HM 113 Healthcare Financing

Lecture Hours: 3
Lab Hours: 9
Credits: 6

Provides the foundation skills required for understanding healthcare financing, medical insurance billing, and reimbursement. Covers local and national insurance programs and offers a practical approach to medical insurance billing and reimbursement procedures.

Prerequisite: Admission into the Health Information Management program, or consent of instructor.
Student Learning Outcomes:

Identify legal issues associated with the claims filing process.
Apply basic principles of claim management and reimbursement.
Prepare legally-correct medical claims forms and correspondence.
Abstract necessary information from patient records and billing statements to complete insurance claim forms.
Analyze insurance claims in both the inpatient/hospital and outpatient settings.
Apply claims adjustment criteria to simulated cases.
Mathematical concepts as it applies to healthcare accounting

Content Outline

Career Overview of Insurance Billing Specialist
Financial Management
Healthcare: Right or Privilege
Legal issues
- Contracts
  - Patient
  - Physician
  - Insurance
- Financial responsibility
- Insurance commissioners
Health Insurance Basics
- Health insurance terminology
- Claims preparation
- Claims submission and processing
Insurance Problem-Solving
- Claims analysis
- Claims adjustment
- Managing delinquent claims
Insurance Plans
- PPO
- HMO
- Medicaid/Oregon Health Plan/CCO
- Medicare
- Workers’ Compensation
- Tricare & CHAMPVA 
- National Healthcare Finances (Current Events)
- Blue/Cross Blue/Shield