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HC 463 Third Party Reimbursement and Risk Management
Goodwin, William


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Course Syllabus
Park Vision/Mission Statement Park University Vision
Park University will be a renowned international leader in providing innovative educational opportunities for learners within the global society.

Park University Mission
The mission of Park University, an entrepreneurial institution of learning, is to provide access to academic excellence which will prepare learners to think critically, communicate effectively and engage in lifelong learning while serving a global community.


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Instructor Information Instructor:

email:

phone:

Term:
William N. Goodwin

william.goodwin@pirate.park.edu

361-547-1700

Summer 1, 04





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Developer's name William N. Goodwin


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Course Description Public and private insurance, case management, preferred provider organizations, health maintenance organizations, and other forms of third party payment for health care services. Loss prevention for the health care organization through risk management and cost containment.


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Overview and Course Goals This course offers the student a comprehensive introduction to the essential elements of risk management for health care institutions relating to managed care as well as other ed risk management areas of exposure. The student will also become familiar with risk management techniques necessary to run an effective risk management program.

The student will be challenged to gain an understanding of the essential elements of risk management for health care institutions in the areas of :

Managed care contracting
Maximization of cash flows from third party payor contracts
Loss prevention for the institution
Cost containment measures
Current compliance issues experienced in the health care industry
The course encapsulates the major areas of knowledge and related industry exposure necessary for the student to gain a thorough background in health care risk management.



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Core Learning Outcomes On completion of the course the student should be able to:

Describe the various forms of third party payment mechanisms for health care services.

Define the various types of risk exposure that health care providers are confronted with in today’s real world environment.

Demonstrate a basic level of understanding of the methodologies utilized to minimize risk for health care providers.

Differentiate between the various third party payers and identify the most important aspects of each different payer’s payment process.

Formulate basic corrective or preventive measures for the various types of risk exposure health care providers must deal with on a day-to-day basis.

Evaluate the loss prevention measures utilized by health care providers.

Select the most appropriate payment methodology for a health care institution’s services to ensure the maximum financial benefit to that institution.

Determine the appropriate cost containment measures to be used by a health care provider.

Identify the basic compliance processes needed by a health care provider and able to measure the effectiveness of each.

Recommend an appropriate operational response for the common compliance issues faced by health care providers in today’s regulatory environment.



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Required Texts/Materials Rejda, George E. Principles of Risk Management and Insurance. Eigth Edition.
Boston: Addison-Wesley, 2003. ISBN:0-201-78563-3


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Course Policies E-Mail Procedures and Submitting

General e-mail: When sending e-mail other than assignments, you must identify yourself fully by name and class in all e-mail sent to me and/or other members of our class.
My Response Policy:I will check my e-mail frequently. I will respond to course-related questions within 24-48 hours (unless I notify you previously that I will be unavailable).
When files are sent attached to an email, the files should be in either Microsoft Word, RTF, ASCII, txt, or PDF file formats.

Students are responsible for clicking on the link below and thoroughly reading each Online course policy. If you have questions about any of these policies, please contact your instructor for clarification.

Online Course Policies




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Grading Policy Grading Scale:

Course Assessment

Conference Thread Participation
70pts

Conference Thread Summary
30pts

Essay Question Responses
100pts

Online Quizzes
100pts

Midterm
100pts

Final Exam
100pts

Total
500pts


Assignments - Each week assignments will be given to you.

Weekly Essay Questions (specifically noted in each week do by Sunday midnight of the assigned week) - 100
Points

Weekly Submission of online quizzes (specifically noted in each week do by Sunday midnight of the assigned
week) - 100 points

Participation in weekly discussions - 70 points (please see week 1 for instructions)

Conference Thread Summary (due in Week 7) – 30 points (please see week 7 for instructions)

Midterm Exam to be given in week 4 - 100 points

Final Exam given in week 8 - 100 points

Total = 500 points

Final examination - An examination will be taken in person during the 8th (or 16th) week of instruction at one of the Park University sites around the country or at an alternative location approved by your Instructor where Park University sites are not available. It will be the responsibility of the student to arrange for a proctor, by the 6th week of the term, who will be accepted and approved by the instructor. Guidelines for selecting an acceptable proctor can be found at the Park University Website. For proctored examinations, photo identification is required at the time of the test. A proctor request form will be made available to you during the first week of class so that you can send your requested proctor to me for approval. Failure to take a final proctored exam (or submit your final project for some online graduate courses) will result in an automatic "F" grade. Some Graduate Online courses may not require a proctored Final Examination.

