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HCR 202 Entire Course(New syllabus)
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HCR 202 Week 1 Health Care Payors Worksheet
HCR 202 Week 2 Payment Systems Worksheet
HCR 202 Week 2 Health Care Reimbursement Worksheet
HCR 202 Week 3 Government Payors Worksheet
HCR 202 Week 3 Government Payors Presentation
HCR 202 Week 4 Features of Private Payor and Consumer-Driven
Health Plans
HCR 202 Week 4 Characteristics of Workers’ Compensation Plans
HCR 202 Week 4 Benchmark AssignmentReimbursement and
Coverage Worksheet
HCR 202 Week 5 Ramifications of Participation Contracts
HCR 202 Week 5 Comparing Cost Control Strategies
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HCR 202 Entire Course
HCR 202 Week 1 CheckPoint Comparing Cost Control Strategies

HCR 202 Week 1 CheckPoint Ramifications of Participation
Contracts
HCR 202 Week 1 Assignment Features of Private Payer and
Consumer-Driven Health Plans
HCR 202 Week 2 CheckPoint Summarizing the Medigap Program
HCR 202 Week 2 DQ 1and DQ 2
HCR 202 Week 3 Assignment welfare reforms act
HCR 202 Week 3 CheckPoint Working with Medicaid
HCR 202 Week 4 Assignment The TRICARE Program
HCR 202 Week 5 Assignment Understanding Work-Related Injuries
HCR 202 Week 5 CheckPoint Characteristics of Workers
Compensation Plans
HCR 202 Week 6 CheckPoint Purpose of the General Appeals
HCR 202 Week 7 Assignment Understanding the Collection Process
HCR 202 Week 7 CheckPoint Effective Financial Policies and
Procedures
HCR 202 Week 8 CheckPoint Inpatient and Outpatient Hospital
Services
HCR 202 Week 9 Assignment Financial Policy DCSAA Finicial
Policy
HCR 202 Week 9 Capstone Checkpoint
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HCR 202 Week 1 Assignment Features of
Private Payer and Consumer-Driven Health
Plans

7. Assignment: Features of Private Payer and Consumer-Driven
Health Plans
Resources: Table 9.1 on p. 293 of Medical Insurance, Table 9.2 on p.
296 of Medical Insurance, and the U.S. Treasurer’s Office and
Oregon Blue Cross/Blue Shield Web sites
Due Date: Day 7 [post to the Assignment Folder]
Refer to Table 9.1 on p. 293 and Table 9.2 on p. 296 of your
textbook.
Review
Compose a 350- to 700-word response that familiarizes you with
private payer plans and CDHP account types. Briefly list three to five
main features for the following nine items. Below each list, provide
one or two 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 three references (you may use your text and the
two Web sites provided) formatted according to APA guidelines.
Post your response to the Assignment Folder
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HCR 202 Week 1 CheckPoint Comparing Cost
Control Strategies
CheckPoint: Comparing Cost Control Strategies
Resource: Ch. 9 (pp. 287-291) of Medical Insurance
Due Date: Day 3 [post to the Individual forum]
Post a 200- to 300-word response to the following: Compare cost
control strategies of employer-sponsored (employers buy from
insurance companies) to self-funded (employers cover costs of
benefits) health plans. Include the following factors:
Riders
Enrollment periods
Provider networks
Third party administrators
****Also discuss how the following affect cost control within group
health plans:
Portability
Creditable coverage
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HCR 202 Week 1 CheckPoint Ramifications of
Participation Contracts

6. CheckPoint: Ramifications of Participation Contracts
Resource: Ch. 9 (pp. 304-305) of Medical Insurance
Due Date: Day 4 [post to the Individual forum]
Discuss how participation contracts represent financial opportunities
for providers. What are positive and negative ramifications of
discounted fee-for-service arrangements? Explain your answers in
200 to 300 words.
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HCR 202 Week 1 Health Care Payors
Worksheet
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: An Integrated Claims
Process Approach (6th ed.)
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 a 50- to 150-word response to each of the following prompts.
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 sources see the Reference and Citation
Generator resource in the Center for Writing Excellence.
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HCR 202 Week 2 CheckPoint Summarizing the
Medigap Program
CheckPoint: Summarizing the Medigap Program
Resources: Figure 10.7 on p. 350 of Medical Insurance, and the
WebMD® and Diabetes.org Web sites

