Master Course Syllabus
for
HMT-210: MEDICAL INSURANCE

Prerequisities: MED 122 must pass with a grade of "C" or higher; or OST 142.

Corequisites: None

Course Description

This course introduces the concepts of medical insurance. Topics include types and characteristics of third-party payers, coding concepts, payment systems, and manual/electronic claims form preparation. Upon completion, students should be able to process third-party claims forms.

Student Learning Outcomes

• Identify the two basic types of health insurance plan.

• Identify the major rules necessary for optical character recognition.

• Define fee-for-service (indemnity) insurance.

• Understand the concept of managed care.

• Name the two major groups that qualify for Medicaid.

• Identify Medicare Parts A, B, C, and D.

• Identify TRICARE's and CHAMPVA eligibility.

• Identify the purpose of workers' compensation and disability income insuranc.

• Identify the six keys to successful claims.

• Explain how computers have affected health insuranc.

• Define electronic data interchange.

• Define electronic data interchange.

• List the essential elements of electronic data interchange.

• Compare and contrast submitting claims through a clearinghouse versus direct data entry.

• Discuss the advantages of submitting claims electronically.

• Explain how the Department of Health and Human Services’ final “rule” affects Medicare.

• List and explain three additional electronic services available to the health insurance professional.

• Discuss the future of electronic medical records (EMR).

• List and explain the various types of reimbursement.

• Discuss the prospective payment system.

• Explain the federal government’s role in the prospective payment system.

• Describe diagnosis-related groups (DRGs), ambulatory payment classifications (APCs), and resource utilization groups (RUGs).

• Discuss peer review organizations’ responsibilities as they relate to the prospective payment system.

• Identify the various functions most patient accounting software systems are capable of performing.

• Explain a “contractual write-off”.

• List the advantages of HIPAA-compliant practice management software.

Academic Grading Policy

A	Excellent	4	Grade Points	Numerical grade of 90 - 100
B	Above Average	3	Grade Points	Numerical grade of 80 - 89
C	Average	2	Grade Points	Numerical grade of 70 - 79
D	Below Average	1	Grade Point	Numerical grade of 60 - 69
F	Failed	0	Grade Point	Numerical below 60
WP	Withdraw Passing	0	Grade Point	Issued if the course is dropped after the census date and on or before the 60% point of the course unless the instructor issues a WF based on extenuating circumstances
WF	Withdraw Failing	0	Grade Point	Issued if the course is dropped after the 60% point of the course or the instructor chooses based on extenuating circumstances

Attendance Requirement for the School of Health and Public Services

Regular, prompt attendance is essential for academic success. Students should strive for perfect attendance. It is recognized, however, that students may be absent from class occasionally. Students should reference the instructor's syllabus to determine the attendance requirement for this course. The instructor is responsible for enforcing the attendance requirement. It is the student's responsibility to withdraw from the course. Students may complete the withdrawal process in the Advising Center. Students may receive a grade of WP if they withdraw from a course by the 60% point/date of the course. Any student withdrawals that occur after the 60% point will result in a grade of WF. Exceptions to the "WF" grade may exist if the student has a mitigating circumstance. Students are encouraged to discuss withdrawal options with the faculty member and complete the withdrawal process in the Advising Center.

Class Recordings

In some classes videoconferencing software will be used to record live class discussions. As a student in such classes, student participation in live class discussions will be recorded. These recordings will be made available only to students enrolled in the class, to assist those who cannot attend the live session or to serve as a resource for those who would like to review content that was presented. All recordings will become unavailable to students in the class when the class ends. Students who prefer to participate via audio only will be allowed to disable their video camera so only audio will be captured. Students should discuss this option with their instructors. The use of all video recordings will be in keeping with the Privacy Statement shown below.

Privacy Statement

Assuring privacy among faculty and students engaged in online and face-to-face instructional activities helps promote open and robust conversations and mitigates concerns that comments made within the context of the class will not be shared beyond the classroom. As such, recordings of instructional activities occurring in online or face-to-face classes may be used solely for internal class purposes by the faculty member and students registered for the course, and only during the period in which the course is offered. Instructors who wish to make subsequent use of recordings that include student activity may do so only with informed written consent of the students involved or if all student activity is removed from the recording. Recordings including student activity that have been initiated by the instructor may be retained by the instructor only for individual use.

