HCR 230 Entire Course NEW

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HCR 230 Claims Preparation II Footing the Bills
Version 2
HCR 230 Week 1 CheckPoint Comparing Cost Control
Strategies
HCR 230 Week 1 CheckPoint Ramifications of
Participation Contracts

HCR 230 Week 1 Individual Features of Private Payer
and Consumer-Driven Health Plans
HCR 230 Week 2 CheckPoint Summarizing the
Medigap Program
HCR 230 Week 3 CheckPoint Working with Medicaid
HCR 230 Week 3 Individual The Welfare Reform Act
HCR 230 Week 4 CheckPoint Describing TRICARE
HCR 230 Week 5 CheckPoint Characteristics of
Workers Compensation Plans
HCR 230 Week 5 Individual Understanding Work-
Related Injuries
HCR 230 Week 6 CheckPoint Purpose of the General
Appeals Process

HCR 230 Week 7 CheckPoint Effective Financial
Policies and Procedures
HCR 230 Week 7 Individual Understanding the
Collection Process
HCR 230 Week 8 CheckPoint Inpatient and Outpatient
Hospital Services
HCR 230 Week 9 Capstone CheckPoint
HCR 230 Week 9 Final Project Design a Financial
Policy

HCR 230 Week 1 CheckPoint Comparing Cost
Control Strategies
230-Week-1-CheckPoint-Comparing-Cost-Control-
Strategies
HCR 230 Week 1 CheckPoint Comparing Cost Control
Strategies
Read Appendix A.

Resource: Ch. 9 (pp. 287–291) of Medical Insurance
Post a 200- to 300-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, in
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

230-Week-1-CheckPoint-Ramifications-of-
Participation-Contracts
Resource: pp. 304–305 in Ch. 9 of Medical Insurance

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.

HCR 230 Week 1 Individual Features of Private
Payer and Consumer-Driven Health Plans
230-Week-1-Individual-Features-of-Private-Payer-
and-Consumer-Driven-Health-Plans
HCR 230 Week 1 Individual 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 BlueCross BlueShield websites

Refer to Table 9.1 on p. 293 and Table 9.2 on p.
296 of your textbook.
Review the U.S. Treasurer’s Office Web site at
http://www.treasury.gov/resource-
center/faqs/Taxes/Pages/Health-Savings-
Accounts.aspx and The Regence BlueCross
BlueShield of Oregon website at
http://www.regence.com/OR/products/medical/i
ndex.jsp. Click the individual health plans for
detailed information.
Write 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.

· PO
· 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 websites provided.
Format your paper consistent with APA guidelines.
Post your paper as an attachment.

Medigap Program
230-Week-2-CheckPoint-Summarizing-the-
Medigap-Program
Medigap Program
Resource: Figure 10.7 on p. 350 of Medical
Insurance, and the WebMD® and American
Diabetes Association websites

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.
Write a 250- to 300-word summary reflecting on
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?
Post your response as an attachment.

HCR 230 Week 3 CheckPoint Working with
Medicaid
230-Week-3-CheckPoint-Working-with-Medicaid
HCR 230 Week 3 CheckPoint Working with
Medicaid
Resources: pp. 374–375 & 385–386 in Ch. 11 of
Medical Insurance, and the U.S. Department of
Health & Human Services website.

Refer to U.S. Department of Health & Human
Services website at
http://www.cms.hhs.gov/home/medicaid.asp
Select Medicaid Program – General Information.
· 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?
. What are some problems facing the program
today?

HCR 230 Week 3 Individual The Welfare Reform
Act
230-Week-3-Individual-The-Welfare-Reform-Act
HCR 230 Week 3 Individual The Welfare Reform
Act
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 consistent with APA guidelines.

230-Week-4-CheckPoint-Describing-TRICARE
Resources: Appendix B and pp. 399–404, 409–411
in Ch. 12 of Medical Insurance
Create a 5- to 8-slide Microsoft® 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 noncovered services
· Network and nonnetwork providers
· Participating and nonparticipating provider
charges
· Reimbursement
Use a minimum of one reference. You may use
your text as a reference.
Format your presentation consistent with APA
guidelines.

Post your presentation as an attachment.

