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HC 463 Third Party Reimburse & Risk Mgt
Goodwin, William


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

S1T 2010 DL

Faculty

Goodwin, William

Title

Senior Instructor

Degrees/Certificates

MBA-Texas A&M University
Doctorate in Process-Texas A&M University-Corpus Christi

Office Location

Virtual Office

Office Hours

24/7

Daytime Phone

361-442-4570

Other Phone

361-547-5155

E-Mail

William.Goodwin @park.edu

bginc47@aol.com

Semester Dates

01/11/10-03/07/10

Class Days

TBA

Class Time

TBA

Credit Hours

3


Textbook:
 

 

Principles of Risk Management and Insurance
Required Edition: 10TH 07 Rejda, George E.

 

Textbooks can be purchased through the MBS bookstore

Textbooks can be purchased through the Parkville Bookstore

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/.
Advising - Park University would like to assist you in achieving your educational goals. Please contact your Campus Center for advising or enrollment adjustment information.
Online Classroom Technical Support - For technical assistance with the Online classroom, email helpdesk@parkonline.org or call the helpdesk at 866-301-PARK (7275). To see the technical requirements for Online courses, please visit the http://parkonline.org website, and click on the "Technical Requirements" link, and click on "BROWSER Test" to see if your system is ready.
FAQ's for Online Students - You might find the answer to your questions here.


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

Educational Philosophy:
The facilitator’s educational philosophy is one of interactiveness based on lectures, readings, quizzes, dialogues, examinations, internet, videos, web sites and writings. The facilitator will engage each learner in what is referred to as disputatious learning to encourage the lively exploration of ideas, issues and contradictions.

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:
 

Weekly Activities

You will be able to track your average throughout the course. The grading scale is below. You will know in advance the standards for each assignment. My goal is to give you prompt, clear, and useful feedback to help you learn about risk management. Each student is responsible for:

    • Completing weekly quizzes consisting of true and false questions from the text             80 pts
    • Reading the weekly discussion article and posting to related discussion thread             160 pts
    • Answering the weekly homework questions and essays. (place in Drop Box)                 160 pts
    • Taking the  Midterm Exam                                                                                       150 pts
    • Writing 1 summary article on a current risk management topic                                        50 pts
    • Completing a Research Paper on the Risk Management process.                                      150 pts 
    • Final proctored exam                                                                                                250 pts
                                                                                                                                 _____________

TOTAL POINTS                                                                                                                1000 pts
                 
                                                                                   

Other Assessment Guidelines

All work must contain appropriate formatting, grammar, and spelling.

Completing a student opinion survey form located in the Distance Learning section of the Park University website in Week Eight of this class.

Locating a suitable Proctor with e-mail and Completing a Proctored Final Examination.

 

 

 

 

 

         


 


 

 

 

 





 




 



 




 




 


 

 

            

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 




 



 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

   

Grading Scale –

In-class writing assignments and class participation will constitute approximately 40% of your course grade.  This includes homework assignments, article summaries, peer review, and discussions.

A midterm exam covering  current issues presented in class, readings and the content of papers developed by students, will constitute 15% of your course grade.

The final exam constitute 25% of your course grade. 

Grading Criteria for Participation Points:

The weekly homework and discussion assignments are worth approximately 32 % of your grade.  Grading criteria for points on discussions and homework is as follows:

The three most important grading criteria for your work will be breadth, depth, and application of course concepts. For purposes of this course, the following definitions will apply to each of these terms:

 

  • Breadth (B):  Refers to the "number" of chapter and lecture concepts that you have applied to the homework questions, discussion, and report.
  • Depth (D):  Refers to the degree you provide "detailed" analyses to the homework questions, discussion, and report.
  • Application (A):  Refers to the chapter and lecture concepts you "apply" to your homework questions, discussion, and report. You can accomplish this by referencing page numbers, concepts such as data collection methods, etc.

During the first two weeks, I will respond to the work you submit with either a B, D, A, or combination thereof. 

