or indirectly through participation or assistance, are subject to disciplinary action through the regular procedures of the student’s home institution.  Refer to the student handbook provided by your home institution to review the student conduct policy.

In addition to other possible disciplinary sanctions that may be imposed, the instructor has the authority to assign an "F" or zero for an activity or to assign an "F" for the course.

Other Course Rules:

Students are expected to:

  • Participate in all aspects of the course
  • Communicate with other students
  • Learn how to navigate in Brightspace
  • Keep abreast of course announcements
  • Use the assigned course management (Brightspace) email address rather than a personal email address
  • Address technical problems immediately:
  • Observe course netiquette at all times.

Guidelines for Communications

Email:

  • Always include a subject line.
  • Remember without facial expressions some comments may be taken the wrong way. Be careful in wording your emails. Use of emoticons might be helpful in some cases.
  • Use standard fonts.
  • Do not send large attachments without permission.
  • Special formatting such as centering, audio messages, tables, html, etc. should be avoided unless necessary to complete an assignment or other communication.
  • Respect the privacy of other class members

Discussions:

  • Review the discussion threads thoroughly before entering the discussion. Be a lurker then a discussant.
  • Try to maintain threads by using the "Reply" button rather starting a new topic.
  • Do not make insulting or inflammatory statements to other members of the discussion group. Be respectful of other’s ideas.
  • Be patient and read the comments of other group members thoroughly before entering your remarks.
  • Be cooperative with group leaders in completing assigned tasks.
  • Be positive and constructive in group discussions.
  • Respond in a thoughtful and timely manner.

Library

The Tennessee Virtual Library is available to all students enrolled in TN eCampus programs and courses. Links to library materials (such as electronic journals, databases, interlibrary loans, digital reserves, dictionaries, encyclopedias, maps, and librarian support) and Internet resources needed by learners to complete online assignments and as background reading will be included within the course modules. To access the Virtual Library, go to the course homepage and select the Virtual Library link under Course Resources.

Students with Disabilities

Qualified students with disabilities will be provided reasonable and necessary academic accommodations if determined eligible by the appropriate disability services staff at their home institution. Prior to granting disability accommodations in this course, the instructor must receive written verification of a student's eligibility for specific accommodations from the disability services staff at the home institution. It is the student's responsibility to initiate contact with their home institution's disability services staff and to follow the established procedures for having the accommodation notice sent to the instructor.

Syllabus Changes

The instructor reserves the right to make changes as necessary to this syllabus. If changes are necessitated during the term of the course, the instructor will immediately notify students of such changes both by individual email communication and posting both notification and nature of change(s) on the course bulletin board.

Disclaimer

The information contained in this syllabus is for general information purposes only. While we endeavor to keep this information up-to-date and accurate, there may be some discrepancies between this syllabus and the one found in your online course. The syllabus of record is the one found in your online course. Please make sure you read the syllabus in your course at the beginning of the semester. Questions regarding course content should be directed to your instructor.


Last Revised on November 27, 2017