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MASTER SYLLABUS |
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OST 2950 |
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| Class Hours: 3.0 | Credit Hours: 3.0 | ||||||||
| Laboratory Hours: 0.0 | Date Revised: Spring 00 | ||||||||
| Catalog Course Description: | |||||||||
| Introduction to the practical knowledge of health care insurance as it relates to accreditation, licensure, certification, regulatory, and mandatory governmental guidelines. The basics of health care insurance standards and managed care will be presented. | |||||||||
| Entry Level Standards: | |||||||||
| Students should be able to read, write, and spell at the college level. | |||||||||
| Prerequisites: | |||||||||
| OST 2920 or department approval | |||||||||
| Textbook(s) and Other Reference Materials Basic to the Course: | |||||||||
| Fordney, M: Insurance
Handbook for the Medical Office, Saunders Publishing Co., Edition 6,
1999.
Fordney, M: Student Workbook. Saunders Publishing Co., Ed 6, 1999 |
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| I. Week/Unit/Topic Basis: | |||||||||
| Week | Topic | ||||||||
| 1 | Career and Legal Issues | ||||||||
| 2 | Basics of Health Insurance | ||||||||
| 3 | Procedural Coding | ||||||||
| 4 | Diagnostic Coding | ||||||||
| 5 | Health Insurance Claim Forms | ||||||||
| 6 | Electronic Data Interchange | ||||||||
| 7 | Tracing Delinquent Claims and Insurance Problem; MID-TERM EXAM | ||||||||
| 8 | Managed Care Systems and Special Plans | ||||||||
| 9 | Blue Cross and Blue Shield Plans | ||||||||
| 10 | Medicaid and Tenncare | ||||||||
| 11 | Medicare | ||||||||
| 12 | Champus, Champva, and Tricare | ||||||||
| 13 | Workers Compensation, Disability Income Insurance | ||||||||
| 14 | Hospital Billings | ||||||||
| 15 | Review | ||||||||
| 16 | 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 Business and Computer Technologies department. | |||||||||
| III. Instructional Processes*: | |||||||||
| Students will: | |||||||||
| 1. | Initiate a personal library of reference material including medical dictionaries, common abbreviates/eponyms which will allow accurate and timely interpretation of the medical terms necessary for effective communication (both verbal and written) in a medical environment. 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 | ||||||||
| 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 Literacy 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 oral presentation skills to review specific medical specialty topics with special emphasis on the terminology used, the tests ordered, the abbreviations employed, and the medical diagnoses most frequently employed for that specialty. Communication Outcome, Information Literacy Outcome, Active Learning Strategy | ||||||||
| 6. | Use E-mail to communicate with your instructor and other www-classmates to questions. Active Learning Strategies, 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 attending class, being punctual, dependable, cooperating with the teacher and other classmates, contributing to class discussions and projects, and acting in a professional manner while in 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. C | ||||||||
| 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: 70% of grade | |||||||||
| Students learn to evaluate themselves to keep aware of any inadequacies in learning. Tests and examinations are scheduled as shown above. Many self-graded (computer graded) quizzes and drills are utilized but are not counted in the final grade. Tests and examinations have values based on 100% and evaluations can be calculated on the basis of 100. | |||||||||
| B. Laboratory Expectations: 30% of grade | |||||||||
| Homework assignments will be given on each topic. Each student is expected to complete all homework assignments. Homework assignments will be turned in for a grade and will be calculated into the final grade as shown above. Homework and class participation will count for 20%. One special outside assignment will be presented orally to the class for 10% of final grade. | |||||||||
| C. Field Work: | |||||||||
| Plan 2-4 hours of study for each one hour of class. If you are experiencing problems, please consult the instructor. Participation in class is vitally necessary to developing ease in pronouncing, spelling, and dissecting medical terms. The student may wish to make flash cards to assist in learning. | |||||||||
| D. Other Evaluation Methods: | |||||||||
| N/A | |||||||||
| E. Grading Scale: | |||||||||
| A
93-100
B+ 90-92 B 85-89 C+ 80-84 C 75-79 D 70-74 F Less than 69 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. |
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| VI. Policies: | |||||||||
| A. Attendance Policy: | |||||||||
| Pellissippi
State Technical Community College expects students to attend all scheduled
instructional activities. As a minimum, students in al l 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.]
Regular attendance is required to receive veteran's benefit pay. Instructors are required to report non-attendance 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. |
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| B. Academic Dishonesty: | |||||||||
| Plagiarism, cheating, and other form 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. Other Policies: | |||||||||
| Students must have a valid PSTCC ID to be presented on demand to gain access to PSTCC facilities. | |||||||||