HC463 Third Party Reimburse & Risk Mgt

for U1LL 2012

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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


U1LL 2012 LR


Hebert, Rachelle A.


BSOE Business
M.A. Health Care Administration

Office Location

Bldg 1490, Designated Classroom

Office Hours

Before or After Class, or By Apppointment

Daytime Phone




Semester Dates

May 28, 2012 - July 22, 2012

Class Days


Class Time

5:00 - 10:00 PM

Credit Hours



Rejda, G. E. (2009). Principles of Risk Management and Insurance, 11th Edition

ISBN-10: 0-13-611702-3

ISBN-13: 978-0-13-611702-5

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/.

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, dialogues, examinations, internet, 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:

 Midterm Examination

 300 points 

 Class Project

 200 points

 Current Articles    

 100 points   

 Final Examination

 300 points

 Class Participation

 100 points 


1000 points


 A = 900 - 1000


 B = 800 - 899

 C = 700 - 799

 D = 600 - 699

 F  = < 599

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.

Classroom Rules of Conduct:
Students are expected to act in a mature and professional manner at all times and respect the ideas of others during class discussion--i.e., listen actively, avoid side discussions while others are talking, etc. Students are expected to arrive on time for class, and be prepared for the lecture/lesson as outlined. Cell phones will be turned off during class time.

Course Topic/Dates/Assignments:

Week 1 (05/31/12)

Administrative announcements, discussion of the course description, requirements, and introductory comments to include articles and class project. Discussion of APA format and research paper requirements. 

Chapter 1. Risk in Our Society

Chapter 2. Insurance and Risk

Chapter 3. Introduction to Risk Management

Chapter 4. Advanced Topics in Risk Management


Week 2 (06/07/12)




Chapter 5. Types of Insurers and Marketing Systems

Chapter 6. Insurance company Operations

Chapter 7. Financial Operations of Insurers

Chapter 8. Government Regulation of Insurance


Week 3 (06/04/12)




Chapter 9. Fundamental Legal Principles

Chapter 10. Analysis of Insurance Contracts

Chapter 11. Life Insurance

Chapter 12. Life Insurance Contractual Provisions

Midterm Review


Week 4 (06/21/12)


Midterm Examination




Chapter 13. Buying Life Insurance

Chapter 14. Annutities

Week 5 (06/28/12)




Chapter 15. Individual Health Insurance

Chapter 16. Employee Benefits

Chapter 17. Retirement Plans

Chapter 18. Social Insurance


Week 6 (07/05/12)




Chapter 19. Risk Liability

Chapter 20. Homeowners Insurance

Chapter 21. Auto Insurance

Chapter 22. Societal Aspects



Week 7 (07/12/12)


Class Projects Due


Chapter 24. Other Liability Coverage

Chapter 25. Commercial Property

Chapter 26. Commercial Liability


Final Review & Synthesis of Course Objectives



Week 8 (07/19/12)


Lecture: Future Insight for Healthcare Insurance


Final Examination




*Subject to change

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.

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 .


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Last Updated:5/20/2012 2:11:33 AM