Please follow all directions
Overview
In this module, you learned about how governmental and nongovernmental health insurance models impact financial
management and strategic planning in a healthcare organiza!on. You also explored the repor!ng requirements for payers. In
this ac!vity, you will create a report that compares the impact of some regulatory requirements on the financial and strategic
performance of a healthcare organiza!on.
From a healthcare management perspec!ve, this ac!vity will help you understand how to iden!fy the pros and cons of
regulatory requirements and compare their impact. In sec!on 5 (Reimbursement Compliance) of the course project, this will
help you prepare for subsec!ons 5A (Regula!ons) and 5B (Repor!ng Requirements).
Scenario
You are part of a large healthcare organiza!on that caters to both governmental and nongovernmental healthcare insurance
programs. Your organiza!on is considering expanding its business and wants to determine the pros and cons of the regulatory
requirements of different insurance programs. Create a sample report analyzing the financial impact of regulatory
requirements on healthcare organiza!ons.
This assignment will help you assess organiza!onal financial performance related to nongovernmental payer models. It will
also help you evaluate how various insurance models impact financial management and strategic planning, as well as
differen!ate among various payer regula!ons and repor!ng requirements.
Direc!ons
Create a report analyzing the financial impact of at least three common regulatory requirements and at least one unique
regulatory requirement each for federal, state, and third-party payers. Then determine which of these unique regulatory
requirements has the maximum strategic impact. Here is a sample format that will help you organize your thoughts.
Common regulatory requirement #1: [Add relevant text here.]
Explana!on of requirement: [Add relevant text here.]
Financial impact of requirement on federal payer: [Add relevant text here.]
Financial impact on state payer: [Add relevant text here.]
Financial impact on third-party payer: [Add relevant text here.]
A common regulatory requirement indicates any requirement that needs to be followed by all three types of payersfederal,
state, and third-party. A unique regulatory requirement implies any requirement that is only applicable to any one of these
three types of payers, and not the other two.
If you need wri!ng support, access the Online Wri!ng Center through the Academic Support module of your course.
Specifically, you must address the following rubric criteria:
1. Common Regulatory Requirement #1: Analyze the financial incen!ves and penal!es of any one regulatory
requirement common to all three types of payersfederal, state, and third partyincluding a brief descrip!on of the
requirement. Consider the following ques!ons to guide your response:
What are the financial incen!ves of this requirement for each of the three payers?
What are the penal!es for not mee!ng this requirement for each of the three payers?
2. Common Regulatory Requirement #2: Analyze the financial incen!ves and penal!es of a second regulatory
requirement common to all three types of payersfederal, state, and third partyincluding a brief descrip!on of the
requirement. Refer to the guiding ques!ons for the Common Regulatory Requirement #1 rubric criteria for
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Page 1 of 4
addi!onal guidance.
3. Common Regulatory Requirement #3: Analyze the financial incen!ves and penal!es of a third regulatory requirement
common to all three types of payersfederal, state, and third partyincluding a brief descrip!on of the requirement.
Refer to the guiding ques!ons for the Common Regulatory Requirement #1 rubric criteria for addi!onal guidance.
4. Federal Unique Regulatory Requirement: Analyze the impact of at least one unique regulatory requirement for federal
payers on the organiza!ons strategic planning and financial performance. You may not use any of the regulatory
requirements you iden!fied as a common regulatory requirement. Consider the following ques!ons to guide your
response:
What is the impact of each requirement on the organiza!ons strategic planning?
What is the impact of each requirement on the organiza!ons financial performance?
5. State Unique Regulatory Requirement: Analyze the impact of at least one unique regulatory requirement for state
payers on the organiza!ons strategic planning and financial performance. Refer to the guiding ques!ons for the
Federal Unique Regulatory Requirements in number 4 above for addi!onal guidance.
6. Third-Party Unique Regulatory Requirement: Analyze the impact of at least one unique regulatory requirement for
third-party payers on the organiza!ons strategic planning and financial performance. Refer to the guiding ques!ons
for the Federal Unique Regulatory Requirements in number 4 above for addi!onal guidance.
7. Maximum Strategic Impact: Evaluate which of the three unique regulatory requirements has the maximum strategic
impact on the opera!ons of the organiza!on. Consider the following ques!ons to guide your response:
Which plan is the most beneficial for the sustainability of the organiza!on, and why?
What kinds of opera!onal impact would the best plan have on the organiza!on?
All the claims in your deliverable should be evidence based. Your cita!ons should be from your independent search for
evidence (not from the scenario, textbook, or module resources) of credible sources and be current within the last five years.
