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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

U1T 2011 DL

Faculty

Goodwin, William

Title

Senior Instructor

Degrees/Certificates

MBA-Texas A&M University
Doctorate in Process

Office Location

Virtual Office

Office Hours

24/7

Daytime Phone

361-547-5155

Other Phone

361-442-4570

E-Mail

William.Goodwin @park.edu

bginc47@aol.com

Semester Dates

06/05/11-07/31/11

Class Days

Online

Class Time

Online

Credit Hours

3


Textbook:
Principles of Risk Management
and Insurance, 10/e


George E. Rejda
ISBN: 0-321-41493-4

Tenth Edition



Textbooks can be purchased through the MBS bookstore

Textbooks can be purchased through the Parkville Bookstore

Additional Resources:
Resources for Current Students - A great place to look for all kinds of information http://www.park.edu/Current/

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.

The student will be challenged to expand their level of understanding and comprehension of the course material.







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:
 

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 business law. Each student is responsible for:

  • Completing  assigned questions and essays each week
  • Completing discussion questions as well as posting at least 2 peer review reviews per week.
  • Completing an open book, online, Mid-Term exam in Week Four.
  • Completing a writing assignment, referred to as a Research Paper at the end of week 8 
  • 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 by the end of week 5completing a Proctored Final Examination.
  • Completing the proctored closed book, closed note, Final Exam in Week Eight.

Grading:

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 business law. Each student is responsible for:

  • Completing Discussion questions each week
  • Completing Focus Topic questions in each week.
  • Completing an open book, online, Mid-Term exam in Week Four.
  • Completing a Substantial Writing Assignment, referred to as a Paper.
  • 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.
  • Completing the proctored closed book, closed note, Final Exam in Week Eight.

 Course Grading Scale

A = 90- 100%
B = 80-89% 
C = 70-79% 
D = 60-69% 
F = < 60% 







































Paper Grading Guidelines

Your paper is due on Sunday, the end of week 8, at midnight in the Central Time Zone. You must pick a topic related to health care law and then email it to me by the end of week 2. You must have a total of at least 4 sources and at least one, but no more than three, must be an internet source.

Your paper should include an outline, seven to ten edited pages with parenthetical references or footnotes, and a list of your sources (a works cited page or a bibliography). Your paper should be double spaced.

The outline should be brief. For example,

Title

I. Introduction.

II. Point One.

III. Point Two.

IV. Point Three.

V. Conclusion.

For writing tips and information on the  APA style, go to the Writing Resources category in the Webliography.

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                                                                                  200 pts
    • Completing a Research Paper on the Risk Management process.                                 100 pts 
    • Final proctored exam                                                                                         300 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, peer review, and discussions.

A midterm exam covering  current issues presented in class, readings and the content of papers developed by students, will constitute 20% of your course grade.

The final exam constitute 30% of your course grade. 

Grading Criteria for Participation 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.

RESEARCH PAPER

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: 

100 points 

Approved Topic by the Instructor:

Title Page

Introduction of Topic

Body of Term Paper includes

a) Role of political process on risk management

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

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

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.

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

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


Effect of current issue on future initiatives in risk management.

Sources of information in body of paper are cited using APA style format.

Reference Page

 
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 Sunday, the end of Week 8 for grading.

 Again remember that the
research paper  must be completed and submitted by Sunday 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                                                                                                200 pts
    • Completing a Research Paper on the Risk Management process.                                  100 pts 
    • Final proctored exam                                                                                                           300 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:
Course Topic/Dates/Assignments:

Week 1                     

Read Lecture
Review Powerpoints
Read Chapters 1-2
Discussion & Case Study
Take Quiz
Homework

Week 2

Set Up Proctor
Read Lecture      
Review  Powerpoint
Read Chapters 3-4
Discussion & Case Study
Take Quiz
Homework
Research Topic Due

Week 3

Read Lecture
Review Powerpoints
Read Chapters 6 & 8
Discussion 
Take Quiz
Homework

Week 4

Read Lecture
Review Powerpoints
Read Chapters 9-10
Discussion
Take Quiz
Homework
Midterm

Week 5

Read Lecture
Review Powerpoints
Read Chapters 15-16
Discussion
Take Quiz
Homework
Check on Research Paper 

Week 6

Read Lecture                 
Review  Powerpoints
Read Chapter 18
Discussion
Take Quiz
Homework
Check on Research Paper 

Week 7

Read Lecture
Review Powerpoints
Read Chapters 19 & 24
Discussion
Research Report Check
Take Quiz
Homework
Research Paper 

Week 8

Read Lecture
Review Notes & Powerpoint
Read Chapters 25-27
Discussion Questions
Take Quiz
Research Paper Due By Sunday of this week

Complete 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 students and faculty members are encouraged to take advantage of the University resources available for learning about academic honesty (www.park.edu/current or http://www.park.edu/faculty/).from Park University 2010-2011 Undergraduate Catalog Page 92

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. from Park University 2010-2011 Undergraduate Catalog Page 92-93

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 2010-2011 Undergraduate Catalog Page 95-96

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 .

Additional Information:
The Instructor reserves the right to change or adjust the syllabus at anytime during the course.

