Course Syllabus

Summer 2024 | AHS-2165-VO01 - Health Insurance Reimbursement & Billing

Online Class

Online courses take place 100% online via Canvas, without required in-person or Zoom meetings.

Faculty

Chris Denis
View Faculty Credentials
View Faculty Statement
Hiring Coordinator for this course: Ryan Joy

Course Description

This course examines the methods and processes for healthcare reimbursement in the United States, including the role of insurance, managed care, HMOs, PPOs, and Medicaid and Medicare in the finance and delivery of healthcare services. Students explore the healthcare revenue cycle for reimbursement and payment of medical claims. Prerequisites: Medical Terminology and Health Information Systems.

Essential Objectives

1. Discuss legal and ethical issues in healthcare reimbursement and billing, including HIPAA, OIG regulations, and patient rights.
2. Identify current and emerging payment models in the United States healthcare system, including fee-for-service and value-based reimbursement models.
3. Describe reimbursement sources in the United States, including managed care, third party payers, and related regulatory compliance issues.
4. Examine the steps of billing and reimbursement within the revenue cycle, including the flow cycle of claim forms, and identify common errors that result in insufficient or non-payment.
5. Analyze complicated medical claims to ensure proper reimbursement.
6. Identify the procedure for two or more party billing, such as Medicare/Medicaid and private insurance.
7. Apply medical insurance vocabulary as it relates to programs such as HMOs, PPOs, Point of Service, TRICARE, Medicare, and Medicaid Healthcare programs.
8. Demonstrate proper use of coding manuals (CPT, HCPCS, HCPCS Level II, and current ICD-CM) within the context of billing across a wide range of services.
9. Identify methods for addressing common issues such as medical necessity, claim denial and appeal, bundling, and charge capture.
10. Demonstrate the ability to accurately follow procedures, fill out common forms, and address common issues to maximize reimbursement.

Required Technology

More information on general computer and internet recommendations is available on the CCV IT Support page. https://support.ccv.edu/general/computer-recommendations/

Please see CCV's Digital Equity Statement (pg. 45) to learn more about CCV's commitment to supporting all students access the technology they need to successfully finish their courses.

Required Textbooks and Resources

This course uses one or more textbooks/books/simulations.

Summer 2024 textbook details will be available on 2023-11-06. On that date a link will be available below that will take you to eCampus, CCV's bookstore. The information provided there will be specific to this class. Please see this page for more information regarding the purchase of textbooks/books.

AHS-2165-VO01 Link to Textbooks for this course in eCampus.

The last day to use a Financial Aid Advance to purchase textbooks/books is the 3rd Tuesday of the semester. See your financial aid counselor at your academic center if you have any questions.

Artificial Intelligence(AI) Policy Statement

CCV recognizes that artificial intelligence (AI) and generative AI tools are widely available and becoming embedded in many online writing and creative applications.

Prohibited: The use of generative AI is not allowed in this course, with the exception of spellcheck, grammar check and similar tools. This course rests in the value of students engaging in the learning process without relying on AI-generated content. Students will develop critical thinking and problem-solving skills independently, owning their learning journey from start to finish. If you use these tools, your actions would be considered academically dishonest and a violation of CCV's Academic Integrity Policy.

Methods

Methods

• Large Group Discussions
• Reflective Journal Writing
• Workbook Critical Thinking Professional Case Scenarios
• Lectures
• Hands-On Projects
• Reading
• Multimedia Resources
• Quiz Simulation Preparation for Professional Credential(s)

Evaluation Criteria

Grading Criteria

CCV Letter Grades as outlined in the Evaluation System Policy are assigned according to the following chart:

	High	Low
A+	100	98
A	Less than 98	93
A-	Less than 93	90
B+	Less than 90	88
B	Less than 88	83
B-	Less than 83	80
C+	Less than 80	78
C	Less than 78	73
C-	Less than 73	70
D+	Less than 70	68
D	Less than 68	63
D-	Less than 63	60
F	Less than 60
P	100	60
NP	Less than 60	0

Weekly Schedule

Attendance Policy

Regular attendance and participation in classes are essential for success in and are completion requirements for courses at CCV. A student's failure to meet attendance requirements as specified in course descriptions will normally result in a non-satisfactory grade.

• In general, missing more than 20% of a course due to absences, lateness or early departures may jeopardize a student's ability to earn a satisfactory final grade.
• Attending an on-ground or synchronous course means a student appeared in the live classroom for at least a meaningful portion of a given class meeting. Attending an online course means a student posted a discussion forum response, completed a quiz or attempted some other academically required activity. Simply viewing a course item or module does not count as attendance.
• Meeting the minimum attendance requirement for a course does not mean a student has satisfied the academic requirements for participation, which require students to go above and beyond simply attending a portion of the class. Faculty members will individually determine what constitutes participation in each course they teach and explain in their course descriptions how participation factors into a student's final grade.

Participation Expectations

Participation Expectations

Attendance and involvement are measured through your presence and participation in all aspects of the class. Your participation is essential to the learning experience for you and your classmates.

Class discussions, in which you willingly share your thoughts and ideas, are also integral to the class and your learning process. Your participation in the discussion (and the assessment of discussions for grading) will be based on the following guidelines:

• Respond to others with questions or comments that provoke elaboration.
• Bring in resources from outside the class materials (website, reading in another class, work experience, etc.).
• Link the comments of two people in a very explicit way that has not been expressed.
• Demonstrate your interest with an active listening question to another.
• Build on another's thinking.
• Use the course materials, including quotes from readings, as "evidence" to support your thinking.
• Avoid unsupported opinions.
• Always describe any addition or expectation you need to share in a supportive manner.

Missing & Late Work Policy

Missing & Late Work Policy

Late assignments submitted after the due date in the rubric will receive a 10% grade deduction/day unless prior arrangements have been made or there are extenuating circumstances, as described below. Assignment grades will be posted in the grade book within four days after the assignment's due date.

Grades will be determined by content and completion. If a rubric is available, the assignment will be graded according to the rubric, so please make sure that you review the rubric before submitting your work. If you have any questions or concerns, please feel free to post in the Questions/Comments for the Instructor discussion or email me. Because this is a 15-week scheduled course, students must stay on schedule. Assignments must be turned in on time. Please be aware that any assignments must be completed on time to make it easier for you to keep up with the course schedule and for me to provide timely feedback. Do everything you can to adhere to the schedule and stay caught up.

Unless otherwise specified, assignments will be due (Monday by 11:59 p.m. (EST). The final week may be shortened, so the assignments due during the last week are due earlier than those expected in weeks one through fifteen.

Late submissions will be accepted up to three (3) days after the due date for students who encounter extenuating circumstances and have prior authorization from me.

Authorization must be requested before the assignment's due date/time, and all late submissions will be penalized. Ten points will be deducted from an assignment's final grade for each day that it is late. For example, if an assignment is due on Monday by 11:59 p.m. EST and it is turned in on Tuesday at 1 p.m. EST, 10 points will be deducted from the grade. If the grade were 90, the final grade after the penalty would be a score of 80. Suppose a student submits a late assignment and discussion post without prior authorization or submits a late one with prior authorization more than three days after the assignment's due date. In that case, the student will receive a zero for the grade on the assignment.

Accessibility Services for Students with Disabilities:

1. Provide disability documentation to the Accessibility Coordinator at your academic center. https://ccv.edu/discover-resources/students-with-disabilities/
2. Request an appointment to meet with accessibility coordinator to discuss your request and create an accommodation plan.
3. Once created, students will share the accommodation plan with faculty. Please note, faculty cannot make disability accommodations outside of this process.

Academic Integrity