Fall 2024 Course Syllabus
Course: PHRA-1340 (Section: 1, CRN: 93228)
Pharmacy Third Party Payment 		LSCPA Logo Image
Instructor Information
Instructor Toy Thornton-Wyckoff
Email thorntontn@lamarpa.edu
Phone (409) 984-6437
Office Educational I - Room: 111
Office Hours Monday - Wednesday By Appointment, Thursday & Friday 8:30-1:30 pm
Additional Contact Information Allied Health Administrative Assistant, Donna Wolfe (409) 984-6356 or 1-800-477-5872
Course Information
Description Overview of third party payment and it's impact on health care. Includes the principles and practices of managed care pharmacy, Medicare and Medicaid, payment plans, reimbursement methods, and formularies.
Required Textbooks Textbook Purchasing Statement: A student attending Lamar State College Port Arthur is not under any obligation to purchase a textbook from the college-affiliated bookstore. The same textbook may also be available from an independent retailer, including an online retailer.

Medical Insurance for Pharmacy Technicians
 ISBN-13: 978-0-07-337416-1
Author(s): Cynthia Newby & Janet Liles McGraw-Hill Publishing
Additional Materials/Resources None.
Corequisites/Prerequisites None
Learning Outcomes
  • Discuss and compare the benefits of managed care.
  • Identify the needs of individuals who are not insurance eligible.
  • Describe pricing schedules and demonstrate effective problem-solving skills.
  • Communicate with third-party administrators related to coverage and eligibility
 
Program Student Learning Outcomes
  • Discuss and compare the benefits of managed care.
  • Identify the needs of individuals who are not insurance eligible.
  • Describe pricing schedules and demonstrate effective problem-solving skills.
  • Communicate with third-party administrators related to coverage and eligibility
 
Lecture Topics Outline COURSE OUTLINE:
From Prescription to Payment
  • The Importance of Pharmacy Benefits
  • Medical Insurance Basics
  • The Pharmacy Practice Billing
  • Procedures, Communication, and Information Technology in the Billing Cycle
  • Effects of Pharmacy Claim Errors
Medicolegal Issues and the Pharmacy
  • Health Care Regulation
  • Pharmacy Records
  • HIPPA
  • Other Legislation Affecting Pharmacy
  • Fraud and Abuse Regulations
Private Insurance Payers and Plans
  • Private Insurance
  • Types of Health Plans
  • Pharmacy Plan Benefits
  • Pharmacy Benefit Management Techniques
  • Calculating Charges
Medicare
  • Medicare Overview
  • Medicare Part B Plans
  • Who Pays First?
  • Medicare Part D
Medicaid, TRICARE, CHAMPVA, WCTX and Discount Card
  • Medicaid
  • TRICARE and CHAMPVA
  • Worker’s Compensation
  • Discount Card Programs
Claim Preparation and Transmission
  • Claim Content
  • Creating Claims
  • Other Types of Pharmacy Billing
Processing Claims and Reconciling Accounts
  • Payer Processing of Claims
  • Remittance Advice
  • Collecting Patient POS Payment
  • Account Reconciliation
  • Audits
Major Assignments Schedule
Week 1 Course Introduction
Syllabus Review  
Week 2 Holiday 
Week 3 From Prescription to Payment (Chp.1)
~Chapter Review Assignment 
Week 4 Medicolegal Issues and the Pharmacy (Chp.2)
~Chapter Review Assignment 
Week 5 Quiz #1 (Chp.1-2)
Private Insurance Payers and Plans (Chp.3)
~Chapter Review Assignment
Week 6 Exam #1 (Chp.1-3)
Week 7 Medicare (Chp.4)
Week 8 Cont’d Medicare (Chp.4)
~Chapter Review Assignment
Week 9
Medicaid, TRICARE, CHAMPVA, WCTX and Discount Card Programs (Chp.5)
Week 10 Cont’d
Medicaid, TRICARE, CHAMPVA, WCTX and Discount Card Programs (Chp.5)
~Chapter Review Assignment
Week 11 Quiz #2 
Claim Preparation and Transmission (Chp.6)
 ~Chapter Review Assignment
Week 12 Exam #2 (Chp.4-6) 
Week 13 Processing Claims and Reconciling Accounts (Chp.7)
~Chapter Review Assignment
Week 14 Exam #3 (Chp.7)
Week 15Final Exam Review/Make Up Day 
Week 16Cumulative Final Exam 
Final Exam Date December 9, 2024 - 11:30 AM   Through  December 9, 2024 - 1:30 PM
Grading Scale 100-90            A
80-89              B
75-79              C
74-60              D
59 & Below     F
Determination of
Final Grade		 1. Quizzes 20%
2. Exams 25%
3. Final Exam 20%
4. Classwork 15%
5. Attendance 10%
Course Policies
Instructor Policies
  • NO CELLPHONESare to be in sight during class lecture or labs, as students will be allowed to use their cell phones during break time. If there is an emergency or situation please notify your instructor BEFORE class and you may be allowed to step out of class otherwise Mrs. Donna Wolfe is available at (409) 984-6366 for emergency contact and will notify the instructor and student.
  • All class and or homework assignments, quizzes, and exams, and attendance will be used in calculating your course grade.
  • Late work will receive deducted points as follows:
  • 24 Hours- 10 points
  • 48 Hours –20 points
  • 72 Hours –not accepted
  • If an exam or quiz is missed, you will be allowed to makeup an exam with the proper documentation for absence and a different exam or quiz may be given with the zero being replaced with the exam or quiz grade.
  • In class activities and participation will include assessments of videos, games, group presentations, EVERYONE is expected to stay engaged as this is 10% of your class grade.
  • Complete the required readings, assignments, discussions as directed by the instructor
  • Keep copies of ALL paperwork, including syllabus, handouts, and assignments.
  • Participate actively by reviewing course material, interacting with classmates, and responding promptly in communication with your instructor via email or by appointment.
  • No gradeswill be discussed over the phone, as you can make an appointment with your instructor. Student must maintain an average grade of 75 or better to pass.
  • If you have a complaint about this course which you cannot resolve through discussion with the instructor, please contact Shirley MacNeill, Chair Allied Health Department phone: 409-984-6365
  • The following materials are officially PROHIBTED in the classroom meetings for this course: food, drink, or tobacco. This policy agrees with the official college policy, breaks will be given.
  • The instructor expects that students illustrate mature behavior with respect to being responsible for your own actions, being respectful of others. Failure to comply may result in removal from the classroom or the course.
  • Students should use their LSCPA email account to send messages to instructor and leave an office voicemail.
Attendance Policy
  • All students are expected to attend class DAILY. A no call, no show will result in a zero for class work/homework assignment, class participation, etc. for the day of absence and cannot be made up.
  • A student who is absent from class more than 3 days within the semester may be dropped from the program by the Program Coordinator.
1st Warning- verbal with record of conference
2nd Warning- written with record of conference
3rd Warning- written and meeting with Program Coordinator and Allied Health Director
  • Late arrivalto class is disruptive, the classroom door is closed at the time class starts, any student arriving at that time will be considered LATE andwill not be allowed to enter the classroom, the student then should wait until break time to enter. Material that has been taught willNOT be retaught as students should follow up with their group or partner for class work.
  • Students who arrive after a quiz or exam starts, but before it ends, may take the quiz or exam without penalty but no additional time will be given.
  • It is the student's responsibility to notify the instructor of any absence. If unable to reach the instructor in the office, please leave a voicemail AND emailusing the student's campus email. Absences must be followed up with the proper documentation for student records.
 
