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HC 463 Third Party Reimburse & Risk Mgt
Sims, Phillip L.


Mission Statement: 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.

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

Course

HC 463 Third Party Reimburse & Risk Mgt

Semester

S2B 2008 BL

Faculty

Sims, Phillip L.

Title

Senior Adjunct Faculty

Degrees/Certificates

BA
MA

Other Phone

204-8985

E-Mail

psims@park.edu

psims@elp.rr.com

Semester Dates

17 March through 11 May 2008

Class Days

-M-W---

Class Time

5:00 - 7:30 PM

Credit Hours

3


Additional 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.
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.
Park Helpdesk - If you have forgotten your OPEN ID or Password, or need assistance with your PirateMail account, please email helpdesk@park.edu or call 800-927-3024
Resources for Current Students - A great place to look for all kinds of information http://www.park.edu/Current/.


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. 3:0:3

Learning Outcomes:
  Core Learning Outcomes

  1. Describe the various forms of third party payment mechanisms for health care services.
  2. Define the various types of risk exposure that health care providers are confronted with in today's real world environment.
  3. Differentiate between the various third party payers and identify the most important aspects of each different payer's payment process.
  4. 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.
  5. Evaluate the loss prevention measures utilized by health care providers.
  6. Select the most appropriate payment methodology for a health care institution's services to ensure the maximum financial benefit to that institution.
  7. Determine the appropriate cost containment measures to be used by a health care provider.
  8. Recommend an appropriate operational response for the common compliance issues faced by health care providers in today's regulatory environment.


Core Assessment:

Grading:

The course grade for students will be based on the overall average of homework and tests taken during the course in accordance with the weighting of the various requirements as stated in the syllabus.

All final exams in all School of Business and Management courses will be comprehensive and will be closed book and closed notes. They will constitute 30% of the total course grade and will not be a take-home exam. They will be completed during the test week in the period designated by the registrar or by the Proctor in the case online courses. If calculators are allowed, they will not be multifunctional electronic devices that include features such as: phones, cameras, instant messaging, pagers, and so forth. Electronic Computers will not be allowed on final exams unless an exception is made by the Dean of the School of Business and Management.

Late Submission of Course Materials:

The research paper must be typewritten and submitted at the last lecture prior to the final examination (4-30) unless previously coordinated with the instructor. Late papers will not be accepted and will be marked down one letter grade.

Classroom Rules of Conduct:

Students are expected to come to all classes and be on time. Roll will be checked at each class meeting. Classes missed for legitimate reasons, such as illness, temporary duty, are excusable; however, the student must make up the missed work. The student is responsible for providing the instructor with justification for an excused absence either prior to or immediately after the absence. Two unexcused absences are excessive and three unexcused absences will result in an involuntary withdrawal and a grade of “F” (attendance) for the course.
 

Submitting someone else’s work as your own will not be tolerated. If determined by the instructor that academic dishonesty has occurred in any part of the course, the student(s) involved will normally be given an immediate grade of  F and dropped

from the course. The second violation results in automatic expulsion from the school. The Assistant Vice President will be notified in writing of the action taken.
 
 

Course Topic/Dates/Assignments:

3-17  Administrative announcements, discussion of the syllabus, lecture/discussion on history and types of health insurance.  Chapters 1 & 2.  Risk in our society. Insurance and risk.
 

3-19  Discuss Chapter 3. Introduction to risk management.

 

3-24  Discuss Chapters 4 and 5. Advanced topics in risk management. Fundamental legal

topics.

 

3-26  Discuss Chapters 6 and 7. Analysis of insurance contracts. The liability risk.

 

3-31  Discuss Chapters 8 and 9. Homeowners insurance, sections I and II.

 

4-2    Discuss Chapters 10, 11, and 12. Automobile insurance and society. Other property

          and liability insurance.

 

4-7    Discuss Chapters 13 and 14. Commercial property insurance and commercial

liability insurance. Review for the mid-term examination.

 

4-8     Mid-term examination. Chapters 1 through 14.

 

4-14  Discuss Chapters 15 and 16. Crime insurance and surety bonds. Fundamentals of

          life insurance. 
 

 

4-16  Discuss Chapters 17, 18, and 19. Types of life insurance. Life insurance

          contractual provisions. Buying life insurance. Student presentations.

 

4-21  Discuss Chapters 20, 21, and 22. Annuities and IRAs. Individual health insurance.

Employee benefits. Student presentations.

 

4-23  Discuss Chapters 23 and 24. Retirement plans. Social insurance. Student

presentations.

 

4-28  Discuss Chapters 25 and 26. Types of insurers. Insurance company operations.

Student presentations.

 

4-30  Discuss Chapters 27 and 28. Insurance pricing. Government regulation of

          insurance. Student presentations. Review for the final examination.

 

5-5     Final examination. Chapters 15 through 28.

 

 5-7   Review of the final examination. Make-up student presentations.
 

Academic Honesty:
Academic integrity is the foundation of the academic community. Because each student has the primary responsibility for being academically honest, students are advised to read and understand all sections of this policy relating to standards of conduct and academic life.   Park University 2007-2008 Undergraduate Catalog Page 85-86

Plagiarism:
Plagiarism involves the use of quotations without quotation marks, the use of quotations without indication of the source, the use of another's idea without acknowledging the source, the submission of a paper, laboratory report, project, or class assignment (any portion of such) prepared by another person, or incorrect paraphrasing. Park University 2007-2008 Undergraduate Catalog Page 85

Attendance Policy:
Instructors are required to maintain attendance records and to report absences via the online attendance reporting system.

  1. The instructor may excuse absences for valid reasons, but missed work must be made up within the semester/term of enrollment.
  2. Work missed through unexcused absences must also be made up within the semester/term of enrollment.
  3. Work missed through unexcused absences must also be made up within the semester/term of enrollment, but unexcused absences may carry further penalties.
  4. In the event of two consecutive weeks of unexcused absences in a semester/term of enrollment, the student will be administratively withdrawn, resulting in a grade of "F".
  5. A "Contract for Incomplete" will not be issued to a student who has unexcused or excessive absences recorded for a course.
  6. Students receiving Military Tuition Assistance or Veterans Administration educational benefits must not exceed three unexcused absences in the semester/term of enrollment. Excessive absences will be reported to the appropriate agency and may result in a monetary penalty to the student.
  7. Report of a "F" grade (attendance or academic) resulting from excessive absence for those students who are receiving financial assistance from agencies not mentioned in item 5 above will be reported to the appropriate agency.

Park University 2007-2008 Undergraduate Catalog Page 87-88

Disability Guidelines:
Park University is committed to meeting the needs of all students that meet the criteria for special assistance. These guidelines are designed to supply directions to students concerning the information necessary to accomplish this goal. It is Park University's policy to comply fully with federal and state law, including Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, regarding students with disabilities. In the case of any inconsistency between these guidelines and federal and/or state law, the provisions of the law will apply. Additional information concerning Park University's policies and procedures related to disability can be found on the Park University web page: http://www.park.edu/disability .

Copyright:

This material is protected by copyright and can not be reused without author permission.

Last Updated:1/26/2008 10:13:33 AM