HC463 Third Party Reimburse & Risk Mgt

for F2B 2008

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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.


HC 463 Third Party Reimburse & Risk Mgt


F2B 2008 BL


Ward, Robert S.


Adjunct Faculty


BS, Health Planning and Administration, Pennsylvania State University.
MA, Health Services Management, Webster University.

Office Hours

Before or after class or by appointment

Daytime Phone





Semester Dates

13 Oct. – 07 Dec. 2008

Class Days


Class Time

7:40 - 10:10 PM

Credit Hours



Principles of Risk Management and Insurance.  George E. Rejeda.  Tenth Edition. Addison-Wesley, 2008. 

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:
HC463 Third Party Reimbursement and Risk Management: 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

Educational Philosophy:

The facilitator's educational philosophy is to bring real world learning into the classroom. This adult learning style will encourage critical thinking, higher-level knowledge, and a fun academic environment. The learning process will be interactive by utilizing the exchange of views/ideas through presentations/case studies, lectures, readings, examinations, and other assignments.  

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:

Class Assessment:

The class assessment will be based on examinations, presentations, case studies, and homework and class attendance/participation.

The grading plan will consist of the following:

Midterm Test: 15 points

Final Exam: 30 points

Case Studies and Homework: there will be a total of 3 assignments each worth 5 points with the combined case study/homework assignment totaling 15 points.

Research Paper: 30 points

Class Participation: 10 points, students will be expected to attend class, answer questions, ask pertinent questions, and participate in the general group discussions on a regular basis.

Total Points = 100


The following will be used to assigned course letter grades:

90 to 100 A

80 to 89    B

70 to 79    C

60 to 69    D

 0 to 59    F (Includes 3 or more unexcused absences)

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:

Late assignments will not be accepted without prior instructor approval.

Classroom Rules of Conduct:

Attend all classes for the entire class period and be on time to all classes. Roll will be taken at each class meeting. If classes are missed for a legitimate reason such as temporary duty or illness the student is responsible to make up the missed work, obtain lecture notes and handouts.

Assignments must be turned in on time. Participate in classroom discussions. Be respectful when others are speaking and do not interrupt. Turn cell phones and pagers to vibrate only during class period. Please do the online survey after the course completion.

Course Topic/Dates/Assignments:

Week 1: Administrative announcements, discussion of the course description, course requirements, student handouts, and introductory comments. Discuss chapter 1 (Risk in Our Society), chapter 2 (Insurance and Risk), and chapter 3 (Introduction to Risk Management). Students will understand the following:

  • Definition of Risk
  • Categories/Types of Risk
  • Burden of Risk on Society
  • Methodologies of Handling Risk
  • Definition and Basic Characteristics of Insurance
  • Types, Benefits and Costs of Insurance to Society
  • Meaning and Objectives of Risk Management
  • Risk Management Process

Week 2: Discuss chapter 4 (Advanced Topics in Risk Management), chapter 5 (Types of Insurers and Marketing Systems), chapter 6 (Insurance Company Operations), chapter 7 (Financial Operations of Insurers). Students will understand the following:
  • Financial Risk Management versus Enterprise Risk Managment
  • Loss Forecasting
  • Financial Analysis in Risk Management
  • Types of Private Insurers
  • Insurance Company Operations
  • Key Components of the Financial Operations of Insurers

Week 3: Discuss chapter 8 (Government Regulation of Insurance) and chapter 9 (Fundamental Legal Principles), chapter 10 (Analysis of Insurance Contracts) and chapter 11 (Life Insurance). Students will understand the following:
  • Purpose of Insurance Regulations
  • Methods of Regulation
  • State versus Federal Regulation
  • Principle’s of Indemnity, Insurable Interest, Subrogation, and Utmost Good Faith)
  • Insurance Contract Requirements
  • Basic Parts of an Insurance Contract
  • Key Definitions of Insurance Contracts
  • Types of Life Insurance

Week 4: Discuss chapter 12 (Life Insurance Contractual Provisions) chapter 13 (Buying Life Insurance) and chapter 14 (Annuities and Individual Retirement Accounts), and review of material for mid-term. Students will understand the following:
  • Key Definitions of Life Insurance Contracts
  • How to Determine the Cost of Life Insurance
  • Definition of Annuities
  • Definition and Key Components of an Individual Retirement Account  

Week 5: Discuss chapter 15 (Individual Health Insurance Coverage’s), chapter 16 (Employee Benefits/Group Life and Health), chapter 17 (Employee Benefits/Retirement Plans), and chapter 18 (Social Insurance). Students will understand the following:
  • Issues and Options Related to the Types of Health Care Insurance Coverage
  • Definitions of the following Health Insurance Products (Major Medical, Health Savings Accounts, Long Term Care Insurance, and Disability Income)
  • Group Life Insurance Plans
  • Various Types of Health Coverage Plans (Group Medical, Indemnity, Managed Care)
  • Fundamentals of Private Retirement Plans
  • Types of Retirement Plans
  • Types of Social Insurance

Week 6: Discuss chapter 19 (Liability Risk), chapters 20 and 21 (Homeowners Insurance Part I and II) and chapters 22 and 23 (Auto Insurance). Students will understand the following:
  • Legal Liability and Types of Negligence
  • Tort Liability Issues
  • Key Components of Homeowners Insurance Policies
  • Key Components of Personal Liability Insurance
  • Auto Insurance Policies, and Types of Coverage
  • True Cost of Auto Insurance

Week 7: Discuss chapter 24 (Other Insurance Coverage’s), chapter 25 (Commercial Property Insurance), chapter 26 (Commercial Liability Insurance), and Chapter 27 (Crime Insurance and Surety Bonds). Students will understand the following:
  • Special Types of Insurance Coverage
  • Definitions of Commercial Property Insurance and Liability
  • Definition of Crime Insurance and Surety Bonds

Week 8: Submit research paper, Student Presentations, Review for Final Exam and Final Exam. 

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 2008-2009 Undergraduate Catalog Page 87

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 2008-2009 Undergraduate Catalog Page 87

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, but unexcused absences may carry further penalties.
  3. 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".
  4. A "Contract for Incomplete" will not be issued to a student who has unexcused or excessive absences recorded for a course.
  5. 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.
  6. 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 2008-2009 Undergraduate Catalog Page 89-90

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 .


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Last Updated:9/23/2008 10:46:56 AM