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U.S. Health Care Processing

COURSE OVERVIEW

This course provides a comprehensive examination of the U.S. health care system, focusing on the processes that underpin its operations. Students will explore the structure of health care delivery, the intricacies of insurance and billing, regulatory frameworks, and the impact of policy on health care practices. The course also delves into the roles of different stakeholders, including providers, payers, and patients, in navigating and shaping the health care landscape.

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CURRICULUM

  • Overview of the U.S. Health Care System
    • The structure of health care delivery in the United States.
    • Public vs. private health care systems.
    • Key components: hospitals, outpatient services, long-term care, and primary care.
  • Major Stakeholders
    • The roles of providers, patients, payers, and government agencies.
    • Health care providers: physicians, nurses, and allied health professionals.
    • The influence of pharmaceutical companies, insurers, and regulatory bodies.
  • Health Care Delivery Models
    • Traditional fee-for-service (FFS) vs. value-based care models.
    • Managed care, accountable care organizations (ACOs), and patient-centered medical homes (PCMHs).
  • Health Care Financing in the U.S.
    • Overview of health care financing models.
    • The role of public and private funding in health care.
    • The impact of health care costs on access and quality of care.
  • Private Health Insurance
    • Types of private health insurance plans: HMO, PPO, EPO, POS.
    • Employer-sponsored insurance and individual market plans.
    • The role of health insurance exchanges and the Affordable Care Act (ACA).
  • Public Health Insurance Programs
    • Overview of Medicare and Medicaid.
    • Eligibility, benefits, and financing of public health insurance programs.
    • Challenges and reforms in public health insurance.
  • The Health Care Billing Process
    • Overview of the billing cycle: patient registration, charge capture, claim submission, and payment posting.
    • Key players in the billing process: providers, billing departments, and payers.
    • Common billing errors and their impact on revenue.
  • Medical Coding Systems
    • Introduction to ICD, CPT, and HCPCS coding systems.
    • The role of medical coders in the billing process.
    • Understanding DRGs (Diagnosis-Related Groups) and APCs (Ambulatory Payment Classifications).
  • Reimbursement Models
    • Fee-for-service vs. capitation and bundled payments.
    • Value-based reimbursement models.
    • The role of reimbursement in driving health care quality and efficiency.
  • Revenue Cycle Management
    • Best practices in managing the health care revenue cycle.
    • The role of technology in revenue cycle management (RCM).
    • Strategies for improving billing accuracy and reducing denials.
  • Overview of Health Care Regulation
    • Key regulatory bodies: CMS, FDA, CDC, and state health departments.
    • The role of accreditation organizations (e.g., The Joint Commission).
    • Legal frameworks governing health care (e.g., HIPAA, EMTALA).
  • Health Care Compliance
    • The importance of compliance in health care settings.
    • Common compliance issues: fraud, waste, and abuse.
    • Strategies for maintaining compliance in health care organizations.
  • Health Information Privacy and Security
    • Understanding HIPAA and the HITECH Act.
    • Ensuring the privacy and security of patient health information.
    • The role of health information technology (HIT) in compliance.
  • Introduction to U.S. Health Policy
    • The role of federal, state, and local governments in health care policy.
    • Key health policies impacting health care delivery (e.g., ACA, MACRA).
    • The policy-making process and stakeholder involvement.
  • Health Care Reform
    • Historical overview of health care reform efforts in the U.S.
    • The impact of the Affordable Care Act on health care access and delivery.
    • Current and emerging health care reform initiatives.
  • Evaluating Health Policy
    • Methods for assessing the impact of health policies on health outcomes.
    • The role of policy analysis in shaping health care decisions.
    • Case studies of health policy implementation and outcomes.
  • Health Information Technology (HIT)
    • The role of electronic health records (EHRs) in health care processing.
    • Health information exchanges (HIEs) and interoperability.
    • The impact of HIT on patient care, billing, and compliance.
  • Telemedicine and Digital Health
    • The rise of telemedicine and its impact on health care delivery.
    • Regulatory and reimbursement challenges in telemedicine.
    • The future of digital health and patient engagement.
  • Innovation in Health Care Delivery
    • Emerging technologies in health care (e.g., AI, blockchain, wearable devices).
    • The role of innovation in improving health care access and quality.
    • Challenges and opportunities in adopting new technologies.
  • Health Care Access and Disparities
    • Addressing disparities in health care access and outcomes.
    • The impact of social determinants of health on health care processing.
    • Strategies for improving access to care for underserved populations.
  • Cost Control and Efficiency
    • Challenges in controlling health care costs.
    • Strategies for improving efficiency in health care delivery and processing.
    • The role of health care providers, payers, and patients in cost control.
  • The Future of Health Care Processing
    • Trends shaping the future of health care processing.
    • The impact of policy changes and technological advancements.
    • Preparing for the future: skills and knowledge needed for health care professionals.
  • Review of Key Concepts
    • Recap of the major topics covered in the course.
    • Discussion on the evolving landscape of U.S. health care processing.
  • Final Project
    • Students will develop a comprehensive analysis of a specific aspect of health care processing, including policy implications, challenges, and potential solutions.
  • Course Reflection and Next Steps
    • Reflecting on the challenges and rewards of working in health care processing.
    • Exploring career opportunities in health care management, policy, and administration.
    • Continuing education and professional development in health care.
Course Price: $74.00
  • Instructor : Eleanor Fant
  • Lectures :14
  • Enrolled :20 students
  • Duration :6 weeks
  • Language :English
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