The insurance payment process in managed care has several steps. In this assessment, create a timeline of the steps involved in the claim process from the patient encounter through the payment.
Evaluation Title: Patient Claim Process
Assume the role of a claims process manager in a primary care medical office. An existing patient comes in to be seen for a knee injury sustained over the weekend playing football with children. A full physical exam is done, and three x-rays are taken. The patient is provided with a referral to orthopedics, as well as two prescriptions for an anti-inflammatory and a pain medication. The patient is also provided an ACE elastic wrap in the office and shown how to properly use compression wrap on the injured area.
Instructions:
List the steps of the patient claim process from the conclusion of the appointment through the MCO payment.
For each step, provide the following:
A brief description of what is happening in each step of the process.
Estimated time for completion of each step.
Responsible parties and others involved in each step.
Estimated time to complete: 2 hours
Rubric
HC433 Unit 1 Assignment – Patient Claim Process
HC433 Unit 1 Assignment – Patient Claim Process
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeContent
20.0 ptsLevel 5
Demonstrates the ability to construct a clear and insightful problem statement/thesis statement/topic statement with evidence of all relevant contextual factors.
18.0 ptsLevel 4
Demonstrates the ability to construct a problem statement, thesis statement/topic statement with evidence of most relevant contextual factors, and problem statement is adequately detailed.
16.0 ptsLevel 3
Begins to demonstrate the ability to construct a problem statement/thesis statement/topic statement with evidence of most relevant contextual factors, but problem statement is superficial.
14.0 ptsLevel 2
Demonstrates a limited ability in identifying a problem statement/thesis statement/topic statement or related contextual factors.
12.0 ptsLevel 1
Demonstrates the ability to explain contextual factors but does not provide a defined statement.
0.0 ptsLevel 0
There is no evidence of a defined statement.
20.0 pts
This criterion is linked to a Learning OutcomeAnalysisPRICE-P
15.0 ptsLevel 5
Organizes and compares evidence to reveal insightful patterns, differences, or similarities related to focus.
13.5 ptsLevel 4
Organizes and interprets evidence to reveal patterns, differences, or similarities related to focus.
12.0 ptsLevel 3
Organizes and describes evidence according to patterns, differences, or similarities related to focus.
10.5 ptsLevel 2
Organizes evidence, but the organization is not effective in revealing patterns, differences, or similarities.
9.0 ptsLevel 1
Describes evidence, but it is not organized and/or is unrelated to focus.
0.0 ptsLevel 0
Lists evidence, but it is not organized and/or is unrelated to focus.
15.0 pts
This criterion is linked to a Learning OutcomeWriting
10.0 ptsLevel 5
The paper exhibits an excellent command of written English language conventions. The paper has no errors in mechanics, grammar, or spelling.
9.0 ptsLevel 4
The paper exhibits a good command of written English language conventions. The paper has no errors in mechanics or spelling with minor grammatical errors that impair the flow of communication.
8.0 ptsLevel 3
The paper exhibits a basic command of written English language conventions. The paper has minor errors in mechanics, grammar, or spelling that impact the flow of communication.
7.0 ptsLevel 2
The paper exhibits a limited command of written English language conventions. The paper has frequent errors in mechanics, grammar, or spelling that impede the flow of communication.
6.0 ptsLevel 1
The paper exhibits little command of written English language conventions. The paper has errors in mechanics, grammar, or spelling that cause the reader to stop and reread parts of the writing to discern meaning.
0.0 ptsLevel 0
The paper does not demonstrate command of written English language conventions. The paper has multiple errors in mechanics, grammar, or spelling that cause the reader difficulty in discerning the meaning.
10.0 pts
This criterion is linked to a Learning OutcomeAPAPRICE-I
5.0 ptsLevel 5
The required APA elements are all included with correct formatting, including in-text citations and references.
4.5 ptsLevel 4
The required APA elements are all included with minor formatting errors, including in-text citations and references.
4.0 ptsLevel 3
The required APA elements are all included with multiple formatting errors, including in-text citations and references.
3.5 ptsLevel 2
The required APA elements are not all included and/or there are major formatting errors, including in-text citations and references.
3.0 ptsLevel 1
Several APA elements are missing. The errors in formatting demonstrate a limited understanding of APA guidelines, in-text-citations, and references.
0.0 ptsLevel 0
There is little to no evidence of APA formatting and/or there are no in-text citations and/or references.