Oregon Health & Science University
BMI 584
Clinical Classification Systems and Applied Reimbursement Methodologies
CREDIT HOURS: 2
TERM: Spring, 2011
INSTRUCTOR: Mary H. Stanfill, MBI, RHIA, CCS, CCS-P, FAHIMA
INSTRUCTOR/TEACHING ASSISTANT V-Lab: Bonnie Altus, MS, RHIT, CHPS
EXPECTATION FOR COMMUNICATION:
Office hours: By arrangement via email
Electronic mail: stanfill@ohsu.edu
Contacting electronically is the fastest way to reach instructor.
Course communication: Forums will be read at least weekly. Assignments will be returned within one
week of receipt. Direct emails will be answered within 24-48 hours of receipt.
PRE-REQUISITES: Working knowledge of ICD-9-CM or consent of instructor.
COURSE DESCRIPTION: This course will address the application of clinical classification systems and
reimbursement methodologies with a focus on analysis and synthesis of case studies relevant to the
Health Information Manager role. Student will examine coding compliance and ethical behavior and the
effects of both on revenue. The course will include the use of software from AHIMA virtual lab and
students will process cases from the workbook. Both group and individual assignments expected.
REQUIRED TEXTBOOKS/RESOURCES: HIM certificate students are required to become student members
of the American Health Information Management Association (AHIMA). Go to www.ahima.org to join as
soon as possible. This membership will provide a discount for the textbook and will provide other
resources needed for this course.
1. Textbook: LaTour, K. and Eichenwald-Maki, S. Health Information Management, Concepts, Principles,
and Practice, third edition with student workbook (on CD with textbook): AHIMA Press
(Note: This textbook is used for all courses in the HIM program. Two chapters will be used for this
course.)
2. Giannangelo, Kathy, MA, RHIA, CCS, CPHIMA. Healthcare Code Sets, Clinical Terminologies, and
Classifications Systems. 2010: AHIMA Press. ISBN # :9781584262251
3. Zeisset, Ann and Bowman, Sue. Pocket Guide of ICD-10-CM and ICD-10-PCS. 2010: AHIMA Press.
ISBN#: 9781584262527
4. AHIMA virtual Lab (provided to student members of AHIMA)
5. Other resources will be listed in weekly assignments on Sakai.
COURSE COORDINATION:
This course is taught mainly with voice over power points. Assigned readings will be posted for each
learning unit. Homework will include the assigned reading, written assignments, various application
exercises, and answering questions in the student forums. All reading materials and assignments will be
posted in the Sakai learning portal, which is the most up to date source.
SAKAI LEARNING WILL BE USED IN THIS COURSE:
Sakai technical assistance is available from 8:00 AM-10:00 PM, Monday through Friday and weekends
noon – 8 p.m. at 503-494-7074, toll-free at 877-972-5249 or submit a “trouble ticket” by sending an
email to sakai@ohsu.edu.
Sakai will have the most current information about each week and you will find

Links to lectures in Flash and MP3, along with a handout of the power point

List of readings

Assignments
EVALUATION: Points for assignments and forums are awarded weekly. A final project, in lieu of a final
exam, is also assigned points.
Assignments: 70 % of grade
Final Project/Exam: 30 % of grade
GRADING:
Letter grades will be given for this course based on the following percentages and based on earned
points.
90-100%
A
80-89%
B
70-79%
C
60-69%
D
<60%
F
COURSE OBJECTIVES:
The following Domains and subdomains of the American Health Information Management Association
form the goals/objectives and outcome competencies for this course. Column two of this grid lists
related BMI courses for additional content in these areas.
I. Domain: Healthcare Data Management
A. Subdomain: Health Data Structure, content and standards
4. Monitor use of clinical vocabularies and terminologies used in the
organization’s health information systems
BMI 510, BMI 512, BMI 584
C. Subdomain: Clinical Classification Systems
1.
2.
1.
2.
3.
4.
Select electronic applications for clinical classification and coding.
Implement and manage applications and processes for clinical
classification and coding.
D. Subdomain: Reimbursement Methodologies
Manage the use of clinical data required in other reimbursement
systems in healthcare delivery.
Manage the use of clinical data required in other reimbursement
systems in healthcare delivery.
Participate in selection and development of applications and
processes for charge master and claims management.
Implement and manage processes for compliance and reporting such
as the National Correct Coding Initiative.
BMI 510, 512, BMI 584
BMI 584
BMI 537, BMI 584
BMI 537, BMI 584
BMI 584
BMI 584
The following Knowledge Clusters are built into the course content at the analysis and synthesis levels as
noted by the ( ). The second column of the grid indicates other related BMI courses that address some of
the knowledge clusters.
4 = Analysis: Breaking down information and inferring (or finding
evidence) to support divergent conclusions
5 = Synthesis: Applying prior knowledge and skills to create a new or
original whole




Break down, differentiate, discriminate
Recognize, infer, point out
Illustrate, outline, prioritize
Learning objectives phrasing: diagram,
distinguish, organize parts, recognize
hidden meanings, identify components,
arrange, select, explain, infer, prioritize



Use old ideas to create new ones
Predict and draw conclusions
Adapting divergent knowledge toward a
new synthesis
Learning objectives phrasing: adapt,
anticipate, collaborate, combine,
compare, compose, design, devise,
facilitate, negotiate, reconstruct,
reorganize, substitute, revise, design,
invent

