Common Course Outline

Course discipline/number/title HIMC 1910: Reimbursement

Catalog Description

Credits 2
Hours/Week 2
Prerequisites (Course discipline/number) None
Other requirements College-level reading and writing skills
MnTC Goals (if any) NA

Course Description

This course provides a study of numerous health insurance plans, reimbursement methodologies, and compliance strategies. Students will adhere to current regulations and established guidelines in code assignment.

Date Last Revised (Month, year)

December, 2025

Outline of Major Content Areas

  1. Healthcare reimbursement methodologies
  2. Fee-for-service
  3. Episode-of-care
  4. Voluntary healthcare insurance plans
  5. Individual
  6. Employer-based
  7. Managed Care
  8. Government-sponsored healthcare
  9. Medicare
  10. Medicaid
  11. Veterans Health Administration
  12. Children’s Health Insurance Program (CHIP)
  13. TRICARE
  14. CHAMPVA
  15. Indian Health Service
  16. Workers’ Compensation
  17. Medicare Prospective Payment Systems for Inpatients
  18. DRGs
  19. MS-DRGs
  20. Medicare Reimbursement Systems for Ambulatory Care
  21. RBRVS
  22. APCs
  23. ASC PPS
  24. Medicare Prospective Payment Systems for Post acute Care
  25. Skilled Nursing Facility
  26. Long-Term Care Hospital
  27. Inpatient Rehabilitation Facility PPS
  28. Home Health PPS
  29. Revenue Cycle Management
  30. Value-Based Purchasing

Learning Outcomes (General)

The student will be able to:

  1. Apply diagnostic/procedural groupings.
  2. Identify and use secondary data sources.
  3. Apply policies and procedures for the use of data required in healthcare reimbursement.
  4. Evaluate the revenue cycle management processes.
  5. Identify potential abuse or fraudulent trends through data analysis.
  6. Identify discrepancies between supporting documentation and coded data.
  7. Describe the differing types of organizations, services, and personnel and their interrelationships across the health care delivery system.

Learning Outcomes (MnTC)

NA

Methods for Evaluation of Student Learning

Methods may include but are not limited to:

RCTC Core Outcome(s)

This course contributes to meeting the following RCTC Core Outcome(s):

Critical Thinking
Students will think systematically and explore information thoroughly before accepting or formulating a position or conclusion.

Special Information (if any)

None