Medical Insurance Syllabus for 2014-2015
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Instructor Information

Course Information

Recording Policy

Disability Statement

Any student who, because of a disabling condition, may require some special arrangements in order to meet course requirements should contact disAbility Services (Student Service Center room 119, phone 371-5436) as soon as possible.

Statement for Mental Health and Advocacy & Resource Center:

As a student you may experience a range of issues that can cause barriers to learning, such as strained relationships, increased anxiety, alcohol/drug problems, feeling down, difficulty concentrating and/or lack of motivation. These mental health concerns or stressful events may lead to diminished academic performance or reduce a student's ability to participate in daily activities. Amarillo College offers services to assist you with addressing these and other concerns you may be experiencing. If you or someone you know are suffering from any of the aforementioned conditions, you can learn more about the broad range of confidential mental health services available on campus by calling the AC Counseling Center at 806-371-5900. The AC Counseling Center website is https://www.actx.edu/counseling/ . Also, if you are in need of social services (affordable housing, utilities, transportation, food, clothing, childcare, medical/dental/vision, legal), please call the AC Advocacy & Resource Center at 806-371-5439. The AC Advocacy & Resource Center website is https://www.actx.edu/arc

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Administrative Drop Policy

N/A

Student Withdrawal Procedures

N/A

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The Amarillo College Privacy Policy is found at https://www.actx.edu/-amarillo-college-privacy-notice , and applies to all Amarillo College students.  If you have questions about this privacy statement or you believe that your personal information has been released without your consent, send email to humanresources@actx.edu .

Course

POFM-1327-001 Medical Insurance

Prerequisites

Course Description

Survey of medical insurance including the life cycle of various claim forms, terminology, litigation, patient relations and ethical issues.

Student Resources Student Resources Website

Department Expectations

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Occupational License Disclaimer

Hours

(3 sem hrs; 3 lec)

Class Type

On Campus Course

Syllabus Information

Textbooks

Insurance Handbook for the Medical Office,  Marilyn Takahaski Fordney, CMA-AC ; W.B. Saunders, Co., 2014, 13th Ed.
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\ Workbook for the Insurance Handbook for the Medical Office, Marilyn Takahashi Fordney, CMA-AC;  W. B. Saunders, Co., 2014, 13th Ed.
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Supplies

Textbook, Workbook, paper, pens, pencils.

Student Performance

\  End-of-Course Outcomes:  Compare and contrast insurance plans; define various health care delivery systems; bill patients and insurance carriers for medical services; and produce insurance claim form.

\ Upon completion of the following the student will be able to perform the following with at least a 70% accuracy as evaluated by the program's faculty.
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\ •           Distinguish between the two major health insurance contract classes.
\ •           List and define the general terms involved with federal, state and private health insurance plans, and common insurance terminology.
\ •          Demonstrate the ability to abstract insurance data from the patient record onto the health insurance claim form.
\ •          Explain the purpose of coding for medical professional services.
\ •           Demonstrate procedural and diagnostic coding correctly.
\ •           Describe the history of the health insurance claim form and be able to understand the different categories involved in the claim form.
\ •           Develop a procedure abstracting insurance data from patient record & followup notations for patient ledger card.
\ •           Cite the essential items of Blue Cross-Blue Shield insurance plans & how it started.
\ •           Develop an understanding of Medicaid benefits and what information is necessary when filing for these benefits.
\ •         Verbalize the essential items of Medicare insurance coverage and how it started.  Develop an understanding of the Medicare abbreviations.                 
\ •          Describe the essential items of CHAMPUS, CHAMPVA and VA Outpatient Clinic insurance.
\            Relate the history of how these insurance coverages started.
\ •          Cite the essential items of coverage for unemployment compensation & for doctor's certificate for verification of disability
\ •         Know and understand the coverage for federal and state workers' compensation laws
\ •         Describe the difference between compulsory and elective laws & how funding is achieved for workers' compensation.
\ •           Define terminology as it relates to workers' compensation.
\ •          Explain the advantages of filing a lien.
\ •          Identify the types of prepaid health plans -- Health Maintenance Organization & Peer Review.
\ •          Explain all the facets of dental insurance, including coverage under prepaid dental plans. 
\            Dental insurance cases will be worked on in the classroom.
\ •          State the different ways in which a medical/dental office can utilize a computer system.
\ •          Describe the application of credit and collection procedures after insurance claims have been filed & payment has been received.  Advantages listed for having a superbill, telephone debt collections, understanding bankruptcy &     small claims court procedures.
\ •          Abstract from the patient records the necessary insurance information for the cases involved in the textbook and added cases in the classroom.
\ •          Recognize the special insurance groups and file claims for these in the classroom.
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\ COURSE OBJECTIVE:
\ To provide the student with the basic knowledge in order to distinguish between the various  types of medical insurance available to patients and to be able to provide maximum reimbursement to the physician, medical facilities and the patient.  
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\ COURSE GOALS:
\ Upon completion of this course the student will be able to:
\ •        Abstract insurance data from the medical record to the health insurance claim form to provide maximum reimbursement to the physician and the patient.
\ •        Increase the efficiency and streamline administrative procedures  for insurance billing.   
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Students Rights and Responsibilities

