KSA PROFESSIONAL COMPETENCIES PERFORMANCE OBJECTIVES Indicators B1.0 Discuss detailed information related B1.1 This competency is measured 3 to various types of managed health cognitively. care plans. LEARNING OBJECTIVES B1.1.1 Define terms associated with managed health care. 1 B1.1.2 Describe the various types of managed and traditional health insurance 3 plans. B1.1.3 Discuss types of physician fee schedules. 3 B1.1.4 Describe factors for determining insurance eligibility. 3 MODULE B OUTLINE Terms and definitions Types of managed and traditional health insurance and eligibility factors HMOs PPOs Medicare Medicaid Integrated delivery systems POS Consumer driven health plans Tricare CHAMPVA Workman’s Compensation/disability Preauthorization and referrals Type of physician fee schedules Charged based Resource based Capitation Contract to fee schedules Other MODULE C - LEGAL AND REGULATORY ISSUES KSA PROFESSIONAL COMPETENCIES PERFORMANCE OBJECTIVES Indicators C1.0 Comprehend legal and regulatory C1.1 This competency is measured 3 requirements for health insurance. cognitively. LEARNING OBJECTIVES C1.1.1 Define terms associated with legal and regulatory health insurance issues. 1 C1.1.2 Discuss the importance of confidentiality. A C1.1.3 Discuss legal and ethical requirements associated with confidentiality. 3 C1.1.4 Differentiate between fraud and abuse. 3 C1.1.5 Explain risk liability. 2 C1.1.6 Differentiate between co-pays and co-insurance. 2 MODULE C OUTLINE Terms and definitions
PROFESSIONAL COMPETENCIES PERFORMANCE OBJECTIVES KSA Indicators B1.0 Discuss detailed information related to various types of managed health care plans. B1.1 This competency is measured cognitively. 3 LEARNING OBJECTIVES B1.1.1 Define terms associated with managed health care. B1.1.2 Describe the various types of managed and traditional health insurance plans. B1.1.3 Discuss types of physician fee schedules. B1.1.4 Describe factors for determining insurance eligibility. 1 3 3 3 MODULE B OUTLINE Terms and definitions Types of managed and traditional health insurance and eligibility factors HMOs PPOs Medicare Medicaid Integrated delivery systems POS Consumer driven health plans Tricare CHAMPVA Workman’s Compensation/disability Preauthorization and referrals Type of physician fee schedules Charged based Resource based Capitation Contract to fee schedules Other MODULE C - LEGAL AND REGULATORY ISSUES PROFESSIONAL COMPETENCIES PERFORMANCE OBJECTIVES KSA Indicators C1.0 Comprehend legal and regulatory requirements for health insurance. C1.1 This competency is measured cognitively. 3 LEARNING OBJECTIVES C1.1.1 Define terms associated with legal and regulatory health insurance issues. C1.1.2 Discuss the importance of confidentiality. C1.1.3 Discuss legal and ethical requirements associated with confidentiality. C1.1.4 Differentiate between fraud and abuse. C1.1.5 Explain risk liability. C1.1.6 Differentiate between co-pays and co-insurance. 1 A 3 3 2 2 MODULE C OUTLINE Terms and definitions