Due Date: Day 5 to the Assignment Folder
Refer to Figure 10.7 and the WebMD® and Diabetes.org Web sites
at: http://www.webmd.com/Medicare/medigap and
http://www.diabetes.org/advocacy-and-
legalresources/healthcare/medicare/medigap.jsp
Compose a 250- to 300-word summary reflecting upon the Medigap
program. Address the following questions in your summary:
What are the core benefits in the Medigap insurance program?
How well does the program meet coverage needs of its consumers?
Is the cost of each plan fair considering the benefits and limits offered
by each plan? Explain your opinion and provide examples.
What are the implications of having a private company associated
with a government insurance program?
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Discussion Question 1
Due Date: Day 2 [Main forum]
Post your response to the following: Explain whether or not you
believe Medicare’s eligibility limitations are reasonable in scope.
4. Discussion Question 2
Post your response to the following: In your opinion, what potential
positive and negative ramifications could result from offering
payment incentives for physician participation in Medicare programs?

Explain your answers and provide examples from this week’s Internet
and ERR readings located on your student web page.
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HCR 202 Week 2 Health Care Reimbursement
Worksheet
HCR 202 Week 2 Health Care Reimbursement Worksheet
Complete the University of Phoenix Material: Health Care
Reimbursement Worksheet.
Health Care Reimbursement 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 The amount owed for covered health care services
before the health insurance plan begins to pay
Deductible 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 A patient who does not have insurance
Self-pay patient 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 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.
properly cite your sources see 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.
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Complete the Payment Systems Worksheet.
Payment System Worksheet
Part A
Complete the table by describing the term. Be clear and concise, use
complete sentences, and define them in your own words.
Cite any outside resources. For additional information on how to
Term Definition
Preauthorization
Precertification
Predetermination
Part B

Write a 250- to 350-word response to each of the following questions.
Be clear and concise, use complete sentences, and use your own
words.
When are patient referrals needed?
How would you determine if a referral is required?
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HCR 202 Week 3 assignment welfare reforms
act
Assignment: The Welfare Reform Act
Due Date: Day 7 [to the Assignment Folder]
Write a 750- to 1,050-word paper discussing the positive and
negative implications of the Welfare Reform Act of 1996 on
Medicaid. Respond to one or more of the following questions in your
paper:
Did the Welfare Reform Act cause existing Medicaid beneficiaries to
lose necessary coverage?

Do eligible Medicaid candidates sometimes remain un-enrolled even
though they are needy as a result of the Welfare Reform Act?
Is the Welfare Reform Act effective in reducing welfare fraud and
increasing personal responsibility?
Has the Welfare Reform Act been successful in meeting its intended
goals?
Include a minimum of two references from the Internet or University
Library.
Format your paper according to APA guidelines.
Post your paper to the Assignment Folder
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HCR 202 Week 3 CheckPoint Working with
Medicaid
CheckPoint: Working with Medicaid
Resources: Ch. 11 (pp. 374-375, 385-386) of Medical Insurance and
the U.S. Department of Health & Human Services Web site.
Refer to U.S. Department of Health & Human Services Web site at
http://www.cms.hhs.gov/home/medicaid.asp
Select Medicaid Program - General Information.
Post a 250- to 300-word response to the following:
Briefly discuss factors that determine Medicaid eligibility, and
whether a procedure or service is covered.
When can a provider bill a Medicaid patient directly for services?

What are the implications of simultaneous federal and state
involvement in the insurance process?
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HCR 202 Week 3 Government Payors
Presentation
HCR 202 Week 3 Government Payors Presentation
Create a 10- to 12-slide Microsoft® PowerPoint® presentation that
discusses Medicare, Medicaid, the Civilian Health and Medical
Program of the Department of Veterans Affairs (CHAMPVA), and
TRICARE.
Include detailed speaker notes to explain the following topics in your
presentation:
Eligibility requirements
Coverage provisions
Participating and non-participating provider charges
Use a minimum of 1 reference. You may use your textbook as a
reference.
Format your assignment according to APA guidelines.
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HCR 202 Week 3 Government Payors
Worksheet
HCR 202 Week 3 Government Payors Worksheet
Complete the University of Phoenix Material: Government Payors
Worksheet.
Government Payers Worksheet
References: Ch. 9, 10, and 11 of Medical Insurance: An Integrated
Claims Process Approach (6th ed.)
Part A