Log in using the AC Connect Portal

In order to receive your AC Connect Email, you must log in through AC Connect at https://acconnect.actx.edu .

If you are an active staff or faculty member according to Human Resources, use "Exchange". All other students, use "AC Connect (Google) Email".

Expected Student Behavior

\ POLICY FOR STUDENTS REQUIRING THEA REMEDIATION:
\ Students that have been identified for THEA-required remediation must, according to Texas State Law, participate continuously in their THEA-remediation courses or they will be withdrawn for ALL course work, including the AH courses, through an administrative withdrawal for THEA non-compliance.  If you have any questions about THEA-remediation, please call the Advising and Counseling Center at 371-5440 or the Allied Health Counselor at 354-6007.
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\ WITHDRAWING FROM A COURSE:
\ It is the responsibility of the student to officially drop or withdraw  from a course.  Failure to officially withdraw may result in the student receiving a grade of “F” in the course.  Students may access Web Advisor to drop a course or the student may obtain assistance from any Amarillo College employee located at any of the Student Service counters on any campus.  Students are not automatically dropped from their class roles as a result on non-attendance.
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\ STUDENT GRIEVANCE PROCEDURE:
\ A student who has a problem with the course or the course instructor should make every attempt to resolve the problem with the course instructor.  If that is not successful, the student may appeal the decision of the instructor to the Program Director, Dean of the Health Sciences Division, Vice President for Academic Affairs, and the President -- IN THAT ORDER.   Please refer to the current Online Amarillo College catalog for complete explanation of the grievance procedures.
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\ CELLULAR TELEPHONES AND PAGERS:
\ Pagers and telephones are disruptive during class time.  Telephones must be turned off during class time with the exception of emergency personnel, pagers must either be turned off or set on vibrate during class time.   Please notify me in writing if you fall in this category, otherwise failure to comply will result in you being asked to leave class for that day.  You will still be responsible for the material covered in class.  If you feel that you will have an emergency during class time, leave the number of the student services office and they will contact you immediately.  The number is 371-5300. 
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\ ACADEMIC DISHONESTY:
\ Academic dishonesty shall constitute a violation of the college rules & regulations & is punishable as prescribed by Amarillo College Board policies.  Academic dishonesty shall include, but is not limited to, cheating on a test, plagiarism, and collusion.
\  “Cheating on a test” shall include:
\ •    Copying from another student’s test paper.
\ •    Using test materials not authorized by the person administering the test.
\ •    Collaborating with or seeking aid from another student during a test without permission from the test administrator/instructor.
\ •    Knowingly using, buying, selling, stealing, or soliciting, in whole or in part, the contents of an administered/unadministered test.
\ •    Substituting for another student, or permitting another student to substitute for one’s self, to take a test.
\ •    Bribing another person to obtain an administered/unadministered test or information about an administered/unadministered test. 

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\ “Plagiarism” shall be defined as the appropriating, buying, receiving as a gift, or obtaining by any means another’s work and the unacknowledged submission or incorporation of it in one’s own written work. 
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\ “Collusion” shall be defined as the unauthorized collaboration with another person in preparing written work for fulfillment of course requirements.
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Grading Criteria

EVALUATION METHOD:
QUIZZES: 
Quizzes will be given at the discretion of the instructor.  Quizzes may or may not be announced by the instructor.  Material covered by these quizzes will consist of review material or new material assigned in class.  Quizzes may be given orally, fill in the blank, matching, crossword puzzles, take-home or in a group.
There will be a minimum 8 to 15 quizzes. 