For example, if you need additional breadth and application as they relate to your work, I will provide the following comment:

Areas for additional focus: BA

Each time you submit work, I will respond (In the comment section) to the work you submit with either a B, D, A, or combination thereof. For example, if you need additional Depth and Application as they relate to your work, I will provide the following comment:

Areas for additional focus: D1/A2.  Note:  A number (1, 2, or 3) by the letter indicates the degree to which additional focus is needed.  For example, D1, indicates a small amount of additional depth is needed, a D2  indicates a moderate amount is needed, while a D3 indicates a substantial amount is needed.  In terms of relating the above to point deductions, the following can be used as a guideline (Actual point deductions may vary somewhat)

Homework Point Deductions

  • B1 or D1 or A1  =  1 point deduction
  • B2 or D2 or A2  =  2 point deduction
  • B3 or D3 or A3  =  3 point deduction
  • B1/A1, etc. = 2 point deduction
  • B1/A2, etc. = 3 point deduction
  • B1/A3, etc. = 4 point deduction
  • B2/A2, etc. = 4 point deduction
  • B2/A3, etc. = 5 point deduction
  • B3/A3, etc. = 6 point deduction
  • B1/A1/D1, etc. = 3 point deduction
  • B1/A2/D1, etc. = 4 point deduction
  • B1/A2/D2, etc. = 5 point deduction
  • B1/A3/D3, etc. = 7 point deduction
  • B2/A2/D2, etc. = 6 point deduction
  • Etc.

Discussion Point Deductions

  • B1 or D1 or A1  =  2 point deduction
  • B2 or D2 or A2  =  4 point deduction
  • B3 or D3 or A3  =  6 point deduction
  • B1/A1, etc. = 4 point deduction
  • B1/A2, etc. = 6 point deduction
  • B1/A3, etc. = 8 point deduction
  • B2/A2, etc. = 8 point deduction
  • B2/A3, etc. = 10 point deduction
  • B3/A3, etc. = 12 point deduction
  • B1/A1/D1, etc. = 6 point deduction
  • B1/A2/D1, etc. = 8 point deduction
  • B1/A2/D2, etc. = 10 point deduction
  • B1/A3/D3, etc. = 14 point deduction
  • B2/A2/D2, etc. = 12 point deduction
  • Etc.

Your participation grade will be determined by your positive responses to the discussion postings of others and your timeliness in terms of submitting your work, etc.

IMPORTANT!! Your grade for each discussion posting will be determined not only by the "B-D-A" of your postings, but also by your positive responses to the postings of your team members. Please respond to at least 2 postings of another student for each discussion assignment. Failure to do so will result in a loss of five points for each case you post in the Discussion Area

Article Summary


You will be writing a paper specifically related to the issues surrounding a current risk management topic. The summary article should be a topic other than the one covered in your research paper. Article Summaries and the original article should be submitted into the dropbox area for grading. Guidelines for completion of the article summary are as follows:

1. Locate a current article that examines a risk management topic that is relevant to the risk management process being utilized by health care organizations in the United States. (A Website is not an acceptable resource, BUT journal articles found on the Internet are). Articles can be found at your local library, a college library, or from Internet sources. The article must show a correlation between the management topic  discussed in your textbook. Textbooks are not an acceptable resource for this assignment.

2. Write a two-three page paper that includes the following components:

a. A summary of the article in your own words: DO NOT COPY from the article!

b. Your own personal reaction to the article: What did you learn? What did you think of the information provided?

c. Your analysis of how the article demonstrates a correlation between what we have been discussing in class (and in the text and lecture materials) about an issue.

In other words: What aspects of the article demonstrate how this risk managent issue relates to risk management practices currently utilized in health care organizations, government regulations, to HIPA regulations, and other risk management activities practiced in health care.

3. Submit the summary along with the copy of the article by the due date listed by Midnight on Sunday night of this week. Papers should be submitted to the drop box area.



GRADING CRITERIA
TOTAL POINTS

Summary of Article
10 Points

Reaction to Article
10 Points

Analysis of Article: Correlation to Course
15 Points

Format/Neatness
05 Points

Source Material
05 Points

College Level Writing Skill
05 Points

TOTAL POINTS
50 POINTS



A midterm exam and a final exam will be given over current issues presented in class, readings and the content of papers developed by students.

