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Compare cost control strategies of employer-sponsored health plans, in which employers buy from insurance companies, to self-funded health plans, in which employers cover costs of benefits.

Resource: Ch. 8 (pp. 277–282) of Medical Insurance

Write a 260- to 350-word response to the following:

Compare cost control strategies of employer-sponsored health plans, in which employers buy from insurance companies, to self-funded health plans, in which employers cover costs of benefits. Include the following factors: Riders Enrollment periods Provider networks Third party administrators.

 

 

HCR 230 Week 1 Check point Ramifications of Participation Contracts 

Resource: Medical Insurance

Refer to Ch. 8 (pp.293–295) of Medical Insurance.

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 260 to 350 words.

HCR 230 Week 1 Assignment: Features of Private Payer and Consumer-Driven Health Plans

Resources: Medical Insurance,the U.S. Treasurer’s Office and Oregon BlueCross BlueShield websites

Refer to Table 8.1 and Table 8.2 in Ch. 8 of Medical Insurance.

Review the following websites U.S. Treasurer’s Office (http://www.treasury.gov/resource-center/faqs/Taxes/Pages/Health-Savings-Accounts.aspx)

The Regence BlueCross BlueShield of Oregon (https://www.regence.com/) Click the individual health plans for detailed information. Write a 350- to 700-word response to familiarize yourself 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• PO • HMO • Group HMO • IPA • POS • Indemnity • CDHP • Health Reimbursement Account • Flexible Savings Account

Use a minimum of three references. You may use your text and the two websites provided. Format your paper consistent with APA guidelines.

 

HCR 230 Week 2 Check Point Summarizing the Medigap Program

Refer to Figure 9.7 in Ch. 9 of Medical Insurance.

Review the following websites: WebMD® (http://www.webmd.com/Medicare/medigap)

American Diabetes Association (http://www.diabetes.org)

Write a 260- to 350-word summary reflecting on 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. What are the implications of having a private company associated with a government insurance program?

 

 

HCR 230 Week 3 CheckPoint Working with Medicaid

Resources: Medical Insurance; the U.S. Department of Health & Human Services website

Refer to Ch. 10 of Medical Insurance.

Access the U.S. Department of Health & Human Services website. Navigate tohttp://www.cms.hhs.gov/home/medicaid.asp Select the Medicaid tab and review the program information.

Post a 260- to 350-word response to the following: Briefly discuss factors that determine Medicaid eligibility, and whether a procedure or service is covered. When can a provider bill a Medicaid patient directly for services? What are the implications of simultaneous federal and state involvement in the insurance process?

HCR230 Week 3 Assignment- The Welfare Reform Act

Write a 700- 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?

Is the Welfare Reform Act effective in reducing welfare fraud and increasing personal responsibility?

Has the Welfare Reform Act been successful in meeting its intended goals?

Include a minimum of two references from the Internet or University Library. Format your paper consistent with APA guidelines.

HCR 230 Week 4 Assignment The TRICARE Program

Resources: Appendix B and Medical Insurance

Refer to Appendix B for guidance on presentations and the Microsoft® Help and Support website (http://support.microsoft.com/) for assistance with questions related to Microsoft® PowerPoint®.

Create a 5- to 8-slide Microsoft® 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 noncovered services Network and nonnetwork providers Participating and nonparticipating provider charges Reimbursement Use a minimum of one reference. You may use your textbook as a reference.

Format your presentation consistent with APA guidelines.

HCR 230 Week 5 CheckPoint Characteristics of Workers Compensation Plans

Resources: Medical Insurance; the U.S. Department of Labor website

Refer to Ch. 12 of Medical Insurance.

Review the U.S. Department of Labor website

(http://www.dol.gov/dol/topic/workcomp/index.htm).

Post a 260- to 350-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?

HCR 230 Week 5 Assignment Understanding Work-Related Injuries

Resources: Appendix C; and Medical Insurance

Complete Appendix C by reading the five case studies and determine whether these injuries are covered under workers compensation. Provide supporting arguments and cite the appropriate workers’ compensation injury classification category as directed in the appendix.

