HCR 230 Course Material HCR 230 Entire Course HCR 230 Week 1 Assignment Features of Private Payer and Consumer-Driven Health Plans. Compose a 350- to 700-word response that familiarizes you with private payer plans and CDHP account types. Briefly list three to five main features for the following nine items. Below each list, provide one or two sentences stating coverage of services and financial responsibility. PPO HMO Group HMO IPA POS Indemnity CDHP Health Reimbursement Account • HCR 230 Week 1 CheckPoint Comparing Cost Control Strategies • HCR 230 Week 1 CheckPoint Ramifications of Participation Contracts • HCR 230 Week 1 Assignment Features of Private Payer and Consumer-Driven Health Plans • HCR 230 Week 2 DQ 1and DQ 2 • HCR 230 Week 2 CheckPoint Summarizing the Medigap Program • HCR 230 Week 3 CheckPoint Working with Medicaid
HCR 230 Course Material HCR 230 Week 1 CheckPoint Comparing Cost Control Strategies HCR 230 Week 1 CheckPoint Ramifications of Participation Contracts Resource: Ch. 9 (pp. 304-305) of Medical Insurance Due Date: Day 4 [post to the Individual forum] Discuss how participation contracts represent financial opportunities for providers. What are positive and negative ramifications of discounted fee-for-service arrangements? Explain your answers in 200 to 300 words. • Post a 200- to 300-word response to the following: Compare cost control strategies of employer-sponsored (employers buy from insurance companies) to self-funded (employers cover costs of benefits) health plans. Include the following factors: • Riders • Enrollment periods • Provider networks • Third party administrators
HCR 230 Course Material HCR 230 Week 2 CheckPoint Summarizing the Medigap Program HCR 230 Week 2 DQ 1and DQ 2 Discussion Question 1 Due Date: Day 2 [Main forum] Post your response to the following: Explain whether or not you believe Medicare’s eligibility limitations are reasonable in scope. • Compose a 250- to 300-word summary reflecting upon the Medigap program. Address the following questions in your summary: • What are the core benefits in the Medigap insurance program? • How well does the program meet coverage needs of its consumers? • Is the cost of each plan fair considering the benefits and limits offered by each plan? Explain your opinion and provide examples.
HCR 230 Course Material HCR 230 Week 3 assignment welfare reforms act HCR 230 Week 3 CheckPoint Working with Medicaid CheckPoint: Working with Medicaid Resources: Ch. 11 (pp. 374-375, 385-386) of Medical Insurance and the U.S. Department of Health & Human Services Web site. Due Date: Day 4 [to the Assignment Folder] Refer to U.S. Department of Health & Human Services Web site at http://www.cms.hhs.gov/home/medicaid.asp Select Medicaid Program - General Information. • Write a 750- to 1,050-word paper discussing the positive and negative implications of the Welfare Reform Act of 1996 on Medicaid. Respond to one or more of the following questions in your paper: • Did the Welfare Reform Act cause existing Medicaid beneficiaries to lose necessary coverage? • Do eligible Medicaid candidates sometimes remain un-enrolled even though they are needy as a result of the Welfare Reform Act?
HCR 230 Course Material HCR 230 Week 4 Assignment The TRICARE Program HCR 230 Week 4 DQ 1and DQ 2 Discussion Question 1 Due Date: Day 2 [Main forum] Post your response to the following: Based on eligibility and cost sharing requirements, what are the financial advantages for either providers or patients participating in the TRICARE program? How do annual limits (catastrophic caps) affect patients’ cost sharing requirements? Explain your answers. • Create a 5- to 8-slide PowerPoint® presentation that describes features of the TRICARE program and its four subsidiaries. Include detailed speaker notes to explain the following topics in your presentation: • Eligibility requirements • Covered and non-covered services • Network and non-network providers • Participating and non-participating provider charges • Reimbursement
HCR 230 Course Material HCR 230 Week 5 Assignment Understanding Work-Related Injuries HCR 230 Week 5 CheckPoint Characteristics of Workers Compensation Plans Refer to Ch. 13 (pp. 423-424) of your textbook and the U.S. Department of Labor Web site at: http://www.dol.gov/dol/topic/workcomp/index.htm Post a 250- to 300-word response to the following: In your own words, briefly describe the features of the four federal workers’ compensation plans and the two types of state workers’ compensation benefits. Why is it necessary to have both federal and state compensation plans? • Compose a 750- to 1,050-word response describing the workers’ compensation claim process. Include the following information in your answer: • Overall description of the workers’ compensation claims process • Responsibilities of the employee, employer, physician, and insurance carrier • How do HIPAA Privacy Rules apply to workers’ compensation? • What are the implications of unrestricted access to a patient’s medical records?
HCR 230 Course Material HCR 230 Week 6 CheckPoint Purpose of the General Appeals HCR 230 Week 6 DQ 1and DQ 2 Post your response to the following: Do you believe the RA/EOB is an effective method of communicating claim adjudication information to patients? When you have received an RA/EOB in the mail, is it easy or difficult to understand? What suggestions could you make to improve patient-payer communication regarding the claim adjudication process? Explain your answers. • Use the Internet to locate three additional examples of claims errors and classify them according the categories noted on page 463 of your textbook. • Respond to the following in 250 to 300 words: Briefly describe the purpose of the general appeals process. Incorporate the three additional examples of claims errors you located on the Internet, classified according to the categories in the text.
HCR 230 Course Material HCR 230 Week 7 Assignment Understanding the Collection Process HCR 230 Week 7 CheckPoint Effective Financial Policies amp Proced Post a 350- to 400-word response to the following: The three major elements to critical thinking are logical inquiry, problem solving, and evaluative decision making. In this CheckPoint, you will exercise critical thinking skills to answer the following questions: What are the basic elements of an effective medical office financial policy? In what ways do medical office procedures support financial policies? • Suppose you are working in a medical office and are helping train a new billing specialist about collections. You decide that a job aid in the form of a flow chart would be a useful tool. • Refer to Microsoft® Help Web site at http://support.microsoft.com/ for questions related to creating a flow chart in Microsoft® Word.
HCR 230 Course Material HCR 230 Week 8 CheckPoint Inpatient and Outpatient Hospital Services HCR 230 Week 8 DQ 1and DQ 2 Post your response to the following: What is the importance of obtaining written consent from patients prior to receiving medical treatment? What are the implications of failing to do so? Does a medical emergency alter the conditions of written consent? Why or why not? Explain your answers. • Due Date: Day 5 [to the Assignment Folder] • Post a 250- to 300-word response to the following: What are the major differences between inpatient and outpatient hospital services? Describe how these differences affect the coding process and provide examples.
HCR 230 Course Material HCR 230 Week 9 Assignment Financial Policy DCSAA Finicial Policy HCR 230 Week 9 Capstone Checkpoint Create a flow chart using Microsoft® Word illustrating the five steps of the claims adjudication process from the time of initial processing through final payment. Include a brief 250- to 300-word explanation for the following: Identify the purpose for each step in claim adjudication process. Explain the relationship between each of the different steps. • Use critical thinking skills to complete your final project. These skills include suspending judgment and applying problem-solving skills and methods while conducting research. You will form evaluative decisions and provide your rationale after considering how you would design a medical office financial policy.