HCI400: Coding and Reimbursement Credit Hours: 3 Contact Hours: This is a 3-credit course, offered in accelerated format. This means that 16 weeks of

material is covered in 8 weeks. The exact number of hours per week that you can expect to spend on each course will vary based upon the weekly coursework, as well as your study style and preferences. You should plan to spend 10-25 hours per week in each course reading material, interacting on the discussion boards, writing papers, completing projects, and doing research.

Course Description and Outcomes

Course Description: This course will focus on health records and federal regulations regarding prospective payment systems and methods of reimbursement. Use of the guidelines in the various contemporary coding systems as well as ensuring their accuracy will be examined. Students will also focus on reimbursement systems and their impact on coding. Course Learning Outcomes:

1. Demonstrate knowledge of, or apply the procedural codes using current coding procedures. 2. Assess the significance of HIPAA codes and their relevancy to the reimbursement process. 3. Describe and/or apply the processes involved in claims and procedural coding. 4. Differentiate among the various reimbursement systems, including private pay, Medicare, Medicaid,

TRICARE, and workers compensation. 5. Summarize specific concepts related to hospital billing and reimbursement. 6. Integrate quality review processes to validate accuracy of code assignments and reporting compliance.

Participation & Attendance

Prompt and consistent attendance in your online courses is essential for your success at CSU-Global Campus. Failure to verify your attendance within the first 7 days of this course may result in your withdrawal. If for some reason you would like to drop a course, please contact your advisor. Online classes have deadlines, assignments, and participation requirements just like on-campus classes. Budget your time carefully and keep an open line of communication with your instructor. If you are having technical problems, problems with your assignments, or other problems that are impeding your progress, let your instructor know as soon as possible.

Course Materials

Textbook Information is located in the CSU-Global Booklist on the Student Portal.

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Course Schedule

Due Dates The Academic Week at CSU-Global begins on Monday and ends the following Sunday.

Discussion Boards: The original post must be completed by Thursday at 11:59 p.m. MT and Peer Responses posted by Sunday 12 11:59 p.m. MT. Late posts may not be awarded points.

Mastery Exercises: Students may access and retake mastery exercises through the last day of class until they achieve the scores they desire.

Critical Thinking Activities: Assignments are due Sunday at 11:59 p.m. MT.

Week # Readings Assignments

1

Chapters 1 & 3 in Medical Insurance: An Integrated Claims Process

Discussion (25 points)

Mastery (10 points)

Critical Thinking (70 points)

2

Chapters 2 & 7 in Medical Insurance: An Integrated Claims Process Discussion (25 points)

Mastery (10 points)

Critical Thinking (70 points)

3

Chapter 4 in Medical Insurance: An Integrated Claims Process Discussion (25 points)

Mastery (10 points)

Critical Thinking (70 points)

4 Chapters 5 & 6 in Medical Insurance: An Integrated Claims Process Discussion (25 points)

Mastery (20 points)

5

Chapters 9 & 10 in Medical Insurance: An Integrated Claims Process

Discussion (25 points)

Mastery (10 points)

Critical Thinking (70 points)

6

Chapters 8, 11, & 12 in Medical Insurance: An Integrated Claims Process

Discussion (25 points)

Mastery (10 points)

Critical Thinking (70 points)

7 Chapters 13 & 14 in Medical Insurance: An Integrated Claims

Process Discussion (25 points)

Mastery (10 points)

8 Chapter 17 in Medical Insurance: An Integrated Claims Process Discussion (25 points)

Mastery (20 points)

Portfolio (350 points)

Assignment Details

This course includes the following assignments/projects: Module 1 SAMPLE

Critical Thinking: AMIA Analysis (70 points) An important skill that health care informatics associates must possess is the ability to utilize technology to support accurate and timely reimbursement processes. For this assignment, explore the Web site for American Medical Informatics Association (AMIA) at http://www.amia.org. Then, in a 2-3 page paper, evaluate and summarize the following information that AMIA provides on its Web site:

Authority (such as president, author[s], staff)

Mission, purposes, and history – What is the mission of AMIA? From what you read about AMIA, what more can you infer about what motivates and guides the organization's actions?

Bylaws and policies

Contributions to general knowledge regarding informatics

Publications available – What are some of the current issues and challenges in Informatics?

Accuracy/Integrity – Who edits or reviews the information? Are references provided? How current is the information?

