Affordable Care Act and other changes in legislation

IHP 630 Final Project Guidelines and Rubric
Overview
The final project for this course is the creation of a payment system and reimbursement method analysis and a report to management.
The healthcare industry is impacted by government payer types as administrators prepare strategies and implement internal procedures designed to maximize
reimbursement. You are reminded that the primary focal point between healthcare firms and other business operations is the payment method. Healthcare
administrators implement strategies designed to meet key performance payment requirements critical for government compliance and reimbursement
guidelines. One way administrators accomplish this is to analyze deficiency errors based on quality measures performed by providers, nursing staff, and front
desk operations. The Affordable Care Act and other changes in legislation are of continual concern for healthcare organizations as administrators review changes
to ensure organizational processes and internal policies are implemented.
Your final project for this course is an analysis with recommendations. The project will require you to prepare an analysis of payment systems and reimbursement
methods. You will compare and contrast your findings and offer subsequent recommendations. You will consider compliance and government regulations along
with financial principles associated with reimbursement. You will also identify collaborative teamwork strategies that can be incorporated into various healthcare
settings.
The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final
submissions. These milestones will be submitted in Modules Three, Five, and Seven. The final submission is due in Module Nine.
In this assignment, you will demonstrate your mastery of the following course outcomes:
Assess the extent to which healthcare organizations utilize financial management principles for guiding strategic planning
Analyze federal, state, and and reporting guidelines for ensuring compliance with healthcare reimbursement requirements
Recommend collaborative teamwork principles for improving strategic planning processes involving healthcare reimbursement
Suggest financial approaches for improving cash flow, days in accounts receivable, and timeliness of reimbursements from various healthcare payer
models
Recommend strategies for maximizing healthcare reimbursement by reviewing the impact of case rates and management utilization data on pay-forperformance incentives
Prompt
Your analysis with recommendations should answer the following big-picture questions: What reimbursement payment methods and strategies are associated
with the healthcare industry? How do financial management principles relate to reimbursement in evaluating operational performance? And, how does the
revenue cycle affect various departments within the healthcare organization?
Specifically, the following critical elements must be addressed:
I. Introduction: What is the purpose, scope, and subject of your analysis and management report? Your introduction must describe the aim of your paper,
what you are assessing, and the analysis you expect to perform.
II. Financial Principles and Reimbursement:
a) Reimbursement Strategies: What is the impact of case rates and management utilization data on pay-for-performance incentives? Be sure to
provide support for your response.
b) Reimbursement Methods: Analyze reimbursement methods, describing the advantages and disadvantages of each method in terms of strategic
planning for operational performance. For example, why might one method be more advantageous than another at a hospital or at a physicians
office?
c) Financial Management Principles: Compare and contrast financial management principles such as financial data that describe financial performance
of revenue reimbursement, benchmarking of industry standards, payer-mix breakdown of payers, and case rate and utilization rate data used to
evaluate operational performance.
d) Accounts Receivable: What are the challenges associated with collecting payments for the accounts receivable or collections department, and what
is the significance of monitoring cash flow and days in accounts receivable in terms of reimbursement?
e) Teamwork Principles: Compare and contrast collaborative teamwork principles to most effectively develop strategic planning that involves crossdisciplinary teams. In other words, what principles work best for teams where individuals are from both clinical and non-clinical departments? What
are some of the challenges this might present for cohesive collaboration? Be sure to provide support for your response.
f) Maximizing Reimbursement: Generally speaking, to what extent do you feel healthcare organizations utilize case rates and management utilization
to maximize reimbursement from both government and third-party payer payment systems? Be sure to provide support for your response.