Each Online Quiz will open @ 6:00pm on the assigned date.
Each Online Quiz will CLOSE @ 11:59pm on the DUE date.

IF A QUIZ IS MISSED, THERE WILL BE NO MAKEUP QUIZZES.  If a student arrives late to class, while a quiz is in progress, he/she will NOT be given extra time to complete the quiz.  If a student arrives late to class after a quiz has been given, he/she will not be allowed to take the quiz.

TAKE-HOME QUIZZES:
You must be in class to receive the quiz & you must be in class to grade the quiz in order for the grade to count.
The student must attend the entire class in order to have the quiz grade count. 
In other words the student cannot drop by class, pick up the quiz and leave. 
If you receive a take-home quiz on Monday, this quiz should be brought to class on Wednesday ready to be graded. 
If you are not in class to grade your quiz, you will receive a grade of zero (0). 
You may not turn take-home quizzes in early or late.     

HOMEWORK:
There will be assignments for homework made in class and these assignments will also be posted to the AC Online course calendar.

Quizzes/Homeowork will be worth 15% of your FINAL GRADE.  
NO quiz or homework grades will be dropped.
   
MAJOR EXAMS:
These exams will be announced during class at least a week in advance of the exam date.
Major Exams will be given online.
Depending on the material covered, there will approximately  5-7 exams.

There will be NO makeup exams for the exams taken online.

Each Online Exam will open @ 6:00pm on the assigned date.
Each Oneline Exam will CLOSE @ 11:59pm on the DUE date.

Students with questions regarding examination results may review examinations, under the supervision of the MDS faculty, by appointment only.  Students who feel that a question was scored improperly must submit the following to the appropriate instructor, in writing by email.

•    The exam question and the reason for requesting an instructor review of the score.
•    The page and paragraph number, in the student's textbook or lecture notes, that verifies that the student's answer is correct.  Other sources of information, such as textbooks that have not been assigned, will not be considered.

The request must be submitted within one (1) calendar week after the instructor notifies the student of the grade.  The student will be notified within one (1)calendar week if the points have or have not been awarded.  Exam questions from an exam given more than one (1) week previously will not be considered.

MAJOR EXAMS WILL ARE WORTH 45% OF YOUR FINAL GRADE.
NO MAJOR EXAM GRADES WILL BE DROPPED.

GRADING SUMMARY:        
A  =    90.0 - 100.0%             
B  =    80.0 - 89.9%                
C  =    70.0 - 79.9%                
F  =    69.9% or less              

GRADE SCALE:
Attendance           =   15% of the final grade.
Quiz/Homework     =   15% of the final grade.
Major Exams        =    45% of the final grade.
Final Exam           =    25% of the final grade

Final grades will not be rounded in this course.

FINAL EXAM:
There will be a comprehensive final exam administered in this course. 
The final exam will be administered online.
The final exam is worth 25% of the final grade.

If a student misses the designated time for the final exam, a grade of zero (0) will be given for the final exam, unless an incomplete has been granted.
Arrangements to receive an incomplete "I" grade for the course must be made prior to the date of the final exam. 
Students will need to provide the instructor with appropriate documentation.
Incompletes are granted only for emergency situations such as hospitalization of the student, serious injury to the student on the day of the final exam, etc.
Incompletes are NOT granted for situations involving vacation plans, transportation difficulties, doctor's appointments, honeymoons, etc.

 

Attendance

ATTENDANCE POLICY: 
"Regular attendance is necessary for satisfactory achievement.  Therefore, it is the responsibility of the student to attend class.."  Any student who is chronically late to class or leaves early or is absent more than 3 times during the course may earn a failing final course grade.

Attendance will be taken at the beginning of all class meetings.  100 points will be given to all students who arrive on time to class and who stay for the entire class period. 
Students who arrive late or leave early, regardless of the reason, will be awarded only 50 points. 
In order to receive any credit for attendance the student must not be more than 15 minutes late or leave class more than 15 minutes early.  
Attendance will be worth 15% of your final grade.
 

Calendar

Additional Information

Dates of Importance:
Jan. 21              First day of class
Mar. 16-21         Spring Break
Apr. 23              Last day to withdraw or drop a class
May 10-13         Final Exams