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Sep 20, 2026
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Undergraduate Catalog 2026-2027
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HIT 215 Healthcare Reimbursement Credits: (3)
This course is the study of the principles of reimbursement and the practice of insurance processing in a variety of healthcare settings. Prospective payment systems, revenue cycle management, and pay-for-performance will be reviewed. Case-mix management, including the assignment and reporting of codes for diagnoses and procedures/services will be covered. Inpatient, skilled nursing, and outpatient cases will be reviewed to identify issues of fraud and abuse. Prerequisite(s): HIT 110 and HIT 212 .
Learning Outcomes
- Apply policies and procedures for the use of clinical data required for reimbursement and prospective payment in healthcare delivery.
- Evaluate and describe reimbursement processes within various healthcare settings.
- Evaluate and describe public and private third-party payers.
- Apply policies and procedures to comply with changing regulations among payment systems for healthcare services such as Medicare, Medicaid, and managed care.
- Support accurate billing through coding, chargemaster, revenue cycle management and bill reconciliation management
- Assess the adequacy of patient record documentation to ensure that it supports codes assigned.
- Apply current regulations and public and private third-party payer guidelines to correctly assign codes for reimbursement purposes, appropriateness of care and processing of claims.
- Apply regulatory agency guidelines for reimbursement purposes.
- Apply policies and procedures for value-based purchasing and pay-for-performance.
- Utilize specialized software for the assignment and validation of diagnostic and procedural codes and case-mix group assignment.
- Identify concerns of fraud and abuse relating to reimbursement of healthcare services.
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