HITS 230 - Reimbursement Methodologies

This course focuses on the history, rationale, and methodology of the systems used by third-party payers to determine the reimbursement health care providers will receive. Reimbursement concepts include fee-for-service, managed care, capitation systems, Diagnosis-Related Groups (DRGs), Resource Based Relative Value Scale (RBRVS), Ambulatory Payment Classifications (APCs), and related concepts. The use of the charge master in reimbursement is discussed, as are the importance of compliance with regulations and the related issues of fraud and abuse.
Prerequisites: HITS-220
Credits: 3