I.C. Clinical Classification Systems
1.
Healthcare taxonomies, clinical vocabularies,
terminologies/nomenclatures (such as ICD-9-CM, ICD-10, CPT,
SNOMED-CT, DSM-IV) (4)
2. Medicare Severity Diagnosis Related Groups (MS-DRGs) (4)
BMI 510 BMI 584
BMI 584
I.D. Reimbursement Methodologies
1.
Clinical data and reimbursement management (5)
BMI 537, BMI 584
2.
Compliance strategies and reporting (e.g. National Correct
Coding Initiative) (4)
BMI 584
3.
Charge master management (4)
BMI 584
4.
Case mix management (4)
BMI 537, BMI 584
5.
Audit process (such as compliance and reimbursement) (5)
BMI 584
6.
Payment systems (such as PPS, DRGs, APCs, RBRVS, RUGs)
(4)
BMI 537, BMI 584
7.
Commercial, managed care and federal insurance plans (4)
BMI 537, BMI 584
ACADEMIC HONESTY: Students are expected to maintain academic honesty in their course work.
Literature and resources (including Internet resources) used in fulfilling assignments must contain
citation. See http://www.ohsu.edu/dmice/enrolled/plag.shtml
In an effort to uphold the principles and practice of academic honesty, faculty members at OHSU may
use originality checking systems such as Turnitin to compare a student’s submitted work against
multiple sources.
STUDENT ACCESS POLICY: If you need reasonable accommodation, please let me know as soon as
possible. Our program is committed to all students achieving their potential. If you have a disability or
think you may have a disability (physical, learning, hearing, vision, psychological) which may need
reasonable accommodation please contact student access at 503-494-0082 or email at
orchards@ohsu.edu to discuss your needs. In addition, you can find more information at
http://www.ohsu.edu/student-access.
COURSE OUTLINE/CALENDAR: Complete instructions including required date of completion for each
assignment is posted on Sakai learning portal. Please check regularly for updates as Sakai will have the
most up to date information.
Week(s)
Topic
Wk. 1
March 28 –
April 3
Intro to Clinical
Classifications
and
Terminologies
Readings
Course Assignments and Due Dates
LaTour &
Eichwenwald,
Chapter 13;
Giannangelo
Chapter 1
Reimbursement LaTour &
Methodologies Eichenwald
Chapter 14



View lecture
Post to Forums – Your Introduction (by April 3)
Post to Forums – Classification/terminology discussion
question (by April 6)



View lecture
Post to Forums – CAC discussion (by April 13)
Post to Submission – Healthcare reform (by April 13)
Wk. 3
April 11 17
ICD-9-CM
Coding and
DRGs



Wk. 4
April 18 –
April 24
Introduction to
ICD-10-CM and
ICD-10-PCS
Giannangelo
Chapter 2, and
select readings
on Sakai
Pocket Guide
of ICD-10-CM
and ICD-10-PCS



View Lecture
Post to forum – MS DRG discussion (by April 20)
Post to submissions – ICD9 VLab worksheets (by April
20)
View Lecture
Post to Forums –implementation of ICD10 (by April 27)
Post to Submissions – ICD10 Vlab exercise (by April 27)
Wk. 5 & 6
April 25 –
May 8
CPT & HCPCS
Giannangelo
Chapter 3 & 4



View Lecture
Post to Forums – Request a new CPT code (by May 11)
Post to Submissions – HCPCS codes (by May 11)
Wk. 7 & 8
May 9 –
May 22
SNOMED CT
and LOINC
Giannangelo

Chapter 7 & 10 
Wk. 9 & 10
May 23 –
June 5
Application of
Terminology
and
Classification
Systems
Giannangelo
Chapter 17 &
18
View Lecture
Post to Forums – terminology action agenda (by May
25)
Post to Submissions –SNOMED CT exercise (by May 25)
View Lecture
Post to Forums – application of terminologies (by June
8)
Post to Submissions – mapping exercise (by June 1)
Post to Submissions – application of terminologies (by
June 8)
Wk. 2
April 4 -10





Wk. 11
June 6 –
June 10
Final Paper
completed

Final paper (due June 10)
FINAL PROJECT/EXAM: The following project constitutes the final examination. Students are advised to
begin the research early in the term and use the full term to complete the project. Several of the
chapters in the Giannangelo textbook, though not specifically covered as assignments in the course, may
be useful in the project. The final project is worth 50 points for 30% of the final course grade. It must be
completed and submitted by the final day of the term (June 10, 2011).
Project description:
Prepare a 5 to 10 page paper on one of the following topics. Students must use the AMIA template and
Vancouver reference for citations. For either topic, students must have a minimum of 10 references
which may include resources from the course materials, but should also include other sources identified
by the student.
1. Topic: Adoption of ICD-10-PCS in the United States
Discuss the adoption of the ICD-10-PCS in inpatient setting. The paper should address:






introduction to problem
how to prepare for the implementation of a new coding system that will affect the
reimbursement system (include discussion on charge master, electronic health records)
training issues that will need to be addressed with a specific outline of how this will be
developed and implemented
human resource issues, including the affect of major changes, how this may impact the common
practice of outsourcing coding to home offices, etc.
summarize your findings
develop a conclusion of thoughts and recommendations for successful adoption
-OR2. Topic: Explore an emerging classification or vocabulary system
Choose one of the emerging classification or vocabulary systems listed in the Giannangelo textbook.
Research it thoroughly, using multiple resources, and address at least the following:







Introduction of the classification/vocabulary system
Background on the system and its intended purpose/use
Evaluation of system against desired elements as discussed by Cimino and Campbell's
Desiderata from textbook
application of the classification/vocabulary system in light of healthcare industry developments
today
Address resource issues related to the implementation and use of the system (this could
address, human resources, technology, etc)
Summarize your findings
Develop a conclusion of thoughts