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2012-2013 Saint Joseph’s College Online [Archived Catalog]

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HIM 320 - Reimbursement Methodologies

This course is divided into four study units and consists of an overview of contemporary healthcare reimbursement in the health information management (HIM) setting. In addition, the course will examine the healthcare reimbursement systems. Students will examine complex financial systems and explore the principles of reimbursement as it applies to various types of health care settings such as acute, post-acute, physician office, and ambulatory surgical centers to name a few. The course will also focus on reimbursement and reporting requirements, and students will become familiar with topics such as prospective payment, transfer policy, diagnosis related group, recovery audit contractor (RAC), fraud and abuse, revenue cycle management, chargemaster, and quality and safety-related reimbursement incentive models just to name a few.

Prerequisites & Notes
None.

Assignment Overview
  • Assignments: 4 Units
  • Interactivity: Discussion Board
  • Final Assessment: Research Paper


Course Learning Objectives
Upon completing this course, you should be able to do the following:

  1. Manage the use of clinical data that is required in prospective payment systems (PPS) in healthcare delivery.
  2. Manage the use of clinical data that is required in other reimbursement systems in healthcare delivery.
  3. Participate in the selection and development of applications and processes for chargemaster and claims management.
  4. Implement and manage processes for compliance and reporting.
  5. Participate in revenue cycle management.


Credits: 3


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