III. Federal and State Payment Systems:
a) Federal and State Regulations: Considering the recent changes in economic policy at the federal and state levels, what changes in federal and state
regulations present the most concern for healthcare leaders? Be sure to provide support for your response.
b) Reporting Requirements: Analyze the reporting guidelines required by Medicaid and Medicare and other government payment systems. What are
the opportunities and challenges for healthcare leaders in meeting reporting requirements?
c) Compliance Standards and Financial Principles: Analyze how healthcare organizations in general utilize financial principles to ensure compliance
with government standards.
d) Government Payer Types: Considering Medicaid, Medicare, and other government payer systems, what strategies would you recommend
organizations implement in order to receive full reimbursement on claims as well as to improve timeliness of this reimbursement? Be sure to justify
your recommendations.
IV. Third-Party Payment Systems:
a) Healthcare System Reimbursement: Evaluate third-party payer models for the impacts they present on healthcare system reimbursement.
b) Reporting Requirements: Analyze the reporting guidelines of third-party payer payment systems. What opportunities and challenges do they
present for healthcare leaders in meeting reporting requirements?
c) Compliance Standards and Financial Principles: Analyze how healthcare organizations in general utilize financial principles to guide strategic
planning to ensure the meeting of .
d) Reimbursement Methods: Considering third-party payer systems, what strategies would you recommend organizations implement in order to
receive full reimbursement on claims as well as to improve timeliness of this reimbursement? Be sure to justify your recommendations.
V. Operational and Strategic Planning in Healthcare:
a) Pay-For-Performance Incentives: Based on your prior analysis of the impact of case rates and management utilization data on pay-for-performance
incentives, recommend appropriate operational strategies to improve performance measures that will maximize reimbursement. Be sure to provide
support for your recommendations
b) Operational Performance Measures: Considering benchmarking data, recommend performance measures that should be monitored for the purpose
of maximizing reimbursement.
c) Teamwork and Strategic Planning: Recommend collaborative teamwork principles that would be beneficial for healthcare strategic planning in terms
of reimbursement. Be sure to provide support for your recommendations.
d) Communicating Strategic Planning Across Teams: What types of tools or strategies would you recommend for communicating strategic planning
conclusions to key stakeholders, members of cross-disciplinary teams, and the rest of the organization? In other words, how would you
communicate strategic planning information to clinical vs. non-clinical staff? To administrative staff? Be sure to provide support for your
recommendations.
e) Financial and Reimbursement Strategies: Considering cash flow and days in accounts receivable of hospital and health systems, recommend
reimbursement strategies that would be appropriate for low- and high-performing health systems. Provide evidence to support your conclusion.
Milestones
Milestone One: Draft of Financial Principles
In Module Three, you will submit a 23-page draft of the Financial Principles and Reimbursement portion of your research and analysis. This milestone will be
graded with the Milestone One Rubric.
Milestone Two: Draft of Federal and State Payment Systems
In Module Five, you will submit a 23-page draft of the Federal and State Payment Systems portion of your research and analysis. This milestone will be graded
with the Milestone Two Rubric.
Milestone Three: Draft of Third-Party Payment Systems and Planning in Healthcare
In Module Seven, you will submit a 23-page draft of the Third-Party Payment Systems and the Operational and Strategic Planning in Healthcare portions of your
research and analysis. Submit both sections together as a single document. This milestone will be graded with the Milestone Three Rubric.
Final Submission: Analysis and Report
In Module Nine, you will submit your analysis and report in its final form addressing all critical elements in this document. In addition to applying the feedback
you have received on each section throughout the term, you will develop your introduction for your final submission of the analysis and report. This submission
will be graded with the Final Project Rubric.
Deliverables
Milestone Deliverable Module Due Grading
One Draft of Financial Principles Three Graded separately; Milestone One Rubric
Two Draft of Federal and State Payment Systems Five Graded separately; Milestone Two Rubric
Three Draft of Third-Party Payment Systems and
Planning in Healthcare
Seven Graded separately; Milestone Three Rubric
Final Submission: Analysis and Report Nine Graded separately; Final Project Rubric
Final Project Rubric
Guidelines for Submission: Your payment system and reimbursement method analysis with report to management should be 10 to 12 pages in length and should
be double-spaced in 12-point Times New Roman font with one-inch margins. All citations and references should be formatted according to current APA
guidelines. Include at least five references.