230-Week-5-CheckPoint-Characteristics-of-
Workers-Compensation-Plans
Resources: pp. 423–424 in Ch. 13 of Medical
Insurance and the U.S. Department of Labor
website

Refer to pp. 423–424 in Ch. 13 of your textbook
and the U.S. Department of Labor website at:
http://www.dol.gov/dol/topic/workcomp/index.h
tm
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?

Related Injuries
230-Week-5-Individual-Understanding-Work-
Related-Injuries
Related Injuries
Resources: Appendix C and pp. 425–427 in Ch. 13
of Medical Insurance

Complete Appendix C by reading the five case
studies and determine whether or not these
injuries are covered under workers compensation.
Provide supporting arguments and cite the
appropriate workers’ compensation injury
classification category as directed in the Appendix.
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 your response consistent with APA
guidelines.

HCR 230 Week 6 CheckPoint Purpose of the
General Appeals Process
230-Week-6-CheckPoint-Purpose-of-the-General-
Appeals-Process
HCR 230 Week 6 CheckPoint Purpose of the
General Appeals Process
Resource: p. 463 in Ch. 14 of Medical Insurance

Research the Internet to locate three additional
examples of claims errors and classify them
according the categories noted on p. 463 of
Medical Insurance.
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.

230-Week-7-CheckPoint-Effective-Financial-
Policies-and-Procedures
Resource: Figures 15.1 & 15.2 on pp. 485–486 of
Medical Insurance

The three major elements to critical thinking are
logical inquiry, problem solving, and evaluative
decision making. In this CheckPoint, you must
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?

Collection Process
230-Week-7-Individual-Understanding-the-
Collection-Process
Collection Process
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.

Resources: pp. 494–505 in Ch. 15 of Medical
Insurance and Microsoft® Help website
Refer to Microsoft® Help website at
http://support.microsoft.com/ for questions
related to creating a flow chart in Microsoft®
Word.
Create a flow chart, using Microsoft® Word,
illustrating the sequence of basic steps in the
collection process.
Write a 350- to 500-word script, below your flow
chart, for a short instructional video to be used
along with the flow chart. The script must 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
flow chart. The audience for the job aid and video
is a medical office billing trainee.

HCR 230 Week 8 CheckPoint Inpatient and
Outpatient Hospital Services
230-Week-8-CheckPoint-Inpatient-and-
Outpatient-Hospital-Services
HCR 230 Week 8 CheckPoint Inpatient and
Outpatient Hospital Services
Resource: pp. 513–514, 523–526 in Ch. 16 of
Medical Insurance

What are the major differences between inpatient
and outpatient hospital services? Describe how
these differences affect the coding process and
provide examples.

230-Week-9-Capstone-CheckPoint
Resource: Appendix A, pp. 449–477 in Ch. 14 of
Medical Insurance.
Refer to Ch. 14 of Medical Insurance and previous
assignments from that chapter as a resource.

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.
· Provide a one-sentence summary describing
how claims adjudication is important to the
medical billing process.
Post your flow chart and explanation as an
attachment.

Policy
230-Week-9-Final-Project-Design-a-Financial-
Policy
Policy
Resources: Appendix A and Figure 15.1 on p. 487
of Medical Insurance

Complete Part A and Part B of your final project
using critical thinking skills. These skills include
suspending judgment and applying problem-
solving skills and methods while conducting
research. You must form evaluative decisions and
provide your rationale after considering how you
would design a medical office financial policy.
Decide on the type of medical office setting you
prefer to research. Focus on that setting as you
complete each portion of the final project.
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
and sample policies.

Write an original 750- to 1,050-word medical
office financial policy for Part A of your final
project. In your policy, provide a minimum of
three references other than your textbook,
formatted according to APA standards. Include the
following components in your policy:
· Collection of copayments, deductibles, and
past-due balances
· Arrangements for handling of unpaid
balances
· Handling of payments for noncovered
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; however, your policy
must include APA-formatted references.
Complete Part B of your project. Include the
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.
· Include a minimum of one reference to
support your explanation and format your paper
consistent with APA guidelines. You may use the
same references to complete the supporting
rationale that you used for the financial policy.

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