HC463 Third Party Reimburse & Risk Mgt

for F2Z 2012

Printer Friendly

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


F2Z 2012 ML


Small, Steven


Adjunct Instructor


Master of Public Administration (Government Contracting)
Master of Science in Management (Healthcare)
Bachelor of Science in Management (Marketing)

Office Hours

Flexible (with appointment)



Class Days


Class Time

7:45 - 10:15 PM



Credit Hours



Rejda, George E.  Principles of Risk Management and Insurance, 11th Edition.  2011.  Prentice Hall, 2012.  ISBN-13: 978-0-13-611702-5 / ISBN-10: 0-13-611702-3

Textbooks can be purchased through the MBS bookstore

Textbooks can be purchased through the Parkville Bookstore

Additional Resources:
American College of Healthcare Executives - www.ache.org

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:

My educational philosophy is one of student interactiveness based on lectures, readings, research, dialogue, examinations, internet, and writings.  I 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:

The student's final course grade will be based on a 1000 POINT SCALE.  Point distribution is as follows:

Class Participation / Weekly Activities (30% - 300 Points)  (This will be comprised of 6 weekly sessions worth 50 points each -- see below for point distribution)  

Participation Activities   

Students are expected to be actively involved, providing substantial contributions to classroom discussions/activities.  Students who contribute in this manner will receive full participation points for the weekly in-class activities.  Students who miss the in-class session will be provided the opportunity to receive credit by submitting an outline of covered chapters (point allocation will be based on thoroughness of outline) and/or accomplishing online activities (as provided by the instructor).  Students who choose not to accomplish the online activities/chapter outlines will not receive participation points for the missed session.  Unless otherwise instructed, assigned chapters will be due no later than 11:59PM on Sunday for the respective week of class.

Mid-Term Examination (20% - 200 Points)

The mid-term exam is an open-book, timed assessment that will cover the first four weeks of class

Research Paper (20% - 200 Points)

Details of the research paper will be discussed during the first week of class

Final Examination (30% - 300 Points)

The final exam is a closed-book comprehensive assessment that will cover all material learned during the course of the class.


Grading will be based on student classroom participation (completion and substance of weekly activities), research paper, mid-term, and final exam, respectively.  The mid-term and final exam will cover assigned readings, lectures, classroom discussions, and hand-outs.  Students who do not attend class regularly or do no participate regularly should not expect to perform as well as those who do.  The method of evaluating total points earned and awarded grades will be based on the following scale:

900 - 1000 =        A

800 - 899 =          B

700 - 799 =          C

600 - 699 =          D

0 - 599 =              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:

As a general practice, I will not accept online assignments, without penalty, that are submitted after the designated due date.  Assignments (e.g. exams, chapter outlines, etc.) will receive a 10% deduction in grade for every day late.  Assignments submitted more than two days late will received a grade of "zero."  I understand that there may be special circumstances that arise, so I ask you to please keep me informed of any issues that may impede your ability to submit timely product.  IT IS THE STUDENT'S RESPONSIBILITY TO KEEP THE INSTRUCTOR INFORMED.

Classroom Rules of Conduct:

Students whose behavior is detrimental to good order in the learning environment will be immediately dismissed from the classroom.  Such behavior includes, but is not limited to the use of abusive or obscene language, attending class under the influence of drugs or alcohol, and disrespect to fellow students or staff.  Students whose behavior, either verbal or written, is detrimental to the good order of Park University may be subject to disciplinary actions ranging from suspension to expulsion from Park University.

Course Topic/Dates/Assignments:

Students are expected to be prepared prior to attending the respective class session.  This includes ensuring that the appropriate readings are accomplished ahead of the class date.  As there are many chapters in this text, we will address just the applicable chapters that address the  core learning outcomes that are germane to health care.

Week #1 (October 22 - October 28)

Chapter 1 - Risk in Our Society

Chapter 2 - Insurance and Risk

Chapter 3 - Introduction to Risk Management

Week #1 Activities

Week #2 (October 29 - November 4)

Chapter 4 - Advanced Topics in Risk Management

Chapter 5 - Types of Insurers and Marketing Systems

Week #2 Activities

Week #3 (November 5 - November 11)

Chapter 6 - Insurance Company Operations

Chapter 7 - Financial Operations of Insurers

Chapter 8 - Government Regulation of Insurance 

Week #3 Activities

Week #4 (November 12 - November 18)


Mid-Term Exam

Week #5 (November 19 - November 25)

Chapter 9 - Fundamental Legal Principles

Chapter 10 - Analysis of Insurance Contracts Week #5 Activities

Week #6 (November 26 - December 2)

Chapter 11 - Life Insurance

Chapter 15 - Individual Health Insurance Coverages 

Chapter 16 - Employee Benefits: Group Life and Health Insurance

Week #6 Activities

Week #7 (December 3 - December 9)

Chapter 18 - Social insurance

Chapter 19 - The Liability Risk 

Week #7 Activities


Week #8 (December 10 - December 16)

Final Exam Review (as needed)

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 95-96

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 95

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 98

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:



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

Last Updated:9/26/2012 11:33:49 AM