Critical Elements Exemplary (100%) Proficient (90%) Needs Improvement (70%) Not Evident (0%) Value
Introduction Meets Proficient criteria and
utilizes industry-specific
language to establish expertise
and clearly articulate purpose,
scope, and subject
Comprehensively introduces
purpose, scope, and subject of
analysis and report
Introduces purpose, scope, and
subject of analysis and report
but with gaps in detail
Does not introduce purpose,
scope, and subject of analysis
and report
3
Financial Principles
and Reimbursement:
Strategies
Meets Proficient criteria and
demonstrates exceptional
insight into the impact of case
rates and management
utilization data on
reimbursement
Logically assesses the impact of
case rates and management
utilization data on pay-forperformance incentives,
supporting response
Assesses the impact of case
rates and management
utilization data on pay-forperformance incentives,
supporting response, but with
gaps in logic, detail, or relevant
support
Does not assess the impact of
case rates and management
utilization data on pay-forperformance incentives
6.27
Financial Principles
and Reimbursement:
Methods
Meets Proficient criteria and
demonstrates advanced
knowledge of reimbursement
methods with regard to
strategic planning
Accurately analyzes
reimbursement methods,
describing the advantages and
disadvantages of each method
in terms of strategic planning
for operational performance
Analyzes reimbursement
methods, describing the
advantages and disadvantages
of each method, but with gaps
in accuracy, detail, or relevancy
to strategic planning for
operational performance
Does not analyze
reimbursement methods,
describing the advantages and
disadvantages of each method
in terms of strategic planning
for operational performance
3.76
Financial Principles
and Reimbursement:
Management
Meets Proficient criteria and
demonstrates exceptional
insight into the use of financial
management principles for
evaluating operational
performance
Accurately compares and
contrasts financial
management principles used to
evaluate operational
performance
Compares and contrasts
financial management
principles used to evaluate
operational performance but
with gaps in accuracy,
relevancy, or detail
Does not compare and contrast
financial management
principles used to evaluate
operational performance
3.76
Financial Principles
and Reimbursement:
Receivable
Meets Proficient criteria and
draws nuanced connections
between cash flow, days in
accounts receivable, and
reimbursement
Logically assesses the
challenges associated with
collecting payments and
explains the significance of
monitoring cash flow and days
in accounts receivable in terms
of reimbursement
Assesses the challenges
associated with collecting
payments and explains the
significance of monitoring cash
flow and days in accounts
receivable, but response has
gaps in logic or detail or is
irrelevant to reimbursement
Does not assess the challenges
associated with collecting
payments, and does not explain
the significance of monitoring
cash flow and days in accounts
receivable
3.76
Financial Principles
and Reimbursement:
Teamwork
Meets Proficient criteria and
demonstrates advanced insight
into using teamwork principles
for developing strategic plans
Logically compares and
contrasts collaborative
teamwork principles for most
effectively developing strategic
planning that involves crossdisciplinary teams, supporting
response
Compares and contrasts
collaborative teamwork
principles for most effectively
developing strategic planning
that involves cross-disciplinary
teams, supporting response,
but with gaps in logic, detail, or
relevant support
Does not compare and contrast
collaborative teamwork
principles for developing
strategic planning that involves
cross-disciplinary teams
6.27
Financial Principles
and Reimbursement:
Maximizing
Meets Proficient criteria and
demonstrates exceptional
insight into the use of case
rates and management
utilization data to maximize
reimbursement
Logically assesses the extent to
which healthcare organizations
utilize case rates and
management utilization data to
maximize reimbursement from
both government and thirdparty payer payment systems,
supporting response
Assesses the extent to which
healthcare organizations utilize
case rates and management
utilization data to maximize
reimbursement from both
government and third-party
payer payment systems,
supporting response, but with
gaps in logic, detail, or relevant
support
Does not assess the extent to
which healthcare organizations
utilize case rates and
management utilization data to
maximize reimbursement from
both government and thirdparty payer payment systems
6.27
Federal and State:
Regulations
Meets Proficient criteria and