Write a 700- 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 HIPAA Privacy Rules apply to workers’ compensation The implications of unrestricted access to a patient’s medical records Refer to Ch. 12 of Medical Insurance and at least one additional reference from the Internet or University Library, for a minimum of two references. Format your response consistent with APA guidelines.

HCR 230 Week 6 CheckPoint Purpose of the General Appeals

Resource: Medical Insurance

Research the Internet to locate three additional examples of claims errors and classify them according the categories noted in Ch. 13 (p. 444) of Medical Insurance.

Write a 260- to 350-word response to the following:

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 Week 7 CheckPoint Effective Financial Policies and Procedures

Resource: Medical Insurance

Refer to Figures 14.1 & 14.2 in Ch. 14 of Medical Insurance.

Post a 350- to 525-word response to the following: The three major elements to critical thinking are logical inquiry, problem solving, and evaluative decision making. In this Individual, you must 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? What are the consequences when office procedures do not support the financial policy? What recommendations, strategies or tools can medical offices use to ensure effective alignment of policies and procedures?

HCR 230 Week 7 Assignment Understanding the Collection Process

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.

Resources: Medical Insurance; and Microsoft® Help website

Refer to Microsoft® Help website (http://support.microsoft.com/) for questions related to creating a flow chart in Microsoft® Word.

Refer to Ch. 14 of Medical Insurance.

Create a flow chart, using Microsoft® Word, illustrating the sequence of basic steps in the collection process for patient accounts.

Write a 350- to 525-word script, below your flow chart, that could be used for a short instructional video to accompany the flow chart. The script must provide an overview of how to use the flow chart as a guideline for when dealing with collections on a patient account.

Include details about what to do at each step in the flow chart. The audience for the job aid and video is a medical office billing trainee.

HCR 230 Week 8 Check Point Inpatient and Outpatient Hospital Services

Resource: Medical Insurance

Refer to Ch. 17 of Medical Insurance.

Post a 260- to 350-word response to the following:

What are the major differences between inpatient and outpatient hospital services? Describe and provide examples of how these differences affect the coding process.

HCR 230 Week 9 Capstone Checkpoint 5 steps to the Adjudication Process

Resources: Appendix A; Medical Insurance; and Microsoft® Help website

Refer to Ch. 13 of Medical Insurance and previous assignments from that chapter as a resource. Visit Microsoft® Help (http://support.microsoft.com/) for assistance with questions related to creating a flow chart in Microsoft® Word.

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 260- to 350-word explanation for the following: Identify the purpose for each step in claim adjudication process. Explain the relationship between each of the different steps. Provide a one-sentence summary describing how claims adjudication is important to the medical billing process.

Post your flow chart and explanation as an attachment.

HCR 230 Week 9 Assignment  Financial Policy  DCSAA Finicial Policy

Resources: Appendix A; and Medical Insurance

Complete Part A and Part B of your final project using critical thinking skills. These skills include suspending judgment and applying problem-solving skills and methods while conducting research. You must form evaluative decisions and provide your rationale after considering how you would design a medical office financial policy.

Decide on the type of medical office setting you prefer to research. Focus on that setting as you complete each portion of the final project.

Refer to Figure 14.1 in Ch. 14 of Medical Insurance, the Internet, and the University Library as resources. Search for medical office financial policy advice and sample policies.

Write an original 700- to 1,050-word medical office financial policy for Part A of your final project. In your policy, provide a minimum of three references other than your textbook, formatted according to APA standards. Include the following components in your policy:

Collection of copayments, deductibles, and past-due balances Arrangements for handling of unpaid balances Handling of payments for noncovered services Prepayment policies Policies for accepting cash, checks, money orders, and credit or debit cards Arrangements for sliding scales and low income payments Other pertinent policies you see fit to include based on your research Format your policy similarly to the examples you see online and in your text; however, your policy must include APA-formatted references.

Complete Part B of your project. Include the following the end of your financial policy: Add a separate section reviewing why you believe your policy is best suited to your selected type of medical office setting. Explain and provide support for your rationale in 500- to 700- words. Include a minimum of one reference to support your explanation and format your paper consistent with APA guidelines. You may use the same references to complete the supporting rationale that you used for the financial policy.


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