Revenue and Reimbursement
MHA-FPX5006 u02a1 - Revenue and Reimbursement Learner: Elizabeth , Foster
OVERALL COMMENTS Elizabeth -
Thank you for your submission. I appreciate the hard work on this.
Revenue and reimbursement are important aspects of any healthcare organization. This provided the foundation for a
good review of revenue and reimbursement.
This mostly provided an overview of the concepts of this assessment without providing any specifics or details. This
needs to give a specific breakdown of the revenue cycle, pricing structure, etc.
This was also not well supported with appropriate scholarly literature, including peer-reviewed journals.
Dr. C
RUBRICS
CRITERIA 1
Develop a step-by-step process for a revenue cycle.
COMPETENCY
Develop financial strategies to address dynamic environmental forces.
NON_PERFORMANCE: Does not develop a step-by-step process for a revenue cycle.
BASIC:
Develops a process for a revenue cycle but does not include each step, or puts steps in an illogical or
inaccurate sequence.
PROFICIENT: Develops a step-by-step process for a revenue cycle.
DISTINGUISHED:
Develops a step-by-step process for a revenue cycle and explains the function or importance of each step.
Comments:
While this demonstrated an understanding of the revenue cycle, this did not delineate a step-by-step process.
I would recommend breaking this down into actual steps. For example:
Step 1. XXXX
Step 2. XXXX
Please also be sure to discuss the function and importance of each step. Please also be sure to support your
work with peer-reviewed sources to give it more credibility.
CRITERIA 2
Recommend a pricing structure method.
COMPETENCY
Develop financial strategies to address dynamic environmental forces.
NON_PERFORMANCE: Does not recommend a pricing structure method.
BASIC: Identifies one or more pricing structures but does not recommend one
PROFICIENT: Recommends a pricing structure method.
DISTINGUISHED:
Recommends a pricing structure method, and explains how the pricing structure method supports the
financial strategies of the organization.
Comments:
This did not provide any details about a pricing structure method. Please also be sure to support your work
with peer-reviewed sources to give it more credibility.
CRITERIA 3
Explain the factors to consider for insurance contract negotiations.
COMPETENCY
Analyze the cost and revenue implications for organizational changes due to environmental forces.
NON_PERFORMANCE: Does not explain the factors to consider for insurance contract negotiations.
BASIC: Identifies the factors to consider for insurance contract negotiations.
PROFICIENT: Explains the factors to consider for insurance contract negotiations.
DISTINGUISHED:
Explains the factors to consider for insurance contract negotiations, and identifies the major payer
categories appropriate for the practice.
Comments:
While negotiating insurance contracts was mentioned, it did not explore the factors sufficiently. Please also be
sure to support your work with peer-reviewed sources to give it more credibility.
CRITERIA 4
Explain a process for handling private pay and charity care.
COMPETENCY
Analyze the cost and revenue implications for organizational changes due to environmental forces.
NON_PERFORMANCE: Does not explain a process for handling private pay and charity care.
BASIC: Identifies a process for handling private pay and charity care.
PROFICIENT: Explains a process for handling private pay and charity care.
DISTINGUISHED:
Explains a process for handling private pay and charity care, and how the process fits into the financial
strategies of the organization.
Comments:
This discussed the benefits of charity care without providing a specific process for handling it. Please also be
sure to support your work with peer-reviewed sources to give it more credibility.
CRITERIA 5
Recommend a billing software system.
COMPETENCY
Analyze the cost and revenue implications for organizational changes due to environmental forces.
NON_PERFORMANCE: Does not recommend a billing software system.
BASIC: Describes billing software systems but does not recommend one.
PROFICIENT: Recommends a billing software system.
DISTINGUISHED:
Recommends a billing software system by comparing the benefits and limitations of each in terms of
organizational needs and financial strategies.
Comments:
Only general comments were given about a software without a specific recommendation. This would also be
enhanced with support form peer-reviewed sources.
CRITERIA 6
Explain how billing process changes benefit physicians, clinics, and patients.
COMPETENCY
Analyze the cost and revenue implications for organizational changes due to environmental forces.
NON_PERFORMANCE:
Does not explain how billing process changes benefit physicians, clinics, and patients.
BASIC: Lists the benefits of billing process changes.
PROFICIENT: Explains how billing process changes benefit physicians, clinics, and patients.
DISTINGUISHED:
Explains how billing process changes benefit physicians, clinics, and patients. Provides supporting
references and examples.
