Healthcare BA
0 STUDENTS ENROLLED
BA Healthcare Course Content:
1.Healthcare Market Overview
- Introduction
- Current healthcare market trend in US
- What is an HMO
- The Industry Outlook
- Trends in Healthcare – Provider Space
- Trends in Healthcare – Payer Space
- Key Players
- References
2.Healthcare Overview
- Unit Objectives
- Genesis Of Healthcare
- How the industry Works?
- Healthcare pillars
- Members
- Providers
- Benefits
- Claims
- Sales
- External Agents
- Healthcare workflow
- Summary
- Review Questions
- References
3.Members
- Unit Objective
- Introduction
- Insurance Business: An Overview
- Individual and Group Insurance in detail
- Individual Insurance
- How to get individual insurance?
- Group Insurance
- Company Paid Groups
- Affinity Groups
- Self Insured Group
- Self-Employed Members
- Exercise
4.Member’s enrollment
- What is Enrollment?
- How is enrollment carried out?
- Output of enrollment process
- Enrollment: Overall Picture
- Exercise
5.Member’s and Dependent’s eligibility
- Eligibility
- Eligibility Process
- How a member should approach right provider?
- Eligibility Data Transfer
- Eligible Dependents
- Exercise
6.Member Services
- Means of services
- Services provided by the insurer
- Premium Collection
- Member Group Maintenance
- What are Groups?
- Groups Formation
- Groups Maintenance
- Disability Benefits
- Member’s concern
- Exercise
7.Provider
- Provider types
- Provider Participation
- Provider Contract
- Provider Contract Process
- Credentialing Criteria
- Verification of Provider Credentialing Information
- Types of Contracts
- Provider Reimbursement
- Exercise
- Provider Referral
- Referrals processing
- Referral types
- Provider Network
- Quality Provider Networks
- Network Adequacy
- Rental networks
- Network Hospital Standards
- Provider maintenance
- some common information of Providers
- Exercise
- Review Questions
- References
8.Sales
- Unit Objectives
- Introduction
- Brokers
- Calculation for Brokers
- Quote Creation
- What is a quote?
- The Process Of Quote Creation
- Actuaries
- Underwriters
- Insurance Payer’s Sales Department
- External Agents that deal with Sales Department of Insurance Payers
- Review Questions
9.Benefits
- Unit Objectives
- Introduction
- Indemnity Plans
- Managed Care Plans
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Point Of Service (POS)
- Exclusive Provider Organization (EPO)
- Which plan is the best?
- Exercise
- Other Plans
- Vision Plans
- Dental Plans
- Pharmacy Plans
- Medicare Plans
- Medigap
- Medicaid
- Long Term Care
- Disability Income Insurance
- Catastrophic Coverage Plans
- Exercise
- Individual Insurance and Group Insurance
- Laws and Legislations
- Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA)
- Health Insurance Portability and Accountability Act (HIPAA)
- Review Questions
- References
10.Claims
- Claim generation and submission to Providers
- Claims Intake Process
- Claims Intake : Diagrammatic
- Claim Adjudication Process
- Claim Preparation and determining eligibility
- Determine payment
- Update Claim
- Claim adjudication outputs
- Claim Payments
- Provider Payments
- Member Re-imbursement
- Member Re-imbursement
- Refund Adjustment
- Minus Debit Adjustment
- Minus Debit Adjustment
- Minus Debit Adjustment
- Stop Adjustment
- Government reporting
- Explanation of Benefits (EOB)
- Accumulators
- What are Accumulators?
- Function/Purpose of Accumulators
- What is accumulated?
- Types of Accumulator
- Overall Claims system diagram
- Review Questions
- References
11.External Agents
- Unit Objectives
- Introduction
- Government Agencies
- Centers for Medicare & Medicaid Services (CMS)
- Department Of Health And Human Services (DHSS)
- Centers for Disease Control and Prevention (CDC)
- Agency for Health Care Research and Quality (AHRQ)
- National Information Center on Health Services Research and Health Care Technology (NICHSR)
- Health Resources and Services Administration (HRSA)
- Exercise
- Government Acts and Regulations
- HIPAA
- Electronic Health Transaction Standards
- CORBA
- Exercise
- Clearing Houses
- Benefits Of A Clearinghouse
- Clearinghouse versus Direct Filing
- Clearinghouse Income
- Exercise
- Third Party Administrators
- Specialized Adjudication Engines/Companies
- General Agents
- Accreditation Agencies
- The Accreditation Process
- Drug Manufacturers
- Review Questions
- References
Course Reviews
No Reviews found for this course.
Write a Review