HC463 Third Party Reimburse & Risk Mgt

for U1OO 2011

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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 Reimbursement  & Risk Management


U1OO 2011 WO


Hutton, Angeline E.


Adjunct Faculty


Bachelor of Science - Accounting & Business
Master of Health Administration

Office Location

Fort Leonard Wood, Mo.  - Site # 10

Office Hours

Monday through Friday - leave message with office personnel

Daytime Phone

573-736-5141 - home

Other Phone

573-644-2602  - DO NOT LEAVE A MESSAGE



Home e-mail -  bhutton2@embarqmail.com

Semester Dates

June 6 - July 31 - 2011

Class Days


Class Time

5:00 - 10:20 PM

Credit Hours



Principles of Risk Management & Insurance  10th Edition -  Rejda, George
ISBN- 978-0321414939

Textbooks can be purchased through the MBS bookstore

Textbooks can be purchased through the Parkville Bookstore

Additional Resources:

Furnished by instructor:
Film - "Can You Afford to Retire?"  Frontline
Film -  "Ethics in the Workplace"  Bill Moyer Journal
Film - Profits Before Patients"  Bill Moyers Journal
Film - Dealing with Disaster -  Nightly Business Report
Brochures, programs  and pamphlets by Primaris & CLAIM, -  Missouri Quality Assurance Organization

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 one of interactiveness based on lectures, student participation, examinations, videos, research and writings. 
I consider each student an adult that has choosen this course of study to learn as much as possible about our world of Risk and the purchasing of  insurance to mitigate that risk. 
I consider myself a partner to each student in the class to facilitate that study;
Therefore, I plan to give much interest and energy  to this class and will expect each student to do the same.   

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. Students will become comfortable discussing definitions of risk and it's 4 basic areas.  Each student will better understand the difference between insurance, gambling and speculation.
  2. Students will understand the nature and basic characteristics of insurance and gain a broad knowledge of the different types of insurance, insurance polices and the importance of each in our health care, private business, and in our private lives.
Core Assessment:

Class Assessment:

Assessment of student learning will be conducted through the use of written exams, homework and class participation
In addition, each student will be expected to choose one type of  Insurance, such as Health, Malpractice, Business Liability, etc. and research at least two different policies from different companies on the same coverage. 
 Each student will be expected to complete a 2 - 3 page paper on each policy - listing a comparison of the benefits, restrictions, cost  and other particular criteria of that policy.  This "shopping list " or research  paper will be turned in and  presented to the class on the 7th night of class. 


Class participation - 25%  - 100 points    Home work -  20%  - 80 points     
 Mid-term exam -   25%   -  100 points   Final exam -  30%  - 120 points 
TOTAL POINTS - 400 points
90 - 100   -     A
80 -  89   -      B
70 -  79  -       C
60 -  69   -      D
Below 60 -      F

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:
Course work 1 - to 2 weeks late with a valid reason will be accepted WITH A REDUCED GRADE.
Assignments past 2 weeks late WILL NOT be accepted. 
Final exam and any course work WILL NOT BE accepted past the 8th and final night of class

Classroom Rules of Conduct:

Each student will be expected to be on time, and present for entire class period and to have read and prepared for full participation in each class. 
Full respect for fellow students and Instructor MUST be present at all times
Cell phones will be turned off during class time.  Short periodic breaks will be allowed to attend to any outside matters

Course Topic/Dates/Assignments:

Week 1 -  READ CHAPTERS 1 -2 -3 -4
                 Introductions -  housekeeping  - discussion of required research and paper
                 We will study and discuss definitions of risk in our society -along with techniques for managing and mitigating it.
                  Students will be able to discuss the steps in the Risk Management Process
                  Students will begin to obtain risk management and insurance terminology and vocabulary
                  We will study and discuss loss forecasting, financial analysis and insurance dynamics in risk management
Week 2 -  READ CHAPTERS  5 -6- 7-8
                 We will study an overview of private insurance and financial services industries. Students will obtain a
                  knowledge of the types of private insurers, agents and brokers
                  We will look at and discuss underwriting, rating and insurance company operations.  Students will obtain a
                  broad knowledge of the types and processes in property and casualty, life and health insurance companies, along
                  with their histories.  Students will have a good knowledge of State and Fed. regulations.
Week 3     READ CHAPTERS 9-10-11-12-13
                 We will study and understand the principles of Indemnity, Insurable Interest , Subrogation, Utmost Good Faith.
                  Students will have a broad understanding of the legal characteristics of insurance contracts with a broad
                  and general knowledge of Life Insurance with its provisions, options and benefits.
                 Students will obtain knowledge of Insurance costs and the requirements of purchasing a policy. 
Week 4 -  READ CHAPTERS 14 AND 15 
                 We will study and understand annunities and individual retirement accounts, along with individual types of health
                 insurance companies
                 MID TERM EXAMINATION
Week 5 -   READ CHAPTERS 16 AND 17
                  We will grade and discuss each question on the Mid Term Examination -  Students will have a good
                  understanding of each question on the test and be able to discuss each question and it's solution, or answer.
Week 6     READ CHAPTERS 18-19-20-21-22-23
                 We will discuss and understand  Group Life Insurance and Group Health Coverage along with other types of
                 employee benefits
                 Students will obtain a broad understanding of retirement plans, Mutual Funds and different types of qualified
                 We will study in depth the social insurances, the types of benefits, the problems and issues that we are currently
                 Students will be able to discuss the basis of legal liability in insurance coverage and Tort coverage. 
Week 7 -  READ CHAPTERS 24-25-26-27
                 We will go in depth on other property and liability insurances, Commercial packages, Malpractice, Commercial
                 Liability and Professional Liability, along with crime insurance and surety Bonds. 
                  Student presentations on their research of individual insurance policies with benefits and restrictions.
Week 8 -  Final Exam  -  CLASS CLOSURE   

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 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.

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 .


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Last Updated:5/21/2011 8:55:19 AM