Reimbursement Methodologies & Compliance

This course was developed to provide students with an in-depth understanding of the structure and function of the US Healthcare Reimbursement system, including the various types of payors, payment methodologies and compliance strategies.  By the end of this course, students will be able to 1) define commercial, federal and managed care insurance plans, and describe the differences between the three types of payors, 2) describe payment methodologies associated with each type of payor, 3) describe each step in the insurance billing process, from claims submission to payment determination, 4) define the legislation created to regulate claims compliance and the agencies responsible that ensuring that these laws are followed.