BST 4030
Medical Insurance
Course Information

Course Description:

This course is designed to introduce the student to the basics of medical insurance, including insurance terminology, private payers and government programs, and general insurance procedures.

Course Objectives:

Upon completion of this course, the student will be able to:

  • Describe types of medical insurance
  • Identify procedures for obtaining patient demographic information, insurance verification, and authorizations.
  • Identify the diagnostic and procedure coding systems used with health care claims
  • Complete HIPAA-compliant health care claims for Medicare, Medicaid, and TRICARE/CHAMPVA; Workers' Compensation; and private payers, including Blue Cross and Blue Shield Plans, commercial carriers, and managed care organizations
  • Discuss HIPAA, legal, and ethical considerations with emphasis on confidentiality and fraud related to insurance
  • Discuss the processing of payers' remittance advices (RAs) and collections
Prerequisites and Corequisites:

It would be helpful for students to have completed the RODP Orientation course covering basic skills for Desire2Learn and on-line courses.

Course Topics:

Module 1: The Health Care Environment (15 hours)

Module 2: Physician Practice Coding and Compliance (25 hours)

Module 3: Claims Processing (20 hours)

Module 4: Health Care Payers (20 hours)

Specific Course Requirements:
No special course requirements or knowledge of specific software is necessary for successful completion of this course.
Textbooks, Supplementary Materials, Hardware and Software Requirements
Required Textbooks:

Please visit the RODP Virtual Bookstore for information regarding the textbook for this course. The Virtual Bookstore is located at http://rodp.bkstr.com.

Supplementary Materials:
None required.
Hardware Requirements:
The minimum requirements can be found at http://www.rodp.org/students/hardware_software.htm.
Software Requirements:
The minimum requirements can be found at http://www.rodp.org/students/hardware_software.htm.
Instructor Information
Please see the separate page inside the course to find instructor contact information.
Assessment and Grading
Testing Procedures:

There will be no outside testing. All testing will be done within Desire2Learn.

Grading Procedure:

Your grades will be based on Skills (50%), Related Work (25%), and Participation (25%).

The Skills score is the average of the 4 major part exams corresponding to Modules 1-4.

The Related Work score is derived from the 15 chapter quizzes found in Modules 1-4.

The Participation grade will be based on initial email communication with the instructor, initial discussion board posting, meeting deadlines, participating in discussion board postings, netiquette, and professionalism (maintaining composure and self-control, attitude, following instructions, mental alertness, attentiveness, observing, eager to learn, working independently and under pressure, using initiative, needing little supervision, quality of work). Once you have successfully finished all the requirements for the course, you will no longer be required to participate in discussion board postings, etc.

Grading Scale:

93 - 100---A
85 - 92----B
77 - 84----C

A score of 77 or better must be achieved to receive credit for this course.

Assignments and Participation
Assignments:

A listing of assignments, quizzes, exams, etc. arranged by module and according to due dates is available on the Calendar.

For each chapter, you will be required to take a timed quiz. The 15 quizzes will be considered assignment grades and help prepare you for the major part exams. There are 4 timed, graded Part exams: Exam Part #1 covers Chapters 1-3, Exam Part#2 covers Chapters 4-6, Exam Part #3 will cover chapters 7-9, and finally Exam Part #4 will cover chapters 10-15. I feel learning the material is very important and therefore I do allow students to take each quiz up to two (2) times, but there is no guarantee that the questions will be identical. Please note that if multiple attempts are made, then the average of all attempts will be the score that will serve as your quiz grade. There are no retakes on the Module Exams so prepare well for these.

When you are READY, enter the Assessments area via the link at the top of the page and take the quiz(zes) or exam(s). The graded quizzes and exams are closed book with no assistance. In taking the course, you are on your honor to "not give or receive help on them". If you have any questions, please contact me.

Class Participation:

Students must participate in all interactive aspects of the course. Students are expected to communicate with the instructor as a learning resource. Students must check the course discussion board where the instructor will post topics for students comments. To begin with students will reply/post an introduction to the class on the discussion board.

Students will email the instructor at the beginning of the course using Desire2Learn email to notify the instructor that they are in the system and have mastered this communication medium.

Punctuality:
Students are permitted to work ahead of the timeline in this course. There are specific module completion dates posted on the Calendar and noted in the modules. Exams and assignments are required to be done by these dates in order not to incur participation penalties.
Course Ground Rules

The following are recommendations for students taking this class:

  • Learn how to navigate in Desire2Learn.
  • Keep abreast of course announcements by viewing the course Calendar for testing and assignment deadlines.
  • Check the Discussion Board several times a week for course announcements, course information, and discussion topics.
  • Manage your time wisely. Give yourself enough time to complete assignments and properly prepare for exams.
  • Keep in contact with the instructor on a regular basis via weekly emails and discussion board.
  • Use the assigned college or university e-mail address as opposed to a personal email address for everything course related.
  • Address technical problems immediately.
  • Students must respect the rights of others at all times when communicating in chat, email, or discussions. Observe course netiquette at all times. 
  • Participation is key to doing well in this course. Be sure all assignments are completed by the due date as posted on the course Calendar.
  • If you have a technical issue, address it at once to avoid falling behind in the class.
  • If you have questions, the discussion board is a great place to ask it. Remember that the only bad question is one not asked. So, if you are unsure of something, ask. If you prefer, you may also email the instructor.
Guidelines for Communications
Email:
  • Always include a subject line.
  • Remember without facial expressions some comments may be taken the wrong way. Be careful in wording your emails. Use of emoticons might be helpful in some cases.
  • Use standard fonts.
  • Do not send large attachments without permission.
  • Special formatting such as centering, audio messages, tables, html, etc. should be avoided unless necessary to complete an assignment or other communication.
  • Respect the privacy of other class members.
Discussion Groups:
  • Review the discussion threads thoroughly before entering the discussion. Be a lurker then a discussant.
  • Maintain threads by using the "Reply" button rather starting a new topic.
  • Do not make insulting or inflammatory statements to other members of the discussion group. Be respectful of other’s ideas.
  • Be patient and read the comments of other group members thoroughly before entering your remarks.
  • Be positive and constructive in group discussions.
  • Respond in a thoughtful and timely manner.
Web Resources:

Library

The Tennessee Virtual Library is available to all students enrolled in the Regents Degree Program. Links to library materials (such as electronic journals, databases, interlibrary loans, digital reserves, dictionaries, encyclopedias, maps, and librarian support) and Internet resources needed by learners to complete online assignments and as background reading must be included in all courses. 

Students With Disabilities

Qualified students with disabilities will be provided reasonable and necessary academic accommodations if determined eligible by the appropriate disability services staff at their home institution. Prior to granting disability accommodations in this course, the instructor must receive written verification of a student's eligibility for specific accommodations from the disability services staff at the home institution. It is the student's responsibility to initiate contact with their home institution's disability services staff and to follow the established procedures for having the accommodation notice sent to the instructor.

Syllabus Changes

The instructor reserves the right to make changes as necessary to this syllabus. If changes are necessitated during the term of the course, the instructor will immediately notify students of such changes by individual email communication and posting both notification and nature of change(s) on the course bulletin board.

Technical Support

Telephone Support:
If you are having problems logging into your course,
timing out of your course, using your course web site tools, or other technical problems, please contact the Eduprise Help Desk by calling :

1-866-550-7637 (toll free)

or go to their website at:

http://help.rodp.org