demonstrates superior insight
into the impact of changes in
federal and state regulations on
healthcare providers
Logically assesses the changes
in federal and state regulations
that present the most concern
for healthcare leaders,
supporting response
Assesses the changes in federal
and state regulations that
present the most concern for
healthcare leaders, supporting
response, but with gaps in logic,
detail, or relevant support
Does not assess the changes in
federal and state regulations
that present the most concern
for healthcare leaders
6.27
Federal and State:
Reporting
Requirements
Meets Proficient criteria and
demonstrates advanced
knowledge of government
payment systems reporting
guidelines and requirements
Accurately analyzes reporting
guidelines required by
government payment systems
for the opportunities and
challenges facing healthcare
leaders in meeting reporting
requirements
Analyzes reporting guidelines
required by government
payment systems for the
opportunities and challenges
facing healthcare leaders in
meeting reporting
requirements but with gaps in
accuracy or detail
Does not analyze reporting
guidelines required by
government payment systems
for the opportunities and
challenges facing healthcare
leaders in meeting reporting
requirements
6.27
Federal and State:
Compliance
Standards
Meets Proficient criteria and
demonstrates keen insight into
the use of financial principles
for ensuring compliance with
government standards
Accurately analyzes how
healthcare organizations utilize
financial principles for ensuring
compliance with government
standards
Analyzes how healthcare
organizations utilize financial
principles for ensuring
compliance with government
standards but with gaps in
accuracy or detail
Does not analyze how
healthcare organizations utilize
financial principles for ensuring
compliance with government
standards
3.76
Federal and State:
Government Payer
Types
Meets Proficient criteria and
recommended strategies are
exceptionally relevant and
appropriate for the intended
purpose
Recommends appropriate
strategies for organizations to
receive full reimbursement on
claims and improve timeliness
of reimbursement from
government payers, justifying
recommendations
Recommends strategies, but
they are not appropriate for
organizations to receive full
reimbursement on claims and
improve timeliness of
reimbursement from
government payers or response
has gaps in detail or relevant
justification
Does not recommend strategies
for organizations to receive full
reimbursement on claims and
improve timeliness of
reimbursement from
government payers
3.76
Third-Party Payment:
Reimbursement
Meets Proficient criteria and
draws nuanced connections
between third-party payer
models and reimbursement
Accurately evaluates thirdparty payer models for the
impact they present on
healthcare system
reimbursement
Evaluates third-party payer
models for the impact they
present on healthcare system
reimbursement but with gaps
in accuracy or detail
Does not evaluate third-party
payer models for the impact
they present on healthcare
system reimbursement
3.76
Third-Party Payment:
Reporting
Requirements
Meets Proficient criteria and
demonstrates advanced
knowledge of third-party payer
payment systems reporting
guidelines and requirements
Accurately analyzes reporting
guidelines required by thirdparty payer payment systems
for the opportunities and
challenges facing healthcare
leaders in meeting reporting
requirements
Analyzes reporting guidelines
required by third-party payer
payment systems for the
opportunities and challenges
facing healthcare leaders in
meeting reporting
requirements but with gaps in
accuracy or detail
Does not analyze reporting
guidelines required by thirdparty payer payment systems
for the opportunities and
challenges facing healthcare
leaders in meeting reporting
requirements
6.26
Third-Party Payment:
Compliance
Standards
Meets Proficient criteria and
demonstrates keen insight into
the use of financial principles
for ensuring compliance with
third-party payer submission
requirements
Accurately analyzes how
healthcare organizations utilize
financial principles for guiding
strategic planning in ensuring
compliance with third-party
payer submission requirements
Analyzes how healthcare
organizations utilize financial
principles for guiding strategic
planning in ensuring
compliance with third-party
payer submission requirements
but with gaps in accuracy or
detail
Does not analyze how
healthcare organizations utilize
financial principles for guiding
strategic planning in ensuring
compliance with third-party
payer submission requirements
3.76
Third-Party Payment:
Reimbursement
Methods
Meets Proficient criteria and
recommended strategies are