Fill in the missing information by completing the table.
Identify the payer type, eligibility, coverage, and patient responsibility
for Medicare programs, Medicaid, CHAMPVA, and Tricare.
Payer Type Eligibility Coverage Patient Responsibility
Medicare Part A First 60 days responsibility is
the annual deductible.
For days 61 to 90 there is a per-day copay and another per-day copay
after days 91 to 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
determines the coverage and sets the payment rates.

Services include hospital, outpatient, physician services, laboratory,
radiology. Some states include prescription services, vision care,
vision, clinic services, and home and community based care.
Some may include a spend down program prior to reimbursement.
Individuals and 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 and families.
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 a 50- to 150-word response to each of the following questions.
Use your own words and provide examples to support your answers.
Why is it important to understand the guidelines for timely claim
filing from the date of treatment or discharge?

Why is it important to understand the different payer coverage and
patient responsibility?
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HCR 202 Week 4 Assignment The TRICARE
Program
CheckPoint: Describing TRICARE
Resources: Appendix B and Ch. 12 (pp. 399-404,409-411)
of Medical Insurance
Refer to Appendix B for guidance on presentations and the
Microsoft® Help and Support Web site for assistance with questions
related to PowerPoint® at http://support.microsoft.com/
Create a 5- to 8-slide PowerPoint® presentation that describes
features of the TRICARE program and its four subsidiaries. Include
detailed speaker notes to explain the following topics in your
presentation:

Eligibility requirements
Covered and non-covered services
Network and non-network providers
Participating and non-participating provider charges
Reimbursement
Use a minimum of one reference (you may use your text as a
reference).
Format your presentation according to APA guidelines.
Post your presentation to the Assignment Folder
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HCR 202 Week 4 Benchmark Assignment—
Reimbursement and Coverage Worksheet
HCR 202 Week 4 Benchmark Assignment—Reimbursement and
Coverage Worksheet
Complete the Reimbursement and Coverage Worksheet.
Reimbursement and Coverage Worksheet

References: Ch. 8 and 12 of Medical Insurance: An Integrated Claims
Process Approach (6th ed.)
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 $1,100.00. 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 from insurance and what the
patient will owe.
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HCR 202 Week 4 Characteristics of Workers’
Compensation Plans

HCR 202 Week 4 Characteristics of Workers’ Compensation
Plans
Resources: Ch. 12 of Medical Insurance: An Integrated Claims
Process Approach (6th ed.) and the U.S. Department of Labor website
Write a 350- to 700-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 both federal and state compensation
plans?
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Post your response to the following: Based on eligibility and cost
sharing requirements, what are the financial advantages for either
providers or patients participating in the TRICARE program? How do

annual limits (catastrophic caps) affect patients’ cost sharing
requirements? Explain your answers.
Post your response to the following: Explain whether or not you
believe CHAMPVA provides an adequate level of health insurance
for participants.
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HCR 202 Week 4 Features of Private Payor
and Consumer-Driven Health Plans
HCR 202 Week 4 Features of Private Payor and Consumer-
Driven Health Plans
Resources: Table 8.1 and Table 8.2 in Ch. 8 of Medical Insurance:
An Integrated Claims Process Approach (6th ed.) and the U.S.
Department of the Treasury website
Write a 350- to 700-word response to familiarize yourself with
private payer plans and consumer-driven health plan (CDHP) account
types. Briefly list two to three main features for the following nine
items.
 Preferred Provider Organization (PPO)
 Health Maintenance Organization (HMO)
 Group HMO
 Association of Independent Healthcare Organisations (AIHO)
 Point-of-Service (POS)
 Indemnity

 CDHP
 Health Reimbursement Account (HRA)
 Flexible Savings Account (FSA)
Use a minimum of 3 references. You may use your textbook and the
two websites provided.
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HCR 202 Week 5 Assignment Understanding
Work-Related Injuries
Assignment: Understanding Work-Related Injuries
Resources: Appendix C and Ch. 13 (pp. 425- 427) of Medical
Insurance
Compose a 750- to 1,050-word response describing the workers’
compensation claim process. Include the following information in
your answer:
Overall description of the workers’ compensation claims process
Responsibilities of the employee, employer, physician, and insurance
carrier
How do HIPAA Privacy Rules apply to workers’ compensation?
What are the implications of unrestricted access to a patient’s medical
records?

