Discussion

Carol Powers

I had had to rewrite this reflection because my perception of what I learned here has changed dramatically with my final grade. I really felt like so many of my classmates were way above my knowledge level and that I had fallen into a discipline that was over my head. I realized early on I could only concentrate on this class and no others. I learned a great deal about coding, reimbursement, federal and state regulations as applied to healthcare reimbursement, but more importantly I began to understand how difficult it is to be a provider in these times. Having worked in health insurance and claims for a little while, I had a vague understanding of how codes were applied to reimbursement and I understood about pre-authorization, managed care, from a different perspective. I think my greatest takeaway from this class at this point is wanting to know more about reimbursement and understanding the importance of legislative influences on the industry. How it is so important that practice managers and doctors understand what is happening in the federal and state legislation, taking accountability for reporting functions. This course to be interesting and it brought together strategies and methods of reimbursement used in the healthcare industry. I was not aware of the benchmarking opportunities available to practitioners and specialties. While there are a multitude of payment models, the Centers for Medicare and Medicaid has created a value-based repayment system where incentives have become an important reimbursement consideration. Private insurers are following CMS lead in developing value-based bundled programs that support treatment and self-management in several areas of care which I found interesting, since I just recently received my MPH degree. I do not have the experiences many of the people in this program have and so I found the class to be very challenging. I really believe that our professor is outstanding and very dedicated to help all students succeed in the class.
I am trying to stay focused as I have reconsidered staying in this program. I do not know if I will work in a practice environment but as a healthcare customer service agent in a healthcare third-party payer system, I still believe this education can help me to advance in my career. I would like to learn more about how coding works and I am looking into membership with the AHIMA. I may have an option to work in utilization review in the future. I am excited now about what this class did for me. Thank you Professor for everything.