*At any time while a student in the Pharmacy Technology Program, two final counseling notes are grounds for immediate dismissal.
Additional Information
Institutional Policies
MyLSCPA Be sure to check your campus email and Course Homepage using MyLSCPA campus web portal. You can also access your grades, transcripts, academic advisors, degree progress, and other services through MyLSCPA.
Academic Honesty Academic honesty is expected from all students, and dishonesty in any form will not be tolerated. Please consult the LSCPA policies (Academic Dishonesty section in the Student Handbook) for consequences of academic dishonesty.
ADA Considerations The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides comprehensive civil rights for persons with disabilities. Among other things, this legislation requires that all students with disabilities be guaranteed a learning environment that provides for reasonable accommodation of their disabilities. If you believe you have a disability requiring an accommodation, please contact the the Office for Disability Services Coordinator, Room 231, in the Madison Monroe Building. The phone number is (409) 984-6241.
COVID 19 Information The Lamar State College Port Arthur (LSCPA) Student Code of Conduct COVID 19 Policy requires students who have been diagnosed with COVID 19 to report their condition directly to their local health department. Students should also contact their course faculty to report their quarantine status. In addition, this policy requires all students to wear face coverings when directly exposed to COVID 19 in compliance with the criteria included in the policy. For more information please refer to the COVID 19 link on the LSCPA website.
Facility Policies No food or tobacco products are allowed in the classroom. Only students enrolled in the course are allowed in the classroom, except by special instructor permission. Use of electronic devices is prohibited.
HB 2504 This syllabus is part of LSCPA's efforts to comply with Texas House Bill 2504.
Mandatory Reporting of Child Abuse and Neglect As per Texas law and LSCPA policy, all LSCPA employees, including faculty, are required to report allegations or disclosures of child abuse or neglect to the designated authorities, which may include a local or state law enforcement agency or the Texas Department of Family Protective Services. For more information about mandatory reporting requirements, see LSCPA's Policy and Procedure Manual.
Title IX and Sexual Misconduct LSCPA is committed to establishing and maintaining an environment that is free from all forms of sex discrimination, including sexual harassment, sexual violence, and other forms of sexual misconduct. All LSCPA employees, including faculty, have the responsibility to report disclosures of sexual misconduct, including sexual harassment, sexual assault (including rape and acquaintance rape), domestic violence, dating violence, relationship violence, or stalking, to LSCPA's Title IX Coordinator, whose role is to coordinate the college's response to sexual misconduct. For more information about Title IX protections, faculty reporting responsibilities, options for confidential reporting, and the resources available for support visit LSCPA's Title IX website.
Clery Act Crime Reporting For more information about the Clery Act and crime reporting, see the Annual Security & Fire Safety Report and the Campus Security website.
Grievance / Complaint / Concern If you have a grievance, complaint, or concern about this course that has not been resolved through discussion with the Instructor, please consult the Department Chair.
Department Information
Allied Health
Chair:Shirley MacNeill
Email:macneisb@lamarpa.edu
Phone:(409) 984-6365