Course Description
This course is an examination of the revenue cycle process in healthcare organizations and best practices for managing the process. The course covers the types of healthcare insurance and reimbursement methodologies used in all healthcare settings as they relate to national billing, compliance, and reporting requirements. Topics include prospective payment systems, billing process and procedures, chargemaster maintenance, regulatory guidelines, reimbursement monitoring, and compliance strategies and reporting. Students will study front end, middle, and back-end revenue cycle management functions from patient access and registration through the claims process. Upon completion, students should be able to describe the health insurance claims process, explain the steps for completing a claim form, and comply with reimbursement and reporting requirements to minimize claims denials.
(3 credits)
Prerequisite
- None
Student Learning Outcomes (SLOs)
Upon successful completion of the course, the student will be able to:
- Define and discuss the components of the revenue cycle.
- Distinguish major payment methods in the US, along with major types of healthcare insurance plans and their authorization rules.
- Apply reimbursement methodologies and payment systems for differing healthcare entities.
- Describe the steps in the healthcare claims process and the steps in completing the universal forms used.
- Implement processes for revenue cycle management and reporting.
- Perform processes to collect accurate, complete, and current information and verify responsible payers.
- Ensure revenue integrity by managing and examining charge capture, coding, and documentation requirements.
- Analyze claims and appeals data to identify frequency, patterns and trends and create strategies to mitigate loss and identify opportunities.
- Discuss the history of the Medicare and Medicaid programs in America and the origins and evolution of the different types of managed care plans.
Course Activities and Grading
| Assignments | Weight |
|---|---|
Quizzes (7) | 20% |
EHR Go and Written Assignments | 55% |
Discussions | 15% |
Final Exam | 10% |
Total | 100% |
Required Textbooks
Available through Charter Oak State College's Book Bundle
- CCastro, Anne and Elizabeth Layman. Principles of Healthcare Reimbursement and Revenue Cycle Management - with Access Code. 8th ed. AHIMA Press, 2023.
- EHR Go Subscription. Archetype Innovations.
Course Schedule
Week | SLOs | Readings and Exercises | Assignments |
1 | 1 | Topic: Introduction
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2 | 2 | Topics: Private and Public Health Plans and Reimbursement Methodologies and Payment Systems
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3 | 3 | Topic: Government Sponsored Healthcare Programs
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4 | 1,5,6 | Topic: Revenue Cycle Process: Front-End
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5 | 1,5,7 | Topic: Revenue Cycle Process:Middle
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6 | 4,7,8 | Topic: Revenue Cycle Process: Back-End
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7 | 8 | Topic: Revenue Cycle Management
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8 | 8 | Topics: Revenue Cycle Analysis
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COSC Accessibility Statement
Charter Oak State College encourages students with disabilities, including non-visible disabilities such as chronic diseases, learning disabilities, head injury, attention deficit/hyperactive disorder, or psychiatric disabilities, to discuss appropriate accommodations with the Office of Accessibility Services at OAS@charteroak.edu.
COSC Policies, Course Policies, Academic Support Services and Resources
Students are responsible for knowing all Charter Oak State College (COSC) institutional policies, course-specific policies, procedures, and available academic support services and resources. Please see COSC Policies for COSC institutional policies, and see also specific policies related to this course. See COSC Resources for information regarding available academic support services and resources.