Rubric


   
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
       
       
           
           
           
           
           
       
       
           
       
       
           
           
           
           
           
       
       
           
       
       
           
           
           
           
           
       
       
           
       
       
           
           
           
           
           
       
       
           
       
       
           
           
           
           
           
       
       
           
       
       
           
           
           
           
           
       
       
           
       
       
           
           
           
           
           
       
       
           
       
       
           
           
           
           
           
       
   
Competency Exceeds Expectation (3) Meets
           Expectation (2)
Does Not Meet Expectation
           (1)
No Evidence (0)
Synthesis
                                                                                  
                                                                                  
                                                                                  
                                    


           Outcomes

           1,5,7                      
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                    
Defines the problem
           goals-methods using 4 or more goals & 6 or more methods based on a
           lit review of 11 or more articles that address the identified research
           problem. 
Uses 3 goals and 5 methods and a lit review of 10
           articles to complete the proposal and written literature review. 
Research
           proposal is presented with less than 3 goal and 5 methodologies and
           less than 10 articles for the written lit review; items are not well
           organized or are haphazard. 
Problem is not well defined and
           goals and methodologies are not logically presented with no  lit
           review. 


           
Analysis
                                                                                  
                                                                                  
                                                                                  
                                     


           Outcomes

           2,3,5,7,8                
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                      
Research proposal
           reflects an extension of existing knowledge and is logically presented;
           lit review identifies major issues clearly. Personal learnings statement
           is systematically stated, 4+ pages. 
Project proposal and lit
           review trace the readily available factors/elements that are associated
           with the  identified problem.  Personal learnings statement is
           adequate—uses three pages. 
Project proposal meets less than the
           required elements and/or the lit review is minimally done.  Personal
           learnings statement is 2 pages or less. 
Research proposal not
           done and/or lit review not completed and /or personal learnings
           statement not provided/ 


           
Evaluation                              
                                                                                  
                                                                                  
                                                                             


           Outcomes

           3,6,7,8
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                        
Learner
           provides accurate and extensive interpretations of the data gathered in
           the lit search and methodically uses it to write the proposal; personal
           learnings summaries clearly stated with depth of insight. 
Learner
           accurately summarizes lit review results and poses a project proposal
           reflecting the summary; personal learnings summary listed as assigned. 
Learner
           neglects relevant data in the lit review and/or shows no cohesion in
           the project proposal and/or shows limited application of learnings to
           personal understanding of the self. 
Lit review and project
           proposal show no connections and/or personal learnings summary not tied
           to project proposal process. 


           
Terminology            
                                                                                  
                                                                                  
                                                                                  
                      


           Outcomes

           1,2,6,7                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                      
Learner uses terms relevant to the
           topic in a manner consistent  with a clear understanding of  concept
           relationships. 
Basic meanings of terms appropriately used.  Meanings
           of terms not clearly connected to discussions provided 
No
           specialized terminology used. 


           
Concepts              
                                                                                  
                                                                                  
                                                                                  
                       


           Outcomes

           1,2,5,7                                
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                        
Learner provides an astute
           project proposal that extends the relationships and application of
           ethics to business problems in ethics. 
Learner provides a
           research question-proposal fitting to the application of business
           ethics 
Learner provides a topic beyond the realm of research or
           the filed of business ethics. 
Research problem/question with
           project proposal and lit search not provided. 


           
Application
                                                                                  
                                                                                  
                                                                                  
                                  


           Outcomes

           1, 3, 4                      
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                  
Learner demonstrates
           extended knowledge of research relationships  and
           extension/applications. 
Learner structures proposal and lit
           review in a workable manner. 
Research methodologies and goals
           not related and/or not related to lt review data. 
No knowledge
           of research design. 


           
Whole Artifact                          
                                                                                  
                                                                                  
                                                                             


           Outcomes

           3,7,8
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                          
APA
           standards applied with 4 errors or less. 
APA standards used
            with 5-9 errors present. 
APA style used with 10 or more
           errors. 
APA style not used. 


           
Component              
                                                                                  
                                                                                  
                                                                                  
                      


           Outcomes

           1, 3, 4                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                      
Text of document is 11 pages or
           longer with proper headings and organization with 1 inch margins, text
           double spaced and 12-point fonts. 
Body of text is 10 pages with
           proper headings and organization with 1 inch margins, text double
           spaced and 12-point fonts. 
Body of text is 8-9 pages with
           proper headings and organization with 1 inch margins, text double spaced
           and 12-point fonts. 
Body of text is 7 pages or less and/or
            with improper headings and organization with odd inch margins, text
           line spacing or fonts. 


           
Courses                                  
                                                                                  
                                                                                  
                                                                            


           Outcomes

           3,4,7,8
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                                  
                                                                        
Learner
           provides transdisciplinary insights into related multicultural issues
           embedded in the research proposal project; poses interventions promoting
           diversity resources/skills. 
Learner addresses the
           multicultural issues within the field of the research topic/question
           chosen. 
Multicultural issues are mentioned but not related to
           the topic at hand. 
Multicultural issues not mentioned. 


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Last Updated:5/25/2011 11:51:28 PM