Comments:
This provided an explanation on how the billing process benefits the various stakeholders. Please, though, be
sure to support your work with peer-reviewed sources; this is an area of the assessment that particularly
needed such support.
CRITERIA 7
Write content clearly and logically with the correct use of grammar, punctuation, and mechanics.
COMPETENCY
Communicate in a manner that is scholarly, professional, and consistent with expectations of professionals in
health care administration.
NON_PERFORMANCE:
Does not write content clearly, logically, or with the correct use of grammar, punctuation, and mechanics.
BASIC: Writes with errors in clarity, logic, grammar, punctuation, or mechanics.
PROFICIENT:
Writes content clearly and logically with the correct use of grammar, punctuation, and mechanics.
DISTINGUISHED:
Writes clearly and logically with the correct use of spelling, grammar, punctuation, and mechanics; uses
relevant evidence to support a central idea.
Comments:
This was well-written.
Supplemental Feedback
CRITERIA 8
Format citations and references using the APA style.
COMPETENCY
Communicate in a manner that is scholarly, professional, and consistent with expectations of professionals in
health care administration.
NON_PERFORMANCE: Does not format citations and references using the APA style.
BASIC: Uses APA to format citations and references but with numerous errors.
PROFICIENT: Formats citations and references using the APA style with few errors.
DISTINGUISHED: Formats citations and references with no errors.
Comments:
Thank you for following APA style.
SUPPLEMENTAL CRITERIA 1
Purpose Compose a text that articulates meaning relevant to the main topic, scope, and purpose of the prompt
BEGINNING: This text is unrelated to the assignment prompt.
DEVELOPING:
This text is related to the assignment prompt but does not demonstrate an understanding of the main topic,
scope, and purpose.
SKILLED:
This text responds to the assignment prompt and appropriately addresses the main topic, scope, and
purpose.
ADVANCED:
This text presents a focused response to the assignment prompt and demonstrates a thorough
understanding of the main topic, scope, and purpose.
Comments:
SUPPLEMENTAL CRITERIA 2
Organization Develop text using organization, structure, and transitions that demonstrate understanding of relationship between main and subtopics
BEGINNING:
This text does not include a thesis statement and is organized inappropriately for the assignment.
DEVELOPING:
The thesis statement in this text is unclear and/or the text is presented in paragraphs with unclear main
idea(s) and/or transitional phrases.
SKILLED:
This text includes a thesis statement and is organized into paragraphs, with clear main ideas and effective
transitional phrases.
ADVANCED:
This text reflects a strong thesis statement. Additionally, this text is organized with skillful transitions into
paragraphs with clear main ideas, sufficient evidence, analysis, and linking information.
Comments:
SUPPLEMENTAL CRITERIA 3
Evidence Integrate into text appropriate use of scholarly sources and evidence
BEGINNING: This text included plagiarized information.
DEVELOPING:
This text lacks synthesis of information from sources and/or the credibility of the sources is questionable,
with many flaws in APA citation style.
SKILLED:
The included evidence was integrated and synthesized from outside sources, most of which are scholarly,
with minimal flaws in APA citation style.
ADVANCED:
The evidence in this text was integrated and synthesized from credible, scholarly, and professionally sound
sources, with minimal flaws in APA citation style.
Comments:
SUPPLEMENTAL CRITERIA 4
Tone Apply in text the standard writing conventions for the discipline, including structure, voice, person and tone
BEGINNING: Text uses language inappropriate for the intended audience.
DEVELOPING:
This text does not meet writing conventions for the discipline and lacks appropriate voice, person, and/or
tone for the intended audience.
SKILLED:
This text meets writing conventions for the discipline and there were minimal issues in appropriate use of
voice, person, or tone for the intended audience.
ADVANCED:
This text exhibits strict adherence to writing conventions for the discipline and uses appropriate voice,
person, and tone for the intended audience.
Comments:
SUPPLEMENTAL CRITERIA 5
Sentence Structure Produce text with minimal grammar, usage, spelling, and mechanical errors
BEGINNING:
Text meaning is unclear due to errors in sentence structure, grammar, usage, word choice, spelling, or
mechanics in 75% or more of text.
DEVELOPING:
Text meaning is interrupted due to sentence structure, grammar, usage, word choice, spelling, or mechanical
errors in 25%-75% or more of text.
SKILLED:
Text conveys clear meaning with minimal issues in grammar, usage, word choice, spelling, or mechanical
errors in 10%-25% of text.
ADVANCED:
Text complexity and concision conveys clear meaning, with grammar, usage, word choice, spelling, or
mechanical errors in 10% or less of text.
Comments: