Healthcare Finance

Healthcare Finance

This course allows students to explore health care finance. Students start by looking at an introduction to basic health care finance concepts. Within this course students will examine financial management, accounting principles in health care organizations, claims processing, as well as government payer types. Students will learn about the Affordable Care Act, Medicare prospective payment systems, hospital outpatient prospective payment system (OPPS), coding for the non-HIM professional, and revenue cycle management (RCM). This course will provide students with a full understanding about health care finance, health care fraud and abuse, electronic health records (EHR) and MACRA.

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Learning Objectives/

  1. 1.1 Explain the accounting principles which govern the financial reporting process in the health care industry.
  2. 1.2 Identify sources of financial data in a health care organization.
  3. 1.3 Differentiate financial organizations such as sole proprietorship, partnership, and corporation.
  1. 2.1 Describe the accounting function for the non-financial health care manager.
  2. 2.2 Interpret basic financial reports.
  3. 2.3 Categorize basic financial ratios and budgeting techniques.
  1. 3.1 Describe basic reimbursement methods.
  2. 3.2 Identify various types of medical claims.
  3. 3.3 Examine the health care reimbursement appeals process.
  1. 4.1 Differentiate the between Medicare and Medicaid programs.
  2. 4.2 Explain alternative government health care programs.
  1. 5.1 Describe the critical components of the Patient Protection and Affordable Care Act (PPACA).
  2. 5.2 Explain the health insurance marketplace.
  3. 5.3 Identify the components of the Summary of Benefit and Coverage documents.
  1. 6.1 Differentiate the various types of managed care plans.
  2. 6.2 Examine contract management and financial incentives used by managed care plans.
  3. 6.3 Identify the cost controls utilized by managed health care plans.
  1. 7.1 Differentiate the components of the coding and billing process in a health care facility.
  2. 7.2 Explain the impact of Health Insurance Prospective Payment Systems (HIPPS) on health care facilities.
  3. 7.3 Explore the relationship of Medicare and prospective payment systems.
  1. 8.1 Explore the Healthcare Common Procedure Coding System (HCPCS) standardized coding system used to identify health care products, supplies, and services.
  2. 8.2 Examine the Medicare Prospective Payment Systems (MPPS) surrounding the Hospital Outpatient Prospective Payment System (OPPS).
  3. 8.3 Differentiate various outpatient prospective payment systems.
  1. 9.1 Explain components of a health record.
  2. 9.2 Describe the requirements for documenting medical record entries.
  3. 9.3 Explain the health record as a legal document.
  1. 10.1 Explain the components of revenue cycle management (RCM).
  2. 10.2 Describe quality improvement measures.
  3. 10.3 Examine the revenue cycle management (RCM) process in the acute care environment.
  1. 11.1 Identify health care fraud and abuse.
  2. 11.2 Evaluate tools for detecting health care fraud and abuse.
  3. 11.3 Examine processes for preventing health care fraud and abuse.
  1. 12.1 Identify the components of an electronic health record (EHR).
  2. 12.2 Categorize the stages of meaningful use.
  3. 12.3 Describe the impact of meaningful use on electronic health records (EHR).
  1. 13.1 Examine the impact of pay for performance on health care organizations.
  2. 13.2 Describe the impact of value based purchasing on a health care organization.
  3. 13.3 Identify the impact of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).
  1. 14.1 Explain the process of the Recovery Audit Contractor (RAC).
  2. 14.2: Describe the Recovery Audit Contractor (RAC) workflow to identify improvements in the health care organization.
  3. 14.3: Examine the levels of appeals in the Recovery Audit Contractor (RAC) process.

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