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Jul 07, 2025
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HIM-2600 Medical Reimbursement and Billing Credits 3 This course will focus on reimbursement and payment systems appropriate to acute and ambulatory settings. Emphasis will be placed on prospective payment systems, third party payers, medical claims processing, and regulatory compliance issues. Prerequisite(s): HIM-1600 with grade of C or higher, or permission of program director. Corequisite(s): HIM-2511 , HIM-2520 , and HIM-2560 concurrent. 3 class/1 lab hours. (Offered fall only.)
Course Outcomes
- Evaluate the accuracy of diagnostic and procedural coding.
- Apply the Centers for Medicare and Medicaid Services (CMS) inpatient and outpatient prospective payment systems.
- Interpret the Ambulatory Payment Classification (APCs) system.
- Process the Uniform Bill UB-04 (CMS 1450) claim form for hospital outpatient care.
- Relate the CMS Ambulatory Surgery Center (ASC) to facility reimbursement.
- Compare/contrast the CMS Resource Based Relative Value System and the National Correct Coding Initiative as it relates to physician reimbursement.
- Distinguish between three major classes of health insurance contracts (managed care, federal, and private).
- Process an insurance claim from the physician’s office including submission, reimbursement, and appeal.
- Complete the CMS 1500 claim form.
- Identify compliance issues as they relate to fraud and abuse when associated with claims coding.
- Identify compliance issues as they relate to fraud and abuse when associated with claims coding.
- Apply the basic concepts of electronic billing.
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