Course Grading Scale – this subsection should list the grading scale and weighting for all of the graded work during a course. The grading scale must use the following scale below, and point totals for each letter grade must be included (see example below).

Example –

A = 90- 100% (or xxx points or higher)
B = 80-89% (or xxx to xxx points)
C = 70-79% (or xxx to xxx points)
D = 60-69% (or xxx to xxx points)
F = < 60% (xxx or fewer points)

Submission of Late Work: Instructors should insert their policy on acceptance/penalties for late work here.

Proctored final examination - A computerized examination will be taken in a proctored testing environment during the 8th (or 16th) week at one of the Park University sites around the country or at an alternative location. For proctored examinations, photo identification is required at the time of the test. Guidelines for selecting an acceptable proctor can be found on the Park University Website.

Other Information on proctored exams:

It will be the responsibility of the student to arrange for a proctor, by the 6th week of the term, who is accepted and approved by the course instructor.
Approval of proctors is the discretion of the Online instructor.
A proctor request form will be made available to you during the first week of class so that you can send your requested proctor to your instructor for approval.
Failure to take a final proctored exam (or submit your final project for some online graduate courses) will result in an automatic "F" grade.
Some Graduate Online courses may not require a proctored Final Examination.



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Academic Honesty Academic honesty is the prerequisite for academic study. Academic dishonesty is inimical to the spirit of a learning community. Hence, Park will not tolerate cheating or plagiarism on tests, examinations, papers, and other course assignments. Students who engage in such dishonesty may be given failing grades or expelled from Park.

Plagiarism, the appropriation or imitation of the language or ideas of another person and presenting them as one’s original work, sometimes occurs through carelessness or ignorance. This does not make it less serious. However, students who are uncertain about proper documentation of sources should consult their course faculty member.



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Attendance Professors are required to keep attendance records and report absences throughout the term. Excused absences can be granted by the instructor for medical reasons, school sponsored activities, and employment-related demands including temporary duty. The student is responsible for completing all missed work. Absences in excess of four (4) class periods (2 weeks in a term) will be reported to the Dean for appropriate action. Any student failing to attend class for two consecutive weeks, without an approved excuse, will be institutionally withdrawn (unofficially withdrawn) and notified by mail that an "F" will be recorded.

Students are expected to spend a substantial amount of time online and offline each week including but not limited to responding to the weekly conference discussions, sending/receiving Email, reading and viewing online lectures, completing online quizzes and tests, and conducting research over the World Wide Web. A rule of thumb is that you should spend approximately 4-5 hours per week online reviewing course content and engaging in group work and discussion and an additional 4-6 hours per week on readings, preparing assignments, or completing papers or examinations.



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Student Resources

McAfee Memorial Library - Online information, links, electronic databases and the Online catalog. Contact the library for further assistance via email or at 800-270-4347.

Park University Online Bookstore - Select "Distance Learning - Graduate," or "Distance Learning Internet," and then click on the appropriate course code (ex. AC 201, PA 501) to see the list of required and optional texts for each course that you are enrolled in.

Advising - Park University would like to assist you in achieving your educational goals. Your Campus Center Administrator can provide advising to you, please contact them for assistance. If you need contact information for your Campus Center, click here.

Online Tutoring Services - Park University has arranged for Online students to receive five hours of free access to Online tutoring and academic support through Smarthinking. If you would like Online tutoring, please contact me to receive their recommendation and information on how to access the Online tutoring.

Career Counseling - The Career Development Center (CDC) provides services for all stages of career development. The mission of the CDC is to provide the career planning tools to ensure a lifetime of career success.

Online Classroom Technical Support - For technical assistance with the Online classroom or your proctor form, email helpdesk@parkonline.org or call the helpdesk at 866-301-PARK (7275).

Park Helpdesk - If you have forgotten your OPEN ID or Password, or need assistance with your PirateMail account, please email the Park Helpdesk or call 800-927-3024.



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My Bio I have been teaching health care, human resources, management, finance, and marketing courses at Park University for over 14 years. I have also taught as a full-time faculty instructor for the Texas A&M University system. I enjoy teaching face-to-face courses but also enjoy the on-line teaching, although I have limited experience. I believe that both formats have strengths and weaknesses, and I am committed to making your online learning experience as valuable and enjoyable as possible.

I enjoy hunting, fishing with my two year old grandson Dylan and am awaiting the arrival of a new grandbaby in June 04.