Refer to Chapter 13 of your textbook and at least one additional
reference from the Internet or University Library, for a minimum of
two references.
Format according to APA guidelines.
Post your paper to the Assignment Folder
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HCR 202 Week 5 CheckPoint Characteristics
of Workers Compensation Plans
CheckPoint: Characteristics of Workers’ Compensation Plans
Resources: Ch. 13 (pp. 423-424) of Medical Insurance and the U.S.
Department of Labor Web site
Refer to Ch. 13 (pp. 423-424)of your textbook and the U.S.
Department of Labor Web site at:
http://www.dol.gov/dol/topic/workcomp/index.htm
Post a 250- to 300-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 both federal and state
compensation plans?
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HCR 202 Week 5 Comparing Cost Control
Strategies
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 (when employers buy from insurance companies) to self-
funded health plans (when 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
*******************************************************
HCR 202 Week 5 Ramifications of
Participation Contracts

HCR 202 Week 5 Ramifications of Participation Contracts
Resource: Ch. 8 of Medical Insurance: An Integrated Claims Process
Approach (6th ed.).
Write a 350- to 700-word paper that discusses how participation
contracts represent financial opportunities for providers. What are
positive and negative ramifications of discounted fee-for-service
arrangements?
Format your paper according to APA guidelines.
*******************************************************
HCR 202 Week 6 CheckPoint Purpose of the
General Appeals
CheckPoint: Purpose of the General Appeals Process
Resource: Ch. 14 (p. 463) of Medical Insurance
Use the Internet to locate three additional examples of claims errors
and classify them according the categories noted on page 463 of your
textbook.

Respond to the following in 250 to 300 words: Briefly describe the
purpose of the general appeals process. Incorporate the three
additional examples of claims errors you located on the Internet,
classified according to the categories in the text.
*******************************************************
Post your response to the following: Do you believe the RA/EOB is
an effective method of communicating claim adjudication information
to patients? When you have received an RA/EOB in the mail, is it
easy or difficult to understand? What suggestions could you make to
improve patient-payer communication regarding the claim
adjudication process? Explain your answers.
Post your response to the following: Locate one article on the Internet
or University Library relating to Medicare post payment audits. Write
a one-paragraph summary of the article plus a discussion question
based on the summary. Well-written discussion questions include the
following elements:
Open-ended questions that elicit a variety of responses
Promote thinking rather than fact-finding

Encourage analysis or evaluation
Connected directly to the week’s content
Include the APA-formatted reference for your article in your post.
Title your subject line appropriately and post your response as a reply
to this message.
When you respond to classmates, answer their discussion questions or
pose additional questions based on their summary.
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HCR 202 Week 7 Assignment Understanding
the Collection Process
Assignment: Understanding the Collection Process
Resources: Ch. 15 (pp. 494-505) of Medical Insurance and
Microsoft® Help Web site
Suppose you are working in a medical office and are helping train a
new billing specialist about collections. You decide that a job aid in
the form of a flow chart would be a useful tool.
Refer to Microsoft® Help Web site at http://support.microsoft.com/
for questions related to creating a flow chart in Microsoft® Word.
Complete the following:
Using Microsoft® Word, create a flow chart illustrating the sequence
of basic steps in the collection process.
Below your flow chart, write a 350- to 500-word script for a short
instructional video to be used along with the flow chart. The script

should provide an overview of how to use the flow chart when
dealing with a collections account. Include details about what to do at
each step in the collections process flow chart.
The audience for the job aid and video is a medical office billing
trainee.
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HCR 202 Week 7 CheckPoint Effective
Financial Policies and Procedures
CheckPoint: Effective Financial Policies and Procedures
Resources: Figures 15.1 and 15.2 (pp. 485-486) in Medical Insurance
Refer to Figure 15.1 and 15.2 in Medical Insurance.
Post a 350- to 400-word response to the following: The three major
elements to critical thinking are logical inquiry, problem solving, and
evaluative decision making. In this CheckPoint, you will exercise
critical thinking skills to answer the following questions:
What are the basic elements of an effective medical office financial
policy?
In what ways do medical office procedures support financial policies?
What are the consequences when office procedures do not support the
financial policy?
What recommendations, strategies or tools can medical offices use to
ensure effective alignment of policies and procedures?