The research paper presented in prescribed format will constitute 15% of your course grade, and is expected to be approximately 7-9 double spaced pages in length not including the reference and title pages.

Final paper: Write a paper about a current issue in Risk Management that is currently being utilized in health care organizations. Include in the paper:

1) The role of the risk management topic in health care organizations.

2) The role of the risk management topic as related to risk management processes utilized across the health  care sprectum.

3) How the risk management topic impacts the cost of health care, staffing capability, and other health care  activities.

4) Explain how the risk management topic is related to the government regulatory environment. 

5) Describe involvement of interest groups and other health care organizations such as JCAHO in determining  the way risk  management is practiced in the United States.

6) Describe any strategies and recommendations necessary to implement this risk management topic or process in health care organizations today.

7) Include any impact the risk management topic or process would have on health care policy making today. 

GRADING OF PAPER: 

150 points 

Approved Topic by the Instructor: 5 points

Title Page: 5 points

Introduction of Topic: 15 points

Body of Term Paper includes:

a) Role of political process on risk management: 15 points

b) Roles of the demanders and suppliers of health policy: 15 points
 Strategies and Recommendations for addressing healthcare issue: 10 points
 
c) How the risk management topic impacts the cost of health care, staffing capability, and other health care activities. 15 pts

d) Explain how the risk management topic is related to the government regulatory environment. 10 pts

e) Describe involvement of interest groups and other health care organizations such as JCAHO in determining  the way risk  management is practiced in the United States. 10 pts

f) Describe any strategies and recommendations necessary to implement this risk management topic or process in health care organizations today. 10 pts

g) Include any impact the risk management topic or process would have on health care policy making today. 15 pts


Effect of current issue on future initiatives in risk management: 10 points

Sources of information in body of paper are cited using APA style format: 5 points

Reference Page: 5 points

TOTAL POINTS: 150 points

Topics should be  Topic should be selected  and approved by the end of Week One, but not later than the end of Week Two.

The entire term paper will be submitted  by Friday, the end of Week 8 for grading.

 Again remember that the
research paper  must be completed and submitted by Friday of Week Eight by Midnight. Please check your calendar dates and arrange to complete the final accordingly.

         

Grading:

Grading:

Course Grading Scale 

  A = 900-1000 points

  B = 800-899   points

  C = 700-799   points

  D = 600-699   points

  F =      0-599   point


POINTS SYSTEM
    • Completing weekly quizzes consisting of true and false questions from the text             80 pts
    • Reading the weekly discussion article and posting to related discussion thread            160 pts
    • Answering the weekly homework questions and essays. (place in Drop Box)                160pts
    • Taking the  Midterm Exam                                                                                                150 pts
    • Writing 1 summary article on a current risk management topic                                        50 pts
    • Completing a Research Paper on the Risk Management process.                                  150 pts 
    • Final proctored exam                                                                                                           250 pts
                                                                                                                                 ________                           _____

TOTAL POINTS                                                                                                                                       1000 pts
                 
                                                                                   

All final exams will be comprehensive and will be closed book and closed notes.  If calculators are allowed, they will not be multifunctional electronic devices that include features such as: phones, cameras, instant messaging, pagers, and so forth. 

.  The grade for students who pass the proctored final will be based on the overall average of homework and tests taken during the course.  The proctored final exam must address only material which the student has been taught in class.

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 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.

Late Submission of Course Materials:
Submission of Late Work:  When an online classroom assignment is due at 12:00, 12:01 is late.  Generally, late work will receive a 80 for the first day, 70 for the second day late, and 0 after that.  Extensions are available for very extenuating circumstances (If you are hospitalized or are deploying to and will not be near a computer for the entire week). 

