Please follow all directions Overview In this module, you learned about how governmental and nongovernmental health insurance models impact financi

Please follow all directions

Overview

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Please follow all directions Overview In this module, you learned about how governmental and nongovernmental health insurance models impact financi
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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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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%

5/1/23, 10:13 PM
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.

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