Objectivity or point of view

Membership requirements/cost

Value of becoming a member – Would you consider becoming a member? Why or why not? Remember that your information must be supported with citations from the AMIA Web site and formatted according to the CSU-Global Guide to Writing and APA Requirements.

PORTFOLIO MILESTONE: (0 Points) Review the Portfolio Project Description on the Module 8 Assignments page. Post any questions or comments about the assignment and its requirements, this week or at any time during the course, to the discussion forum called General Course Questions. Visit the forum periodically to read your peers’ thoughts on the project. Whether you have a question about the assignment or not, contribute a question or comment about the Portfolio Project by the end of Week 1. This is a required component of the Portfolio Project assignment, due this week. See the Portfolio Project rubric for how this milestone will be assessed at the end of Week 8.

Module 2

CRITICAL THINKING: HIPPAA Privacy and Security Rules (70 Points) In 2009 a law was passed under the Health Information Technology for Economic and Clinical Health (HITECH) Act that required business associates to provide notification following a breach of unsecured protected health information (PHI). For this assignment, go to the U.S. Department of Health & Human Services Web site (linked on the Week 2 Assignments page) to review the HIPAA Privacy Rule and HIPAA Security Rule. Then, conduct a thorough investigation of the Breach Notification Rule, including the definition of breach, breach notification requirements, burden of proof, and how to submit a breach notification to the authorities. Summarize your findings in a 2-3 page paper that is formatted according to the CSU Global Guide to Writing and APA Requirements. Support your summary using a minimum of one scholarly reference that supports or refutes the information on the HHS Web site. The CSU-Global library is an excellent resource to search out references.

Module 3

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CRITICAL THINKING: Case Studies (70 Points) It is important to apply the concepts that you are learning regarding diagnostic coding as well learning about them. Chapter 15 in your textbook provides case studies that allow you to practice this information. For your Mod 3 CT assignment, complete the following case studies. Before you begin, carefully read the sections entitled Learning Outcomes and Method of Claim Completion.

Case Study 15.1: Identify the coding error that is demonstrated in the patient’s information.

Case Study 15.3: Complete a correct insurance claim form using information from the patient information form and patient encounter form.

Case Study 15.16: Prepare a correct insurance claim by selecting the correct ICD-10-CM and CPT codes for the encounter using data from the patient’s information form, diagnostic statement, and procedural statement.

Case Study 15.17: Prepare a correct insurance claim by selecting the correct ICD-10-CM and CPT codes for the encounter using data from the patient’s information form, diagnostic statement, and procedural statement.

Case Study 15.18: Prepare a correct insurance claim by selecting the correct ICD-10-CM and CPT codes for the encounter using data from the patient’s information form, diagnostic statement, and procedural statement.

Case Study answers should be complete and address each item of the question or item. Thoroughness in response and correctness are more important than length. You are welcome to be brief in your responses so long as you are addressing each item in its entirety. Be sure to format your responses according to the CSU Global Guide to Writing and APA Requirements.

Module 4

PORTFOLIO MILESTONE: Outline (0 Points) Create an outline for the PowerPoint presentation for your Portfolio assignment in Module 8. Your outline should include, but is not limited to, the following sections:

History and background of diagnostic (ICD) and procedural (CPT) coding

Purpose of ICD and CPT coding

Differences between ICD-10-CM and ICD-9-CM coding

Related technology to assist in the coding and reimbursement process

Maintaining coding accuracy and minimizing errors. Remember that your Final Portfolio Project is a slide presentation with a minimum of 20 slides, including your cover slide and reference slide. Submit your outline as a Word document or PowerPoint slide(s) in the Assignment link for Module 4. This is a required component of the Portfolio Project assignment, due this week. See the Portfolio Project rubric for how this milestone will be assessed at the end of Week 8.

Module 5

CRITICAL THINKING: Medicare vs. Medicaid (70 points) You have the option of creating a graphic or writing a 2-4 page paper that identifies the key elements of Medicare and Medicaid. Your assignment, regardless of the option you choose, must include:

A description of the program itself, including the differences between Medicare Part A, Part B, Part C, and Part D

Medicare Advantage versus the original Medicare plan

Eligibility

Medigap

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Differences between participating and non-participating providers

Excluded services

Requirements for submitting claims

Coding issues that are specific to Medicare billing and coding. Ensure your assignment (in either option) is detailed, cites two scholarly journals in addition to the textbook, and follows CSU-Global APA formatting requirements, which includes creating a title and reference pages. The CSU-Global Library is a great place to find sources for your assignment!