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HCR 202 Week 8 CheckPoint Inpatient and
Outpatient Hospital Services
CheckPoint: Inpatient and Outpatient Hospital Services
Resource: Ch. 16 (pp. 513-514, 523-526)of Medical Insurance
 Post a 250- to 300-word response to the following: What are the
major differences between inpatient and outpatient hospital services?
Describe how these differences affect the coding process and provide
examples.
*******************************************************

Refer to your text and the following links to help you answer
questions about written consent:
American Medical Association Web site at: http://archsurg.ama-
assn.org/cgi/reprint/135/1/26.pdf
Integrated Publishing Web site at:
http://www.tpub.com/content/medical/14295/css/14295_416.htm
Post your response to the following: What is the importance of
obtaining written consent from patients prior to receiving medical
treatment? What are the implications of failing to do so? Does a
medical emergency alter the conditions of written consent? Why or
why not? Explain your answers.
Post your response to the following: How are inpatient and outpatient
coding similar or different? Should there be a uniform standard of
classification for both inpatient and outpatient coding? Support your
opinions with examples.
*******************************************************
HCR 202 Week 9 Assignment Financial Policy
DCSAA Finicial Policy
Final Project: Design a Financial Policy

Resources: Appendix A and Figure 15.1 on p. 487 of Medical
Insurance
Use critical thinking skills to complete your final project. These
skills include suspending judgment and applying problem-solving
skills and methods while conducting research. You will form
evaluative decisions and provide your rationale after considering how
you would design a medical office financial policy.
Decide upon the type of medical office setting you prefer to research.
Focus on that setting as you complete each portion of the final project.
Complete Part A and Part B:
Part A:
Refer to Figure 15.1 on p. 487 of your textbook, the Internet, and the
University Library as resources. Search for medical office financial
policy advice as well as sample policies.
Compose an original 750- to 1,050-word medical office financial
policy. Provide a minimum of three references other than your
textbook, formatted according to APA guidelines. Include the
following components in your policy:
Collection of co-payments, deductibles, and past-due balances
Arrangements for handling of unpaid balances
Handling of payments for non-covered services
Prepayment policies
Policies for accepting cash, checks, money orders, and credit or debit
cards
Arrangements for sliding scales and low income payments
Other pertinent policies you see fit to include based on your research
Format your policy similarly to the examples you see online and in
your text, except yours will include APA-formatted references.
Part B:
Following the end of your financial policy, add a separate section
reviewing why you believe your policy is best suited to your selected
type of medical office setting. Explain and provide support for your
rationale in 550 to 700 words. Use a minimum of one reference to
support your explanation and format your paper according to APA

guidelines. You may use the same reference(s) to complete the
supporting rationale that you used for the financial policy.
Post your Final Project to the Assignment Folder
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HCR 202 Week 9 Capstone Checkpoint
Capstone CheckPoint
Resources: Appendix A, Chapter 14 (pp. 449-477) of Medical
Insurance, and Microsoft® Help Web site
Refer to Chapter 14 of Medical Insurance and previous assignments
from that chapter as a resource. Visit the Microsoft® Help link for
assistance with questions related to creating a flow chart in
Microsoft® Word at: http://support.microsoft.com/
Create a flow chart using Microsoft® Word illustrating the five steps
of the claims adjudication process from the time of initial processing
through final payment. Include a brief 250- to 300-word explanation
for the following:
Identify the purpose for each step in claim adjudication process.
Explain the relationship between each of the different steps.
Give a one-sentence summary describing how claims adjudication is
important to the medical billing process.
Post your flow chart and explanation to the Assignment Folder

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