PELLISSIPPI STATE TECHNICAL COMMUNITY COLLEGE  MASTER SYLLABUS
HEALTH CARE INSURANCE SURVEY OST 2950
Class Hours: 3.0								Credit Hours: 3.0
Laboratory Hours: 0.0								Date Revised: Spring 99
Catalog Course Description:
	Introduction to the practical knowledge of health care insurance as it relates to accreditation, licensure, certification, regulatory, and mandatory governmental guidelines. Guest lecturers and field trips will provide the basics of health care insurance standards.
Entry Level Standards:
	None
Prerequisite:
	OST 2340 and OST 2940
Textbook(s) and Other Reference Materials Basic to the Course:
	Fordney, M: Insurance Handbook for the Medical Office, Saunders Publishing Co. 1997
I. Week/Unit/Topic Basis:
	Week					Topic
	1-2					Career and Legal Issues
	3					Basics of Health Insurance
	4					Procedural Coding
	5					Diagnostic Coding
	6					Health Insurance Claim Forms
	7					Electronic Data Interchange
	8					Tracing Delinquent Claims and Insurance Problems; Midterm Exam
	9					Managed Care Systems and Special Plans
	10					Blue Cross and Blue Shield Plans
	11					Medicaid and Tenncare
	12					Medicare
	13					Champus, Champva, and Tricare
	14-15					Workers Compensation, Disability Income Insurance
	16					Hospital Billings; Final Exam
II. Course Objectives*:
	A.			Exhibit an understanding of the role of mandatory regulatory and governmental agencies within the medical practice setting. XII
	B.			Demonstrate knowledge of requirements for proper licensure, accreditation, and certification within a  medical setting. XII
	C.			Describe insurance plans that will be present within a medical setting. XII
	D.			Demonstrate knowledge of Joint Commission Accrediting Hospitals and Offices (JCAHO) and the role it plays within a hospital setting. XII
	E			Acquire an understanding of basic risk management principles within a medical setting. XII
	F.			Acquire job seeking skills. IV, VI, X, XI
*Roman numerals after course objectives reference goals of the OST program.
III. Instructional Processes*:
Students will:
	1.				Initiate a personal library of reference material including medical dictionaries, common abbreviations/eponyms which will allow accurate and timely interpretation of the medical terms necessary for effective communication (both verbal and written) in a medical environment. Information Literacy Outcome, Personal Development Outcome
	2.				Solve medical insurance problems in a simulated real world environment like a medical office or affiliated health care practice to allow accurate and efficient communication. Problem Solving and Decision Making Outcome,  Transitional Strategies, Active Learning Strategies
	3.				Research the Internet to find the latest technologies used in medical fields and to relate this to medical terminology employed in the health care environment. Information Literacy Outcome, Technological Lieteracy Outcome
	4.				Access Pellissippi State User Account to find library resources pertaining to Health Care Insurance, and evaluate these resources with particular reference to billing.  Information Literacy Outcome
	5.				Use independently gathered material and presentation skills to review specific medical specialty topics with special emphasis on Medical Insurance, the tests ordered, the abbreviations employed, and the medical diagnoses most frequently employed for that specialty. Communication Outcome, Information Literacy Outcome
	6.				Use E-mail to communicate with your instructor and other www-classmates. Technological Literacy Outcome
	7.				Learn to use a computer software package to evaluate insurance and billing questions. Practice communication skills by use of E-Mail to other students and to communicate with the lead instructor. Technological Literacy Outcome
	8.				Internalize the work ethic by regularly completing assignments, being punctual, dependable, cooperating with the teacher and other classmates, completing class project, and acting in a professional manner while taking class. Personal Development Outcome
*Strategies and outcomes listed after instructional processes reference Pellissippi State’s goals for strengthening general education knowledge and skills, connecting coursework to experiences beyond the classroom, and encouraging students to take active and responsible roles in the educational process.
IV. Expectations for Student Performance*:
Upon successful completion of this course, the student should be able to:
	1.			Identify and define the role of mandatory, regulatory, and governmental agencies within the medical office setting. A
	2.			Discuss the requirements for proper licensure, accreditation and certification. B
	3.			Explain the differences in various health insurance plans: HMO, POS, PPO, Medicaid, and Medicare. ©
	4.			Understand how different health care settings are organized and operate. D
	5.			Describe the historical development of medical accreditation and regulatory agencies. B,D
	6.			Apply principles of risk management to reduce medical practice liability. E
	7.			Prepare a resume to attain a position as a Health Care Office Administrator. F
*Letters after performance expectations reference the course objectives listed above.
V. Evaluation:
	A. Testing Procedures: 40% of grade
			A mid-term exam and a final examination will be given for this course. Information from class lectures, the text, and any guest speakers or field trips will be covered on the exams.
	B. Laboratory Expectations: 30% of grade
		There will be homework assignments and in-class work done related to selected topics.  Assessment will also be made based on participation in any field trips and discussions with guest speakers.
	C. Field Work: 30% of grade
		20% on written presentation of a research paper on an approved topic.  10% on oral presentation of the paper to the class.
	D. Grading Scale:
		A     93 - 100 B+   90 - 92 B     85 - 89 C+   80 - 84 C     75 - 79 D     70 - 74 F     Below 70
VI. Policies:
	A. Attendance Policy:
		Pellissippi State Technical Community College expects students to attend all scheduled instructional activities. As a minimum, students in all courses must be present for at least 75 percent of their scheduled class and laboratory meetings in order to receive credit for the course. [NOTE: No differentiation is noted for excused/unexcused absences. These will be treated as an absence.] In order to receive credit for this course, you should miss no more than: 4 times for a class meeting once a week 8 times for a class meeting twice a week 12 times for a class meeting three times a week Regular attendance is required to receive veteran's benefit pay. Instructors are required to report non-attendance of veterans to the Veterans Affairs Office which reports non-attendance to the Veterans Administration Regional Office. Payments are adjusted or canceled if attendance is not regular.
	B. Academic Dishonesty:
		Plagiarism, cheating, and other forms of academic dishonesty are prohibited. Students guilty of academic misconduct, either directly or indirectly through participation or assistance, are immediately responsible to the instructor of the class. In addition to other possible disciplinary sanctions which may be imposed through the regular Pellissippi State procedures as a result of academic misconduct, the instructor has the authority to assign an F or a zero for the exercise or examination or to assign an F in the course.
	C. Late Work:
		In order for grades to be calculated, all assigned work must be submitted in a timely fashion. Assigned work must be turned in by date designated. Late work will be charged with a late penalty as indicated by the instructor.