Discussion: Private Insurance Companies.

Discussion: Private Insurance Companies.

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Discussion week 2
Please review the discussion board rubric under “Start Here”.

Use in-text citations appropriately and provide full citations for your initial post and at least one of your response posts. One of your citations needs to be outside of your text.

The idea is that you would not only comment on your classmate’s post but also do some additional research furthering the discussion.

To begin discussing in this forum, click the forum title, “Week 2 Discussion”. Then, click Create Thread on the Action Bar to post your initial reply. To reply to a fellow participant, click the title of the initial post, then click Reply.

PEER RESPONSE 1

Chenelle Weaver

Week 2 Discussion (Initial Post) Discussion week

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Total views: 2 (Your views: 2)
How does the location of where a service is performed determine which code set is used. Relate issues such as reimbursement schedules, co-pay amounts, and coverage limitations.

Where the service is or was provided determines the code that is used. Every place has its own set of codes. Payers have different reimbursement schedules, co-pay amounts, or coverage limitations depending on the place and/or location of service, this allows for proper billing to Medicaid, Medicare, or other private insurance companies.

What is a fee schedule?

According to www.cms.gov, “A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies.”

What is a co-pay?A co-pay or copayment is a flat fee that you pay on the spot every time you go to your doctor or fill a prescription. For example, if you hurt sprain your wrist or refill a prescription for an asthma inhaler, the amount you pay for that visit or medicine is considered your co-pay. Your co-pay amount is usually printed right on your insurance card. If your health insurance plan pays 100% for annual check-ups and preventive care services, you may not have a co-pay for those visits.

What types of services does the term “procedure coding” include?

Procedure coding include all healthcare related services like – Medicare, hospital services, ambulance services, insurance coverage services, non-physician services etc.

Word Count: 265

References:

www.cms.gov retrieved on June 14, 2017

www.healthcare.gov retrieved on June 14, 2017

Aalseth, P. (2015). Medical Coding What Is and How It Works. (2nd Ed) Burlington, MA: Jones & Barlett Learning

PEER RESPONSE 2

Quetsy Garcia

discussion week 2 Discussion week

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Total views: 9 (Your views: 2)
How does the location of where a service is performed determine which code set is used.
Procedure codesare a sub-type of medical classification used to identify specific surgical, medical, or diagnostic interventions. The code plays an essential role in patient access to new and existing technologies for the following reasons: It enables providers and payers to identify with specificity, for billing and claims processing purposes, the product that was provided to a patient. It serves as a means to define a health care product and provide a common identifier for providers and payers for obtaining data that measure outcomes and cost.

2. What is a fee schedule:

A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppl. This comprehensive listing of fee maximums is used to reimburse a physician and other providers on a fee-for-service basis.

3. What is a co pay:

A payment made by a patient in addition to that made by an insurer.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865619/

Discussion Board Rubric

Discussion Board: Participation and Professionalism Rubric

Expectations and Points Awarded

Exemplary

Acceptable

Needs Improvement

Unacceptable

Posting Requirements

50 pts

Student always posts to the discussion board on three separate days within the week. Proper APA format is used for in-text citation and referencing in the initial post. The student writes in a scholarly tone demonstrating critical thinking that goes beyond just sharing opinions. Student demonstrates ability to cite sources in proper APA.

50 pts

Student does not post on three separate days of the week, but posts on two separate days of the week.

35 pts

Student posts only one initial response to the discussion board.

20 pts

Student does not post an initial answer to address the topic or answer the question, and/or does not make any responses at all.

0 pts

Discussion: Private Insurance Companies

Level of Engagement and Participation

15 pts

Student posts promote further discussion by offering ideas and asking questions that are relevant to the discussion and course material. The posts offer an expansion on other student’s posts and course material.

15 pts

Student contributes to the class by posting but offers only a few ideas and asks questions that promote discussion on occasion but not all the time.

10 pts

Student rarely contributes to the discussion by offering ideas and asking questions.

3 pts

Student never contributes to the discussion by offering ideas and asking questions.

0 pts

Response Skill

15 pts

Student responses demonstrate they have read their classmates post. Their response indicates they are furthering the discussion by building on the post their classmate made. Proper APA format is used for in-text citation and referencing. The student writes in a scholarly tone demonstrating critical thinking that goes beyond just sharing opinions. Student demonstrates ability to cite sources in proper APA.

15 pts

Student responses often, but not always, indicate they have read their classmate and instructor posts.

10 pts

Student responses rarely demonstrate an understanding of other posts and course material.

5 pts

Student posts do not demonstrate they have read the material or other students’ posts.

0 pts

Posting Behavior

10 pts

Student demonstrates a professional level of respect for learning while participating on the discussion board. This level of respect is shown through behavior and attitude.

10 pts

Student posting is usually respectful. There is no display of disruptive posting.

7 pts

Student posts sometimes display a lack of respect or professional writing behavior, including rules of Netiquette

3 pts

Student is often disruptive by posting posts that are not respectful, do not demonstrate professionalism, or breach Netiquette rules.

0 pts

Preparation

10 pts

Student is always prepared with discussion posts that demonstrate a commitment to reading the course material and posts. The student’s post contains scholarly support for ideas by citing credible references

10 pts

Student is usually prepared with posts that demonstrate some understanding of the topic.

7 pts

Student is only occasionally prepared for class with posts that demonstrate they have read the course material and posts from the Instructor and other students.

2 pts

Student is never prepared for class with assignments and required class materials.

0 pts

DBRubric7.16.2014.pdf

Discussion: Private Insurance Companies

Discussion: Private Insurance Companies

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.