Reimbursement Methodologies

Catalog description

A study of the reimbursement systems and issues which include the compliance environment; payers and reimbursement vocabulary. Reimbursement systems that are studied include the Inpatient and Outpatient Prospective Payment System, MS-DRGs, RBRVS, and APCs. The Chargemaster processes, EDI billing technologies and applications programs are reviewed. The code sets of HIPAA are reviewed, as well as claim processing and revenue cycle management. Co-requisite: HIT 241