HM 270 Healthcare Revenue Cycle 2

Lecture Hours: 3
Credits: 3

Builds on skills learned in HM 170 while learning how to trace delinquent claims, appeal denied claims and complete a CMS-1500 Claim Form to streamline billing procedures by completing case studies.

Prerequisite: HM 101, HM 120, HM 121, HM 170; or consent of instructor. (All prerequisite courses must be completed with a grade of C or better.)
Student Learning Outcomes:

Explain the claims adjudication process.
Interpret a remittance advice.
Assess how appeals, post payment audits and overpayments might affect the claims process.
Explain the structure of a financial policy.
Describe the processes and methods used to collect outstanding balances.
Complete case studies to increase proficiency.

Content Outline

Claim Follow-up
- Payments Appeals and Secondary Claims
- Primary Case Studies
- Secondary Case Studies
Payment Processing
- Patient Billing and Collections
Hospital Services
- Hospital Billing and Reimbursement