HIT 106B - Healthcare Reimbursement

1. Discuss basic health insurance concepts and legal responsibilities.
2. Apply managed care basics.
3. Apply current regulations for compliance with privacy and security concerns by responding to legal and regulatory issues that impact the billing process.
4. Differentiate among different major insurer groups.
5. Validate medical necessity using LCD (local coverage determinations) and NCD (national coverage determinations).
6. Apply policies and procedures for the use of data required in healthcare reimbursement by comprehending the billing cycle, preparing claim forms, and responding to denials.
7. Adhere to the legal and regulatory requirements related to health information management by interpreting reimbursement monitoring, reporting terms, and rules.
8. Analyze current regulations in clinical classification systems for compliance with ethical coding and privacy and security concerns by evaluating the revenue cycle management processes.