Mid-Term: You must turn in the Midterm by Sunday of Week 5. You can only turn in the Mid-Term late with my permission. Without an excuse that I approve of (hospitalization, for example), you will receive no higher than a C if you take it 1 day late and no higher than a 50% if you turn it in it 2 days late. You cannot take the Mid-Term late after Sunday of Week 5 unless you have an excuse.

For the paper that is due in Week 8, papers that are one day late will receive a grade no higher than a B; papers that are late by two days will receive no grade higher than a C, past 2 days late will receive a 0. What does late mean? If your assignment is due by midnight and the time is 12:01, it is late.

Final Exam: You can't take the Final Exam late without instructor permission.

Classroom Rules of Conduct:

This course is offered on-line, over the Internet, using the ECollege computer service. Each student is expected to devote a minimum of five hours per class week logged on to the computer conferencing system. This is same amount of time you'd spend in the physical classroom. See "Ground Rules for On-line Participation" for additional information.

According to Park University guidelines, this course is divided into eight weeks with the first week beginning on the first day of the semester, a Monday, and ends midnight the following Sunday. Weeks Two through Eight also begin on Monday and end on the following Sunday.  All work and formal papers should be completed and successfully emailed so that they are in by the due date.

Ground Rules for On-line Participation

  1. Students should use E-Mail for private messages to the instructor and other students. The Class Conference is for public messages.
  2. Students are expected to complete 5 hours per week of conferencing or other appropriate online activities, including sending/receiving E-mail and navigating and conducting research over the World Wide Web.
  3. KEEP A COPY of all course work you submit until the end of the term.
  4. All students will participate in conference discussion. Conventions of "on-line etiquette," which include courtesy to all users, will be observed.
  5. If you need assistance please contact me.
  6. Students will normally submit papers as MS Word, RTF or ASCII uploaded to the computer and routed to the instructor or emailed. Please do not use any MS Works format. Overall it works well to copy your assignments from you word processing program and paste it into the e-mail.
  7. Each student is responsible for clicking on the link below and thoroughly reading each online course policy. If you have any questions about any of these policies, please contact me for clarification.

Course Topic/Dates/Assignments:

Week 1 Basic Concepts In Risk Management and Insurance

Learning Objectives
Students will be able to:
1.Describe and explain the difference between risk and chance of risk?  .
2. Explain the 2 categories of loss prevention and provide an example of each.
3. Describe and differentiate between the 4 distinct characteristics of insurance   plans.
4. Describe the risk management process in detail.
5. Explain the methodology a risk manager employs to forecast possible losses. 

What to do:
1. Read the Online Lecture
2. Read Chapters 1 through 2 and go through chapter power points
3. Participate in Discussion Thread
4. Complete Weekly Assignment (Deposit in Drop Box)
5. Take Weekly Quiz


Week 2 Risk Management In Perspective

Learning Objectives
Students will be able to:
1. Identify and differentiate between the four steps in the risk management process.
2. Describe the risk control function and discuss the various techniques utilized in this process.
3. Describe risk financing and explain the appropriate risk financing techniques used in risk management.
4 Compare and contrast traditional risk management with the enterprise risk management.
5. Define the underwriting cycle and be to able to analyze appropriate underwriting situations.

What to do:
1. Read the Online Lecture 
2. Read Chapters 3-4 and go through chapter power points
3. Participate in Discussion Thread
4. Complete Weekly Assignments (Deposit responses in Drop Box)
5. Take and complete Weekly Quiz

 

Week 3 The Private Insurance Industry

Learning Objectives
The student will be able to

1. Identify and provide examples of the significant underwriting principles. 
2. Define the underlying principles of reinsurance and identify the situations would reinsurance be utilized?
3. Discuss the regulatory process for the insurance industry.
4. Compare and contrast the state versus federal insurance industry regulatory processes.

What to do:
1. Read the Online Lecture
2. Read Chapters 6 and 8 and go through chapter power points
3. Participate in Discussion Thread
4. Complete Weekly Assignment (Deposit responses in Drop Box)
5. Take and complete Weekly Quiz

 

Week 4 Legal Principles In Risk and Insurance

Learning Objectives
The student will be able to:
1. Describe the three general rules of agency and that govern the actions of agents and their relationships with insured’s?
2. Analyze and interpret the various coordination of benefit results that occur between group insurance plans.
3. Describe the fundamental legal principles reflected in insurance contracts and interpret the purpose of each principle.
4. Discuss and differentiate between the required components of insurance contracts.