exceptionally relevant and
appropriate for the intended
purpose
Recommends appropriate
strategies for organizations to
receive full reimbursement on
claims and improve timeliness
of reimbursement from thirdparty payer systems, justifying
recommendations
Recommends strategies, but
they are not appropriate for
organizations to receive full
reimbursement on claims and
improve timeliness of
reimbursement from thirdparty payer systems or
response has gaps in detail or
relevant justification
Does not recommend strategies
for organizations to receive full
reimbursement on claims and
improve timeliness of
reimbursement from thirdparty payer systems
3.76
Planning: Pay-forPerformance
Meets Proficient criteria and
demonstrates exceptional
insight into the use of
improving performance
measures to maximize
reimbursement
Makes appropriate
recommendations for
operational strategies to
improve performance
measures that will maximize
reimbursement based on prior
analysis of impact of case rates
and management utilization
data, providing support for
recommendations
Makes recommendations, but
they are not appropriate for
operational strategies to
improve performance
measures that will maximize
reimbursement,
recommendations are not
based on prior analysis of
impact of case rates and
management utilization data,
or response has gaps in detail
or relevant support
Does not make
recommendations for
operational strategies to
improve performance
measures that will maximize
reimbursement
6.26
Planning: Operational
Performance
Meets Proficient criteria and
demonstrates exceptional
insight into the use of
benchmarking for maximizing
reimbursement through
improved operational
performance
Recommends appropriate
performance measures that
should be monitored for the
purpose of maximizing
reimbursement, considering
benchmarking data
Recommends performance
measures that should be
monitored for the purpose of
maximizing reimbursement, but
measures are not appropriate
for the intended purpose or
recommendations are not
based on benchmarking data
Does not recommend
performance measures that
should be monitored for the
purpose of maximizing
reimbursement, considering
benchmarking data
3.76
Planning: Teamwork Meets Proficient criteria and
demonstrates advanced insight
into using teamwork principles
for developing strategic plans
surrounding reimbursement
Recommends appropriate
collaborative teamwork
principles that would be
beneficial for healthcare
strategic planning in terms of
reimbursement, providing
support for recommendations
Recommends teamwork
principles, but they are not
appropriate or adequate for the
intended purpose or response
has gaps in detail or relevant
support
Does not recommend
collaborative teamwork
principles that would be
beneficial for healthcare
strategic planning in terms of
reimbursement
6.27
Planning:
Communicating
Meets Proficient criteria and
demonstrates exceptional
insight into communication
tools and strategies for
targeted audiences
Recommends appropriate tools
or strategies for communicating
strategic planning conclusions
to various audiences, providing
support for recommendations
Recommends tools or
strategies, but they are not
appropriate for communicating
strategic planning conclusions
to various audiences or
response has gaps in detail or
relevant support
Does not recommend tools or
strategies for communicating
strategic planning conclusions
to various audiences
6.26
Planning: Financial
and Reimbursement
Strategies
Meets Proficient criteria and
recommended strategies are
exceptionally relevant and wellsuited for the intended purpose
Recommends appropriate
reimbursement strategies for
low- and high-performing
health systems, considering
cash flow and days in accounts
receivable, supporting
conclusion with evidence
Recommends strategies for
low- and high-performing
health systems, but
recommendations are not
appropriate for the intended
purpose or do not consider
cash flow and days in accounts
receivable, or response has
gaps in detail or relevant
support
Does not recommend
reimbursement strategies for
low- and high-performing
health systems
3.76
Articulation of
Response
Submission is free of errors
related to citations, grammar,
spelling, syntax, and
organization and is presented in
a professional and easy-to-read
format
Submission has no major errors
related to citations, grammar,
spelling, syntax, or organization
Submission has major errors
related to citations, grammar,
spelling, syntax, or organization
that negatively impact
readability and articulation of
main ideas
Submission has critical errors
related to citations, grammar,
spelling, syntax, or organization
that prevent understanding of
ideas
3
Total 100%

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