You are required to cite a minimum of five sources, at least one of which should be separate from your own research. Refer to
the IHP 630 Library Guide located in the Start Here sec!on of the course for addi!onal support.
What to Submit
Submit your report as a 3- to 5-page Microso# Word document with double spacing, 12-point Times New Roman font, and
one-inch margins. Sources should be cited according to APA style.
Criteria Exemplary (100%) Proficient (90%)
Needs
Improvement (70%)
Not Evident (0%) Value
Common
Regulatory
Requirement #1
Exceeds proficiency
in an excep!onally
clear and insigh$ul
manner, using
industry-specific
language
Analyzes the
financial incen!ves
and penal!es of any
one regulatory
requirement
common to all three
types of payers
federal, state, and
third party
including a brief
descrip!on of the
Shows progress
toward proficiency,
but with errors or
omissions
Does not a%empt
criterion
15
Module Four Project Prepara!on Rubric
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Page 2 of 4
requirement
Common
Regulatory
Requirement #2
Exceeds proficiency
in an excep!onally
clear and insigh$ul
manner, using
industry-specific
language
Analyzes the
financial incen!ves
and penal!es of a
second regulatory
requirement
common to all three
types of payers
federal, state, and
third party
including a brief
descrip!on of the
requirement
Shows progress
toward proficiency,
but with errors or
omissions
Does not a%empt
criterion
15
Common
Regulatory
Requirement #3
Exceeds proficiency
in an excep!onally
clear and insigh$ul
manner, using
industry-specific
language
Analyzes the
financial incen!ves
and penal!es of a
third regulatory
requirement
common to all three
types of payers
federal, state, and
third party
including a brief
descrip!on of the
requirement
Shows progress
toward proficiency,
but with errors or
omissions
Does not a%empt
criterion
15
Federal Unique
Regulatory
Requirement
Exceeds proficiency
in an excep!onally
clear and insigh$ul
manner, using
industry-specific
language
Analyzes the
impact of at least
one unique
regulatory
requirement for
federal payers on
strategic planning
and financial
performance of the
organiza!on
Shows progress
toward proficiency,
but with errors or
omissions
Does not a%empt
criterion
10
State Unique
Regulatory
Requirement
Exceeds proficiency
in an excep!onally
clear and insigh$ul
manner, using
industry-specific
language
Analyzes the
impact of at least
one unique
regulatory
requirement for
state payers on
strategic planning
and financial
performance of the
organiza!on
Shows progress
toward proficiency,
but with errors or
omissions
Does not a%empt
criterion
10
Third-Party
Unique
Regulatory
Requirement
Exceeds proficiency
in an excep!onally
clear and insigh$ul
manner, using
Analyzes the
impact of at least
one unique
regulatory
Shows progress
toward proficiency,
but with errors or
omissions
Does not a%empt
criterion
10
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Page 3 of 4
industry-specific
language
requirement for
third-party payers
on strategic
planning and
financial
performance of the
organiza!on
Maximum
Strategic Impact
Exceeds proficiency
in an excep!onally
clear and insigh$ul
manner, using
industry-specific
language
Evaluates which of
the three unique
regulatory
requirements has
the maximum
strategic impact on
the opera!ons of
the organiza!on
Shows progress
toward proficiency,
but with errors or
omissions
Does not a%empt
criterion
10
Ar!cula!on of
Response
Exceeds proficiency
in an excep!onally
clear and insigh$ul
manner
Clearly conveys
meaning with
correct grammar,
sentence structure,
and spelling,
demonstra!ng an
understanding of
audience and
purpose
Shows progress
toward proficiency,
but with errors in
grammar, sentence
structure, and
spelling, nega!vely
impac!ng
readability
Submission has
cri!cal errors in
grammar, sentence
structure, and
spelling, preven!ng
understanding of
ideas
5
Scholarly and
Professional
Sources
Incorporates more
than five scholarly,
current (within the
last five years)
sources, or use of
sources is
excep!onally
insigh$ul
Incorporates five
scholarly, current
(within the last five
years) sources that
support claims
Incorporates fewer
than five scholarly,
current (within the
last five years)
sources, or not all
sources support
claims
Does not
incorporate sources
5
APA Style Formats in-text
cita!ons and
reference list
according to APA
style with no errors
Formats in-text
cita!ons and
reference list
according to APA
style with fewer
than five errors
Formats in-text
cita!ons and
reference list
according to APA
style with five or
more errors
Does not format in-
text cita!ons and
reference list
according to APA
style
5
Total: 100%
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Page 4 of 4 Project Preparation: Identification of Sources
Precious Teasley
Southern New Hampshire University
IHP 630-Q4555: Healthcare Finance and Reimbursement 23TW4
Professor: Dr. Arsenault
April 14, 2023
Project Preparation: Identification of Sources
Revenue Cycle Process
Reference One
Matson, E. (2018). Give Your Revenue Cycle a Clean Bill of Health.
