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HCR 230 Week 1 Assignment Features of Private Payer and Consumer-Driven Health Plans.

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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

http://www.ustreas.gov/offices/public-affairs/hsa/faq_basics.shtml and http://www.or.regence.com/agent/product/docs/healthReimbArrangFAQ.pdf

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 230 Week 1 CheckPoint Comparing Cost Control Strategies

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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 230 Week 2 CheckPoint Summarizing the Medigap Program

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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?

Post your response to the Assignment Folder

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HCR 230 Week 3 assignment welfare reforms act

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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 230 Week 3 CheckPoint Working with Medicaid

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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.

Due Date: Day 4 [to the Assignment Folder]

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 230 Week 5 Assignment Understanding Work-Related Injuries

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Assignment: Understanding Work-Related Injuries

Resources: Appendix C and Ch. 13 (pp. 425- 427) of Medical Insurance

Due Date: Day 7 [to the Assignment Folder]

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 230 Week 6 CheckPoint Purpose of the General Appeals

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CheckPoint: Purpose of the General Appeals Process

Resource: Ch. 14 (p. 463) of Medical Insurance

Due Date: Day 5 [to the Assignment Folder]

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.

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