HIM 1510 - Reimbursement Methodologies
Fall 2026 Syllabus, Section 01, CRN 43598,
Credit hours: 3
Course Meeting Times
Log in to view more
Instructor
Amy Zinno
Email: amzinno@ysu.edu
Course Description
1510. Reimbursement Methodologies. This course will cover information about major insurance programs and federal healthcare legislation. This course provides students with classroom activities to enrich critical thinking and problem-solving applications. Reimbursement methodologies will also cover the history, evolution, and basic knowledge of diagnosis and procedure coding systems. Reimbursement methodologies will introduce the students to reimbursement issues and systems such as the Prospective Payment System (PPS), Diagnosis Related Group (DRG), Resource-Basted Relative Value Scale System (RBRVS), and Ambulatory Payment Classification (APC), Electronic Data Interchange (EDI) various billing techniques and software application programs. Coding scenarios with the utilization of encoder applications will be introduced. 3 Lecture Hours. Prereq.: HIM 1500 with a grade of C or higher. 3 s.h.
Course Readings
| Group | Title | Author | ISBN |
|---|---|---|---|
| Required | Principles of Healthcare Reimbursement | Castro, Anne & Layman, Elizabeth | ISBN-13: 978-1-58426-915-1, ISBN-13: e-book: 978-1-58426-916-8 |
Also Required:
Carter, Darcy & Shaw, Patricia, Registered Health Information Technician (RHIT®) Exam Preparation, Ninth Edition, ISBN: 978-1-58426-872-7, ebook ISBN: 978-1-58426-873-4
Refer to the weekly required reading assignments listed in the Learning Materials tab within your course in Blackboard.
The course readings are subject to change in the event of extenuating circumstances, research developments, current events, and/or to ensure better learning.
Assignments/Assessments
Log in to view more
Schedule of Topics and Assignments
| Week of | Reading(s) | Proposed Topic | Due/To Prepare for Class |
|---|---|---|---|
| 8/24 | Chapter 1: Healthcare Reimbursement and Revenue Cycle Management (pages 11-14) Chapter 9: Revenue Cycle Front End Processes - Patient Engagement Chapter 10: Revenue Cycle: Middle Processes - Resource Tracking Chapter 11: Revenue Cycle: Back-End- Claims Production and Revenue Collection |
Introduction to the Healthcare Revenue Cycle |
Due 8/30 at 11:59pm: Week 1 Assignment: Revenue Cycle Scenarios Part 1 Due 8/30 before midnight: Week 1 Discussion Board: Revenue Cycle Steps - Reply |
| 8/31 | Re-Read Chapter 1: Healthcare Reimbursement and Revenue Cycle Management (pages 11-14) Re-Read Chapter 9: Revenue Cycle Front End Processes - Patient Engagement Re-Read Chapter 10: Revenue Cycle: Middle Processes - Resource Tracking Re-Read Chapter 11: Revenue Cycle: Back-End Processes - Claims Production and Revenue Collection |
Revenue Cycle Management and Financial Performance | Due 9/6 before 11:59:53pm: Week 2 Discussion Board: Revenue Cycle Management and Fiscal Stability - Reply Due 9/6 at 11:59pm: Week 2 Assignment: Revenue Cycle Scenarios Part 2 |
| 9/7 | Chapter 3 - Government-Sponsored Healthcare Programs Reference Reading: Chapters 5–8 as needed for information about Medicare reimbursement and payment systems. |
Government-Sponsored Health Plans | Due 9/9 before 11:59:26pm: Week 3 Discussion Board: Government Health Plans Due 9/13 before 11:59:02pm: Week 3 Discussion Board: Government Health Plans - Reply Due 9/13 at 11:59pm: Week 3 Assignment: Government Sponsored Health Plans Comparison |
| 9/14 | Chapter 2 – Health Insurance Re-Read Chapter 3 – Government-Sponsored Healthcare Programs |
Medicare, Medicaid, and Health Information Management | Due 9/16 at 11:59pm: Week 4 Discussion Board: Medicare and Medicaid in HIM Due 9/20 before 11:59:27pm: Week 4 Discussion Board: Medicare and Medicaid in HIM - Reply Due 9/20 at 11:59pm: Week 4 Assignment: Medicare, Medicaid, & HIM |
| 9/21 | Re-Read Chapter 2 – Health Insurance | Employer-Sponsored and Commercial Health Plans | Due 9/23 before 11:59:26pm: Week 5 Discussion Board: Understanding Employer-Sponsored & Commercial Health Plans Due 9/27 before 11:59:51pm: Week 5 Discussion Board: Understanding Employer-Sponsored & Commercial Health Plans - Reply Due 9/27 at 11:59pm: Week 5 Assignment: Employee Open Enrollment Flyer/Poster |
| 9/28 | Re-Read: Chapter 9 – Revenue Cycle Front-End Processes—Patient Engagement Reference Reading: Chapter 11 – Revenue Cycle Back-End Processes—Claims Production and Revenue Collection |
Medical Necessity, Prior Authorization, and Patient Access | Due 9/30 before 11:59:34pm: Week 6 Discussion Board: Medical Necessity & Prior Authorizations Due 10/4 at 11:59pm: Week 6 Discussion Board: Medical Necessity & Prior Authorizations - Reply Week 6 Assignment: Patient Access Customer Service Scenario |