Healthcare Financial Management,
72(9), 20-21.
Relevance: The article is relevant to the subject since it focuses on issues impacting revenue cycles processes
Credibility: It is credible because it is a peer-reviewed journal published in a reliable journal
Gap Assessment: The article does not provide conclusive recommendations on how the findings can be applied widely
Reference Two
Mackey, T. K., Kuo, T. T., Gummadi, B., Clauson, K. A., Church, G., Grishin, D., & Palombini, M. (2019). Fit-for-purpose?challenges and opportunities for applications of blockchain technology in the future of healthcare.
BMC Medicine,
17(1), 1-17.
Relevance: The article focuses on the challenges and opportunities for revenue cycle improvement
Credibility: Its findings are based on empirical findings and published in the reliable journal
Gap Assessment: While the source explains the challenges and opportunities, it does not base its findings on primary data.
Healthcare Reimbursement
Resource One
Britton, J. R. (2015). Healthcare reimbursement and quality improvement: Integration using the electronic medical record: Comment on” fee-for-service payment- an evil practice that must be stamped out?”.
International Journal of health policy and Management,
4(8), 549.
Relevance: Healthcare experts who understand healthcare dynamics did the study. Therefore, the findings are relevant to the subject.
Credibility: Its findings are founded on empirical findings and published in the reliable journal
Gap Assessment: The article author only used secondary data to synthesize study findings.
Resource Two
Casto, A. B., & Forrestal, E. (2013).
Principles of healthcare reimbursement (p. 371). American Health Information Management Association.
Relevance: The source explains the law and regulations that guide the work of people involved in reimbursement
Credibility: The book was published by a group of professionals from a healthcare association
Gap Assessment: Since a group of professionals did the study from one discipline, the findings may not reflect the dynamics in the entire healthcare.
Strategic Planning
Resource One
Ehrlich, H., McKenney, M., & Elkbuli, A. (2020). Strategic planning and recommendations for healthcare workers during the COVID-19 pandemic.
The American Journal of emergency medicine,
38(7), 1446.
Relevance: Provide health professionals and administrators with recommendations on strategic planning.
Credibility: Its findings are based on empirical findings and published in the reliable journal
Gap Assessment: The study’s findings cannot be generalized because they provide a restricted working environment.
Resource Two
Hans, E. W., Van Houdenhoven, M., & Hulshof, P. J. (2011). A framework for healthcare planning and control. In
Handbook of healthcare system scheduling (pp. 303-320). Boston, MA: Springer US.
Relevance: The article focuses on the challenges and opportunities for revenue cycle improvement
Credibility: Healthcare experts who understand healthcare dynamics did the study. Therefore, the findings are relevant to the subject.
Gap Assessment: While the resource provides an important planning framework, the authors do not explain how the framework can benefit the organization.
Reimbursement Compliance
Resource One
Degelsegger-Mrquez, A., & Panteli, D. (2020). Towards reimbursement of mobile digital health applications? An international comparison of practices.
European Journal of Public Health,
30(Supplement_5), ckaa165-1327.
Relevance: The resource explains how people dealing with reimbursement can utilize technology to maintain best practices.
Credibility: Its findings are based on empirical findings and published in the reliable journal
Gap Assessment: Since a group of professionals did the study from one discipline, it is possible that the findings do not reflect the dynamics in the entire healthcare.
Resource Two
Green, M. (2020).
Understanding Health Insurance: A Guide to Billing and Reimbursement-2020. Cengage Learning.
Relevance: The study, rather than the guide, is based on the topic, which is helping the professional, understand principles that guide billing from a healthcare perspective.
Credibility: Billing is an important aspect of reimbursement compliance. Therefore, the study’s findings are reliable and credible to the professionals in the field.
Gap Assessment: The books author only used secondary data to synthesize study findings. Scenario
You are a healthcare consultant hired by a large healthcare organization. The organization has some new members on the board of directors who have requested an orientation on the organizations strategic planning, revenue-cycle processes, and reimbursement-compliance processes. As a consultant, you have been asked to educate the new board members at their next retreat on these areas, highlighting internal strengths and weaknesses, as well as external opportunities and barriers that might impact financial performance and reimbursement.