Module 6

CRITICAL THINKING: Case Studies (70 Points) The case studies in Chapter 16 of your textbook provide additional practice associated with handling denied claims, processing Medicare RAs and preparing secondary claims. For your Module 6 CT assignment, complete the following case studies that are based on the claims that you completed in Mod 3:

Case Study 16.4: Processing Commercial payer RAs and Preparing Secondary Claims (Chapter 15, Case study 15.17)

Case Study 16.7: Calculating Patient’s Balances (Chapter 15, Case study 15.3)

Case Study 16.20: Calculating Patient’s Balances (Chapter 15, Case study 15.16)

Case Study 16.21: Calculating Patient’s Balances (Chapter 15, Case study 15.17)

Case Study 16.22: Calculating Patient’s Balances (Chapter 15, Case study 15.18). Case Study answers should be complete and address each item of the question or item. Thoroughness in response and correctness are more important than length. You are welcome to be brief in your responses so long as you are addressing each item in its entirety. Be sure to format your responses according to the CSU Global Guide to Writing and APA Requirements.

Module 8

PORTFOLIO: Coding and Reimbursement Presentation (350 Points) Scenario: You have been an employee at Healing Haven Hospital in the health information management (HIM) department for the past two years. Each month, during the new employee orientation, the medical billing specialist from the billing department does a presentation on coding and reimbursement. This year, the specialist is at a conference. Because your supervisor knows you are taking this class, she has asked you to do the presentation. Prepare a PowerPoint presentation that follows the criteria below. Ensure it adheres to the appropriate guidelines for a PPT as provided in the CSU Global Library. Remember to limit the amount of information on each slide to the key points, and use the note section for additional information and explanations. You should also include information from a minimum of five resources, making sure that these resources are cited in your presentation. Your presentation should include, but is not limited to, the following sections:

History and background of diagnostic (ICD) and procedural (CPT) coding

Purpose of ICD and CPT coding

Differences between ICD-10-CM and ICD-9-CM coding

Related technology to assist in the coding and reimbursement process

Maintaining coding accuracy and minimizing errors. Your presentation should contain a minimum of 20 slides, including your cover slide and reference slide. Ensure each source is cited per CSU-Global APA formatting guidelines.

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Course Policies

Course Grading

20% Discussion Participation

10% Mastery Exercises

35% Critical Thinking Activities

35% Final Portfolio Paper

Grading Scale and Policies

A 95.0 – 100

A- 90.0 – 94.9

B+ 86.7 – 89.9

B 83.3 – 86.6

B- 80.0 – 83.2

C+ 75.0 – 79.9

C 70.0 – 74.9

D 60.0 – 69.9

F 59.9 or below

In-Classroom Policies For information on late work and Incomplete grade policies, please refer to our In-Classroom Student Policies and Guidelines or the Academic Catalog for comprehensive documentation of CSU-Global institutional policies.

Academic Integrity Students must assume responsibility for maintaining honesty in all work submitted for credit and in any other work designated by the instructor of the course. Academic dishonesty includes cheating, fabrication, facilitating academic dishonesty, plagiarism, reusing /re-purposing your own work (see CSU-Global Guide to Writing and APA Requirements for percentage of repurposed work that can be used in an assignment), unauthorized possession of academic materials, and unauthorized collaboration. The CSU-Global Library provides information on how students can avoid plagiarism by understanding what it is and how to use the Library and Internet resources. Citing Sources with APA Style All students are expected to follow the CSU-Global Guide to Writing and APA Requirements when citing in APA (based on the APA Style Manual, 6th edition) for all assignments. For details on CSU-Global APA style, please review the APA resources within the CSU-Global Library under the “APA Guide & Resources” link. A link to this document should also be provided within most assignment descriptions on your course’s Assignments page. Netiquette Respect the diversity of opinions among the instructor and classmates and engage with them in a courteous,

respectful, and professional manner. All posts and classroom communication must be conducted in accordance

with the student code of conduct. Think before you push the Send button. Did you say just what you meant?

How will the person on the other end read the words?

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Maintain an environment free of harassment, stalking, threats, abuse, insults or humiliation toward the

instructor and classmates. This includes, but is not limited to, demeaning written or oral comments of an ethnic,

religious, age, disability, sexist (or sexual orientation), or racist nature; and the unwanted sexual advances or

intimidations by email, or on discussion boards and other postings within or connected to the online classroom.

If you have concerns about something that has been said, please let your instructor know.

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