What to do:
1. Read the Online Lectures
2. Read Chapters 9-10 and go through chapter power points 
3. Participate in Discussion Thread
4. Complete Weekly Assignment (Deposit responses in Drop Box)
5. Take and complete Weekly Quiz
6. Midterm Examination will be sent to all students. The midterm is due back by Midnight, Sunday of Week 5.

 

Week 5 Health Insurance and Employee Benefits

Weekly Learning Objectives
The student will be able to:
1 .Describe self-insured health plans are operated and distinguish between the different types of plans.
2. Explain the Patient Bill of Rights and also compare and contrast how it is utilized in different health care settings.
3. Describe managed care process and distinguish between managed care and traditional group health insurance plans.
4. Articulate the difference between PPO’s, HMO’s and EPO's; and provide examples of each organization.
5. Identify the four major health care issues in the United States and be able appraise the importance of each.

What to do:
1. Read the Online Lectures
2. Read Chapters 15-16 and go through chapter power points 
3. Participate in Discussion Thread
4. Complete Weekly Assignments (Deposit responses in Drop Box)
5.Take and complete Weekly Quiz                                                

6. Midterm Exam Returned (Via drop box)

 

Week 6  Social Insurance

Learning Objectives:

The student will be able to:
1. Identify the major components offered under the Medicare Program and compare and contrast differences between each.
2. Describe the Medicaid program and distinguish the differences between it and the Medicare program.
3. Explain the major characteristics of Social Insurance and interpret its impact on the United States economy if implemented.
5. Describe and outline the various third party reimbursement mechanisms.
6. Appraise the appropriate reimbursement technique for an organization.

What to do:
1. Read the Online Lectures
2. Read Chapter 18 and go through the chapter power point
3. Participate in Discussion Thread
4. Complete Weekly Assignments (Deposit responses in Drop Box)
5. Take and complete Weekly Quiz. 

6. Article Summary Due (Place in Drop Box)


Week 7 Personal Property and Liability Risks

Learning Objectives

The students will be able to:
1. Define the three categories of torts and be able to differentiate between each type.
2. Describe the primary elements of negligence.
3 Outline and formulate the common defenses against negligence.
4.
Demonstrate a working knowledge of the different types of medical malpractice and be able to compare and contrast each type of related liability.

What to do
1. Read the Online Lecture
2. Read Chapters 19 and 24 and go through the chapter power points
3. Participate in Discussion Thread
4. Complete Weekly Assignments (Deposit responses in Drop Box)
5. Take and complete Weekly Quiz

 

Week 8 Commercial Property and Liability Risks       

Learning Objectives
The student will be able to:
1.Describe the various general liability insurance programs available and evaluate the effectiveness of each.
2. Explain the individual components making up the commercial insurance umbrella policy and communicate the purpose of this insurance product.
3. Distinguish between the various types of commercial insurance crime policies.

What to do
1. Read the Online Lecture
2. Read Chapters 25-27 and go through the chapter power points 
3. Participate in Discussion Thread
4. Complete Weekly Assignments (Deposit responses in Drop Box)
5.Take and complete Weekly Quiz                                                            

6. Turn In Research Paper (Via Drop Box)                                                 

7. Take your Final Exam                                                                               

8. Complete Course Evaluation

 

 

 

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:
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 2009-2010 Undergraduate Catalog Page 92

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.
ONLINE NOTE: An attendance report of "P" (present) will be recorded for students who have logged in to the Online classroom at least once during each week of the term. Recording of attendance is not equivalent to participation. Participation grades will be assigned by each instructor according to the criteria in the Grading Policy section of the syllabus.

Park University 2009-2010 Undergraduate Catalog Page 95

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:

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Last Updated:12/28/2009 1:34:19 PM