HCR 202 Entire Course

Entire Course Download Link

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 HCR/202

MEDICAL INSURANCE

 

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HCR 202 Entire Course Link

https://uopcourses.com/category/hcr-202/

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HCR 202 Week 1 Health Care Payors Worksheet
 

Complete the University of Phoenix Material: Health Care Payors Worksheet.

Click the Assignment Files tab to submit your assignment.

Health Care Payors Worksheet

 

Complete Parts A and B of this worksheet.

 

Reference: Ch. 1 of Medical Insurance

 

Part A

 

Complete the table by describing the health care payor listed. Be clear and concise, use complete sentences, and define them in your own words.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Health care payors
Characteristics
Medicare
 
Blue Cross
 
Medicaid
 
Aetna
 
PPO
 
HMO
 
 

 

Part B

 

Write 50- to 150-word responses to the following questions. Be clear and concise, use complete sentences, and use your own words.

 

Cite any outside sources. For additional information on how to properly cite your sourcessee the Reference and Citation Generator resource in the Center for Writing Excellence.

 

 

 
 

 

 

HCR 202 Week 2 Payment Systems Summary
 

Imagine you are an assistant office manager at a health care facility. You have been asked by your manager to research and provide a summary of different payment systems.

Write a 350- to 700-word summary that discusses at least three types of payment systems (e.g., per diem, DRG, and IPPS).

Include the following in your summary:

 

 

 

Identify the systems selected.
 

 

Discuss their purpose and use.
 

 

Format your assignment according to APA guidelines and cite any sources.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCR 202 Week 2 Health Care Reimbursement Worksheet
 

Complete the University of Phoenix Material: Health Care Reimbursement Worksheet.

Click the Assignment Files tab to submit your assignment.

Health Care Reimbursement Worksheet

 

Complete Parts A and B of this worksheet.

 

Reference: Ch. 1 and Ch. 17 of Medical Insurance

 

Part A

 

Pair the health care term from Column A with the appropriate definition from Column B. List the corresponding letter in Column C.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Column A
Column C
Column B
co-pay
 
A.    The amount owed for covered health care services before the health insurance plan begins to pay
Deductible
 
B.    The portion of charges an insured person must pay for health care services after payment of the deductible amount is met; usually stated as a percentage
Out-of-pocket max
 
C.    A patient who does not have insurance
Self-pay patient
 
D.    The most an insured person will have to pay for covered health care services in a policy period. Until this maximum amount is met, the health care plan and insured person share costs
co-insurance
 
E.    A set dollar amount a health plan requires an insured person to pay at the time of service for each health care encounter
 

 

Part B

 

Resource: Table 1.2 in Ch. 1 of Medical Insurance

 

Describe three to four health plans by completing the following table. Be clear and concise, use complete sentences, and use in your own words.

 

Health Plans

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plan type
Provider options
Payment methods
Features
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Write 50- to 150-word responses to the following question. Use your own words and provide examples to support your answer.

 

Cite any outside sources. For additional information on how to properly cite your sourcessee the Reference and Citation Generator resource in the Center for Writing Excellence.

 

 

 

 

How do provider options (network) impact reimbursement for patients?
 

 

 

 

 

 

Review the features of the plan types discussed in the table and identify what features are most important to a patient.
 

 

 

 
 

 

 

HCR 202 Week 3 Government Payors Worksheet
 

Complete the University of Phoenix Material: Government Payors Worksheet.

Click the Assignment Files tab to submit your assignment.

Government Payors Worksheet

 

Complete Parts A and B of this worksheet.

 

References: Ch. 9, 10, 11 Medical Insurance

 

Part A

 

Fill in the missing information by completing the table.

 

Identify the Payor Type, eligibility and coverage for Medicare programs, Medicaid, CHAMPVA, and Tricare.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payor type
Eligibility
Coverage
Patient responsibility
Medicare Part A
 
 
First 60 days responsibility is the annual deductible. 

 

For days 61–90 there is a per-day copay and another per-day copay after days 91–150.

 

Beyond day 150 Medicare Part A does not make a payment.
 
Individuals entitled to Medicare Part A are automatically qualified to enroll in Part B. 

 

Needs to be a U.S. citizen and over the age of 65 (voluntary program)
Physician services, outpatient hospital services, medical equipment, and other supplies and services
 
 
 
Private health insurance companies contract with The Centers for Medicare and Medicaid to offer Medicare Advantage plans.
 
Medicare Part D
 
Medicare prescription drug plan (private insurance plan)
 
 
Categorically needy
Administered at a State Level- each state determine coverage and sets the payment rates. 

 

Services include hospital, outpatient, physician services, laboratory, radiology- some States include Prescription services, vision care, vision, clinic services, home and community based care.
Some may include a spend down program prior to reimbursement 

 

Individuals/families may be required to spend a portion of income or resources on health care which is similar to a deductible.
Tricare
 
 
Coinsurance for nonparticipating providers 

 

Annual enrollment and copays for retirees/family
 
Government health insurance program for families of veterans with 100% services related to disability
Includes most all treatment with the exception of unnecessary services and supplies 

 

Does not include experimental treatment, custodial care, or dental care
 
 

 

Part B

 

Write 50- to 150-word responses to the following questions. Use your own words and provide examples to support your answers.

 

Cite any outside sources. For additional information on how to properly cite your sourcessee the Reference and Citation Generator resource in the Center for Writing Excellence.

 

 

 

 

Why is it important to understand the guidelines for timely claim filing from the date of treatment or discharge?
 

 

 

 

 

 

Explain why it is important to understand the different payor coverage and patient responsibility?
 

