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Course Planning by Program

2022-23

Essential Objectives

Course Syllabus


Revision Date: 01-Jan-23
 

Spring 2023 | AHS-2165-VO02F - Health Insurance Reimbursement & Billing


Flex Class

FLEX courses are online courses with flexible assignment submission, allowing students to manage their completion pace during the semester. FLEX courses remain open for enrollment throughout the first half of the semester. Flex course enrollment for Spring 2023 ends on March 17.


Location: Online
Credits: 3 (45 hours)
Day/Times: Meets online
Semester Dates: 01-24-2023 to 05-08-2023
Last day to drop without a grade: 02-12-2023 - Refund Policy
Last day to withdraw (W grade): 03-26-2023 - Refund Policy
This course has started, please contact the offering academic center about registration

Faculty

Amy Bourgeois
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.

Spring 2023 textbook details will be available on 2022-11-14. 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-VO02F 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.


Evaluation Criteria

Students will be evaluated on the following:

* Completion and performance of all Demonstration of Learning Discussions
* Completion and performance on all assignments: Case Studies, Coding Exercises, etc.
* Completion and performance of assessments/quizzes.

Students will have many opportunities to demonstrate their academic success in this course. A student’s final grade will be based on the following criteria:

* 40% Class discussion (Demonstrate Your Learning)
* 30% Chapter Assessments (quizzes)
* 30% Assignments (homework, reviews, etc.)


Course Completion

To complete and pass the course students must:

* Satisfactorily complete all projects, assignments, assessments and exams by the end of the semester
* Begin the course at least 2 weeks prior to the end of semester.

Modules to complete over 15 weeks:

  • Module 1: Introduction to Health Insurance
  • Module 2: Commercial Health Insurance and Government Plans
  • Module 3: Legal & Regulatory, Ethics, HIPAA, OIG, Compliance and Workers Comp
  • Module 4: Claim Development and Life Cycle
  • Module 5: Medical Coding Systems
  • Module 6: Reimbursement Methodologies
  • Module 7: Multiple Standard Claim Form Submersion

Students should estimate 1.5 to 2 weeks to complete each module. Some modules will take longer than others.


Grading Criteria

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

 HighLow
A+10098
A Less than 9893
A-Less than 9390
B+Less than 9088
B Less than 8883
B-Less than 8380
C+Less than 8078
C Less than 7873
C-Less than 7370
D+Less than 7068
D Less than 6863
D-Less than 6360
FLess than 60 
P10060
NPLess than 600


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.


Missing & Late Work Policy

This is a flex course so no assignments are considered late. All assignments must be submitted before the end of course.


Accessibility Services for Students with Disabilities:


CCV strives to mitigate barriers to course access for students with documented disabilities. To request accommodations, please
  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


CCV has a commitment to honesty and excellence in academic work and expects the same from all students. Academic dishonesty, or cheating, can occur whenever you present -as your own work- something that you did not do. You can also be guilty of cheating if you help someone else cheat. Being unaware of what constitutes academic dishonesty (such as knowing what plagiarism is) does not absolve a student of the responsibility to be honest in his/her academic work. Academic dishonesty is taken very seriously and may lead to dismissal from the College.





 


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