HC463 Third Party Reimburse & Risk Mgt

for F2T 2011

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Mission Statement: Park University provides access to a quality higher education experience that prepares a diverse community of learners to think critically, communicate effectively, demonstrate a global perspective and engage in lifelong learning and service to others.

Vision Statement: Park University, a pioneering institution of higher learning since 1875, will provide leadership in quality, innovative education for a diversity of learners who will excel in their professional and personal service to the global community.


HC 463 Third Party Reimburse & Risk Mgt


F2T 2011 DL


Jackson, Detra T.


Adjunct Faculty


DBA Northcentral University-in progress
MHA Webster University
BSN Thomas Jefferson University

Office Location

Virtual Office

Office Hours


Daytime Phone


Other Phone




Semester Dates


Class Days


Class Time


Credit Hours



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:



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.
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FAQ's for Online Students - You might find the answer to your questions here.

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 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.

  Instructor Learning Outcomes
  1. All work must contain appropriate formatting, grammar, and spelling.
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 5 completing a Proctored Final Examination.
  • Completing the proctored closed book, closed note, Final Exam in Week Eight. 
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:

Discussion questions must be completely answered, not just a simple once sentence answer or response, grammatically correct, and have references correctly sited in order to receive full credit.

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.


Topic to be approved by the Instructor and should be selected and approved by the end of Week One, but no later than the end of Week Two.

The research paper presented in prescribed format will constitute 10% of your course grade, and is expected to be approximately 7-9 double spaced pages in length not including the reference and title pages. APA format will be used when writing this paper.

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

-A title page
-An introduction to your topic
-The body of the paper should include:

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.

8) Effect of current issue on future initiatives in risk management.

-A reference page

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


 Course Grading Scale

A = 900-1000 points

B = 800-899 points

C = 700-799 points

D = 600-699 points

F = 0-599 points

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


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

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

Week 2

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

Week 3

Read Lecture
Review Powerpoints
Read Chapters 6 & 8
Take Quiz

Week 4

Read Lecture
Review Powerpoints
Read Chapters 9-10
Take Quiz

Week 5

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

Week 6

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

Week 7

Read Lecture
Review Powerpoints
Read Chapters 19 & 24
Research Report Check
Take Quiz
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 2011-2012 Undergraduate Catalog Page 93

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 2011-2012 Undergraduate Catalog Page 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: Students must participate in an academically related activity on a weekly basis in order to be marked present in an online class. Examples of academically-related activities include but are not limited to: contributing to an online discussion, completing a quiz or exam, completing an assignment, initiating contact with a faculty member to ask a courserelated question, or using any of the learning management system tools.

Park University 2011-2012 Undergraduate Catalog Page 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:

























































































Competency Exceeds Expectation (3) Meets

           Expectation (2)
Does Not Meet Expectation

No Evidence (0)









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

Uses 3 goals and 5 methods and a lit review of 10

           articles to complete the proposal and written literature review.

           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











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/












           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.

           accurately summarizes lit review results and poses a project proposal

           reflecting the summary; personal learnings summary listed as assigned.

           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.







Learner uses terms relevant to the

           topic in a manner consistent with a clear understanding of concept

Basic meanings of terms appropriately used. Meanings

           of terms not clearly connected to discussions provided

           specialized terminology used.







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

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.




           1, 3, 4

Learner demonstrates

           extended knowledge of research relationships and

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






           standards applied with 4 errors or less.
APA standards used

           with 5-9 errors present.
APA style used with 10 or more

APA style not used.




           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.










           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

Multicultural issues are mentioned but not related to

           the topic at hand.
Multicultural issues not mentioned.


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

Last Updated:9/22/2011 8:55:16 PM