 

 

 
 

 

 

HCR 202 Week 3 Government Payors Presentation
 

Create a 10- to 12-slide Microsoft® PowerPoint® presentation that discusses Medicare, Medicaid, CHAMPVA, and TRICARE.

Include detailed speaker notes to explain the following topics in your presentation:

 

 

 

Eligibility requirements
 

 

Coverage provisions
 

 

Participating and nonparticipating provider charges
 

 

Use at least 1 reference. You may use your textbook as a reference.

Cite any sources.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCR 202 Week 4 Features of Private Payor and Consumer-Driven Health Plans
 

Resources: Medical Insurance: An Integrated Claims Process Approach (6th ed.), the Department of the Treasury website, and Oregon BlueCross BlueShield website

Refer to Table 8.1 and Table 8.2 in Ch. 8 of Medical Insurance: An Integrated Claims Process Approach (6th ed.).

Review the following:

 

 

 

Health Savings Accounts page in the Resource Center on the U.S. Department of the Treasury website
 

 

The Regence BlueCross BlueShield of Oregon. Click the individual health plans for detailed information
 

 

Write a 350- to 700-word response to familiarize yourself with private payor plans and CDHP account types. Briefly list 3 to 5 main features for the following items. Below each list, provide 1 or 2 sentences stating coverage of services and financial responsibility.

 

 

 

PPO
 

 

HMO
 

 

Group HMO
 

 

IPA
 

 

POS
 

 

Indemnity
 

 

CDHP
 

 

Health Reimbursement Account
 

 

Flexible Savings Account
 

 

Use a minimum of 3 references. You may use your textbook and the two websites provided.

Cite all sources.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCR 202 Week 4 Characteristics of Workers’ Compensation Plans
 

Resources: Medical Insurance: An Integrated Claims Process Approach (6th ed.), U.S. Department of Labor website

Refer to Ch. 12 of Medical Insurance: An Integrated Claims Process Approach (6th ed.).

Review the U.S. Department of Labor website.

Post a 250- 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 federal and state compensation plans?

Cite any sources.

 

 
 

 

 

HCR 202 Week 4 Reimbursement and Coverage Worksheet
 

Complete the University of Phoenix Material: Reimbursement and Coverage Worksheet.

Click the Assignment Files tab to submit your assignment.

Reimbursement and Coverage Worksheet

 

References: Ch. 8 and 12 of Medical Insurance

 

Imagine you are a billing supervisor at a local health facility. You have been asked to determine the expected reimbursement and coverage determination on the following claims:

 

 

 

 

You reviewed the claim 1500 form for patient Kevin Luke. You realize it is a new calendar year and he had not met his deductible. You had an authorization on file for treatment. Total billed charge amount is $1100.00. His benefits are as follows:
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PPO-Medical Care for diagnostic testing
In-network benefit preauthorization required. Pays at 100% after deductible is met.
Must meet deductible. Annual family deductible is $500. 
 

 

Calculate the expected reimbursement by insurance and what the patient will owe.

 

 

 

 

You review the claim form for Lisa Smith for treatment of hyperglycemia. You discover she received treatment from a non-network provider. She has met her annual deductible. Total charges for the date of service are $170. The plan pays at usual and customary which is exactly what was billed. Her benefits are as follows:
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PPO-Medical Care office visits
In-network benefit-Office visit copayment: $10.00
Out-of-network Deductible and Coinsurance of 20%.
 

 

Calculate the expected reimbursement from insurance and her coinsurance.

 

 

 

 

You are reviewing a claim for Maria Johnson, a 45-year-old who received a well check and flu shot from her in network provider. Her benefits are as follows:
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PPO-Medical Care office visits
In-network benefit- copayment: Office visit $10.00 and Injections $25.00
Out-of-network Deductible and Coinsurance of 20%.
 

 

Mrs. Johnson called the office because she thought she had overpaid during her visit. What was Mrs. Johnson’s copay the date of the visit?

 

 

 

 

You are reviewing the vision exam benefits for Zach Bergman. He presented for an eye exam stating he needed new glasses. He had an examination 13 months prior and notes he can have an exam every year. His benefits are as follows:
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PPO-Medical Care office visits
In-network benefit-One vision exam every 2 calendar years.
Out-of-network Deductible and Coinsurance of 20%. Covered every 2 calendar years.
 

 

What is Mr. Bergman’s benefit?

 

 

 

 

Lisa Smith called your office noting she had to be transported to the hospital by ambulance while on vacation for food poisoning. She was concerned about what she will need to pay out-of-pocket. She was not admitted. Her benefits for emergency treatment are as follows:
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PPO-Emergency treatment
In-network benefit-Copay $100. Waived if admitted. Ambulance services no charge.
Out-of-network Copay $100. Waived if admitted. Ambulance services no charge.
 

 

What should Lisa Smith expect to pay out-of-pocket?

 

 
 

 

 

HCR 202 Week 5 Comparing Cost Control Strategies
 

Resource: Ch. 8 of Medical Insurance: An Integrated Claims Process Approach (6th ed.)

Write a 350- to 700-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, for which employers cover costs of benefits.

Include the following factors:

 

 

 

Riders
 

 

Enrollment periods
 

 

Provider networks
 

 

Third party administrators
 

 

Discuss how the following affect cost control within group health plans:

 

 

 

Portability
 

 

Creditable coverage
 

 

Cite any sources.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCR 202 Week 5 Ramifications of Participation Contracts
 

Resource: Medical Insurance: An Integrated Claims Process Approach (6th ed.)

Refer to Ch. 8 of Medical Insurance: An Integrated Claims Process Approach (6th ed.).

Write a 150- to 350-word summary that discusses how participation contracts represent financial opportunities for providers. What are positive and negative ramifications of discounted fee-for-service arrangements?

Cite any sources.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 
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