Hima 240: principles of health care reimbursement methodologies

Prepare a revenue cycle plan for a community hospital.  Include the following information in your plan:

  • Introduction
  • Evaluation of clinical data required for payment and reimbursement systems (PPS, DRG, RBRVS, RUGs, VBP, Billing/insurance plans).
  • Explanation of chargemaster and claims management applications and processes.
  • Assess effect on healthcare finance of revenue management (cost reporting, budget variances).
  • Summarize revenue cycle management and reporting processes (CCI, X12N).
  • Evaluation of severity of illness and how it impacts the healthcare payment systems.

The format of this plan is like a policy and procedure but is a longer document. Compile your document based on the findings and collection of information for each of the requirements. 

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