Course Syllabus

Health Insurance Reimbursement & Billing

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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

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.

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

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.

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