Disability Statement

If you have a documented disability and wish to discuss academic accommodations, please contact the Counselor for Students with Disabilities and Special Programs located in room 429 of the Student Center. If you are a student with a mobility impairment and have a class in a multi-story building, please discuss evacuation plans with your instructor.

Religious Observance Statement

Students shall be permitted excused absences from all classes two days per academic year for religious observances required by their faith. The absences requested in accordance with this policy are "one of" and not "in addition to" any absences otherwise permitted by the faculty for a class. The excused absence request must be submitted by the second class meeting and a minimum of two (2) weeks in advance of the absence. Please contact your instructor for the required forms.

Academic Honesty Policy

Students at CVCC are expected to be honest in all academic pursuits, whether class, lab, shop, or clinical. Acts of academic dishonesty are considered unethical and subject to behavior sanctions. Examples of academic dishonesty include, but are not limited to the following:

1. Sharing information about the content of quizzes, exams, classroom/lab/shop/clinical assignments (scheduled or make-up) without approval of the instructor including but not limited to unauthorized copying, collaboration, or use of notes, books, or other materials when preparing for or completing examinations or other academic assignments (scheduled or make-up).

2. Buying, selling, or otherwise obtaining a copy of a quiz, exams, project, term paper, or like document, without approval of the instructor.

3. Plagiarism, which is defined as the intentional representation of another person's work, words, thoughts, or ideas (from any source) as one's own.

4. Failing to follow approved test taking procedures by performing such acts as:

   • Looking on another student's test
   • Use of unauthorized notes; written, electronic, or otherwise
   • Changing answers after exam is scored
   • Verbal, non-verbal, or electronic communication with another student during an exam

Instructors have the authority to impose either a warning, probation, or dismissal from the class for acts of academic dishonesty relative to classes under their supervision.

Students have an obligation to report any acts of academic dishonesty to the instructor or appropriate campus authority when reasonable grounds exist for such a report. Students also have a responsibility to cooperate in the investigation of any alleged acts of academic dishonesty. Failure to report acts of academic dishonesty could result in a behavior sanction as outlined in the Student Conduct Policy, Policy 3.18.

CVCC Emergency Procedures

To Report a Serious Emergency Dial 911 from any campus phone or 911 from mobile phones; then dial 711 (Campus Safety & Security) from a campus phone.

Safety & Security: S.E.L.F. Active Shooter Response Training Video

Lockdown

Quickly get all persons behind a locked door, close blinds, lock all windows/doors, and turn off lights. Sit against an interior wall away from windows and doors (hide). Keep cell phones ON in silent mode or vibrate. Do not leave the locked area until notified by a known CVCC administrator or by law enforcement that the emergency is over.

Seek Shelter (tornados, hurricanes, etc.)

Move to hallways and/or other inner rooms. Stay away from windows and doors. Sit on floor facing the inner wall and shield head with hands. Remain in shelter until notified by CVCC administration or by emergency personnel that the danger is over.

Building Evacuation

Leave the building immediately and proceed to a parking lot location at least 300 feet from the building. Do not delay to retrieve books or other personal items. Do not use elevators. Do not touch suspicious objects. Stay clear of the building once outside. Faculty should take class rosters if possible and account for all students at evacuation locations. Report any special assistance needed to CVCC faculty/staff or to emergency personnel. If you are aware or suspect someone is trapped in a threatened building, notify CVCC faculty/staff or emergency personnel. Remain at your building evacuation location until further instructions are provided by CVCC administration or by emergency personnel. In case of bomb threat, avoid using cell phones and wireless devices; this may detonate the bomb.

Smoke, Fire or Hazardous Materials

Activate the nearest fire alarm. Before attempting to fight a fire, notify someone nearby. Never attempt to fight a fire larger than wastebasket size. Close doors and windows to isolate the problem if the situation permits. If trapped in a building during a fire, use wet towels or cloths to protect you from flames and smoke. Stop/drop/roll if your clothes catch on fire. Do not open doors that feel hot. Always stay between the fire and an exit. Stay low to the floor as you try to exit.

Personal Emergencies

Unless you feel threatened, stay with the victim until emergency personnel arrive. Avoid contact with bodily fluids. Stay calm and try to minimize panic. If the person is conscious, ask if he/she is a High School student (if so, include this information in your 911 call).

Emergency Procedures Revised: August 15, 2019

Cell phone backup to 711 Campus Safety & Security can be reached at: 828-327-7000 ext. 0