Module 4 project prep

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 payers—federal,

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 payers—federal, state, and third party—including 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 payers—federal, state, and third party—including 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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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 payers—federal, state, and third party—including 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!on’s 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!on’s strategic planning?

What is the impact of each requirement on the organiza!on’s financial performance?

5. State Unique Regulatory Requirement: Analyze the impact of at least one unique regulatory requirement for state

payers on the organiza!on’s 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!on’s 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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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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