| 10/5 | Re-Read Chapter 10 – Revenue Cycle Middle Processes—Resource Tracking Re-Read Chapter 5 – Medicare Hospital Acute Inpatient Services Payment System Reference Reading: Chapter 4 – Healthcare Reimbursement Methodologies |
Utilization Review and Claims Processing | Due 10/7 before 11:59:31pm: Week 7 Discussion Board: Utilization Review Due 10/11 before 11:59:59pm: Week 7 Discussion Board: Utilization Review - Reply Due 10/11 at 11:59pm: Week 7 Assignment: Creating an Explanation of Benefits (EOB |
| 10/12 | Chapter 14 - Healthcare Data in Action: Real-World Analysis | Application of Healthcare Reimbursement Concepts | Due 10/18 at 11:59pm: Week 8 Assignment: Reimbursement Case Study |
| 10/19 | Re-Read: Chapter 10 – Revenue Cycle Middle Processes—Resource Tracking Re-Read Chapter 11 – Revenue Cycle Back-End Processes—Claims Production and Revenue Collection Reference Reading: Re-Read Chapter 2 – Health Insurance (commercial/employer-sponsored plans) Re-Read Chapter 3 – Government-Sponsored Healthcare Programs (Medicare/Medicaid) |
Healthcare Claim Forms and Submission | Due 10/21 before 11:59:46pm: Week 9 Discussion Board: Insurance Claim Forms Due 10/25 before 11:59:14pm: Week 9 Discussion Board: Insurance Claim Forms - Reply Due 10/25 at 11:59pm: Week 9 Assignment: Completing CMS-1500 and UB-04 Claim Forms |
| 10/26 | Re-Read Chapter 11 – Revenue Cycle Back-End Processes—Claims Production and Revenue Collection Reference Reading Chapter 4 – Healthcare Reimbursement Methodologies |
Claims Processing and Compliance | Due 10/28 before 11:59:02pm: Week 10 Discussion Board: Claims Processing & Compliance |
| 11/2 | Chapter 12 – Post-acute Care and Other Healthcare Reimbursement Systems Chapter 4 – Healthcare Reimbursement Methodologies Reference Reading Chapter 6 – Medicare Skilled Nursing Facility Services Payment System (as applicable to the long-term care scenario) |
Health Data Sets and Healthcare Reimbursement | Due 11/1 before 11:59:44pm: Week 10 Discussion Board: Claims Processing & Compliance - Reply Due 11/1 at 11:59pm: Week 10 Assignment: Revenue Cycle Claim Process Due 11/4 before 11:59:09pm: Week 11 Discussion Board: Health Data Sets |
| 11/9 | Re-Read: Chapter 10 – Revenue Cycle Middle Processes—Resource Tracking Re-Read: Chapter 11 – Revenue Cycle Back-End Processes—Claims Production and Revenue Collection Reference Reading: Re-Read: Chapter 4 – Healthcare Reimbursement Methodologies |
Charge Description Master, Revenue Centers, and Patient Collections | Due 11/8 before 11:59:37pm: Week 11 Discussion Board: Health Data Sets - Reply Due 11/8 at 11:59pm: Week 11 Assignment: Patient Reimbursement Scenarios Due 11/11 before 11:59:20pm: Week 12 Discussion Board: Charge Description Master (CDM) and Revenue Centers |
| 11/16 | Websites listed in the weekly learning materials tab | Healthcare Statistics and Comparative Data | Due 11/15 before 11:59:46pm: Week 12 Discussion Board: Charge Description Master (CDM) and Revenue Centers - Reply Due 11/15 at 11:59pm: Week 12 Assignment: Improving Patient Payment Collections Due 11/18 before 11:59:56pm: Week 13 Discussion Board: Comparative Data Types |
| 11/23 | Websites listed in the weekly learning materials tab | Healthcare Statistical Formulas and Calculations | Due 11/22 before 11:59:24pm: Week 13 Discussion Board: Comparative Data Types - Reply Due 11/22 at 11:59pm: Week 13 Assignment: Statistics Exercises Part 1 Due 11/25 before 11:59:21pm: Week 14 Discussion Board: Statistical Formulas |
| 11/30 | Review the assigned section of the RHIT Exam Preparation book covering healthcare statistics, epidemiology, morbidity, mortality, and public health. | Public Health and Epidemiology | Due 11/29 before 11:59:46pm: Week 14 Discussion Board: Statistical Formulas - Reply Due 11/29 at 11:59pm: Week 14 Assignment: Statistics Exercises Part 2 Due 12/2 before 11:59:38pm: Week 15 Discussion Board: Public Health & Epidemiology |
| 12/7 | Chapter 14 - Healthcare Data in Action: Real-World Analysis | Application of Healthcare Reimbursement Concepts | Due 12/6 before 11:59:02pm: Week 15 Discussion Board: Public Health & Epidemiology - Reply Due 12/6 at 11:59pm: Week 15 Assignment: Communicable Disease Analysis Due 12/12 at 11:59pm: Week 16 Assignment: Reimbursement Case Studies |
The course schedule, policies, procedures, and assignments in this course are subject to change in the event of extenuating circumstances, by mutual agreement, and/or to ensure better learning.