Reimbursement Methodology

Online Education Courses

The purpose of this course is to expose the student to contemporary prospective payment systems used by the U.S. government and other key health plans that comprise most patients' source of payment for healthcare services. Reimbursement systems from a variety of healthcare settings are presented to round out the student's experience in preparation for employment as a coding professional in a variety of settings.

Coding Basics is a self-paced program which will cover the foundational concepts in the coding and billing profession. Coding professionals abstract clinical data from health records and assign appropriate medical codes. These codes are used for reimbursement, planning, and research. Comprehensive training in inpatient and outpatient coding is provided, along with the necessary background courses in health record content, medical terminology, and disease process.


At the end of this course, students will be able to:

  • Explain prospective payments and their implications for coding.
  • Define the basic language associated with reimbursement.
  • Analyze various reimbursement methodologies including: MS-DRGs, RUGs, OASIS, APCs, and RBRVS.
  • Differentiate various prospective payment systems and identify the applicable healthcare setting.
  • Recognize the importance of correct clinical coding and compliance.
  • Distinguish between the various types of voluntary healthcare insurance plans.
  • Understand the creation and maintenance of federal insurance programs.
  • Understand the concept and history of managed care.
  • List types of managed care health plans.
  • Identify the benefits and non-benefits of federal programs such as Medicare and Medicaid.
  • Outline the process of revenue cycle management.
  • Identify current quality trends in health care.


You must complete each item found on the main course page to successfully complete this course. Completion is identified with a green check mark symbol.

Each lesson has an associated lesson-level quiz provided for review. You may take the quizzes as many times as you like. However, note that you must achieve a score of 70% or higher on each quiz for it to mark as complete.

Unlike the quizzes, you are only allowed to take the Final Exam once, and you must complete it with a score of 70% or higher to successfully complete the course.



    • Principles of Healthcare Reimbursement, 5th edition Casto and Forrestal
      Product code: AB202014

Note: Course enrollment includes one attempt to take the Final Exam. You must get a score of 70% or higher on the final to earn your CEUs and Certificate of Completion for the course. However, you will be able to continue on to the Course Evaluation or go back and review any of the previous content after taking the Final Exam regardless of score.


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