4-2 Project Preparation

3/19/24, 10:46 AM Assignment Information

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IHP 630 Module Four Project Preparation Guidelines and Rubric

Overview

In this module, you learned about how governmental and nongovernmental health insurance models impact �nancial management and strategic planning in a healthcare organization. You also

explored the reporting requirements for payers. In this activity, you will create a report that compares the impact of some regulatory requirements on the �nancial and strategic performance

of a healthcare organization.

From a healthcare management perspective, this activity will help you understand how to identify the pros and cons of regulatory requirements and compare their impact. In section 6

(Reimbursement Compliance) of the course project, this will help you prepare for subsections 6A (Regulations) and 6B (Reporting Requirements).

Scenario

You are part of a large healthcare organization that caters to both governmental and nongovernmental healthcare insurance programs. Your organization 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 �nancial impact of regulatory requirements on

healthcare organizations.

This assignment will help you assess organizational �nancial performance related to nongovernmental payer models. It will also help you evaluate how various insurance models impact

�nancial management and strategic planning, as well as differentiate among various payer regulations and reporting requirements.

Directions

Create a report analyzing the �nancial 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.]

Explanation 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 writing support, access the Online Writing Center through the Academic Support module of your course.

Speci�cally, you must address the following rubric criteria:

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3/19/24, 10:46 AM Assignment Information

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1. Common Regulatory Requirement #1: Analyze the �nancial incentives and penalties of any one regulatory requirement common to all three types of payers—federal, state, and third

party—including a brief description of the requirement. Consider the following questions to guide your response:

What are the �nancial incentives of this requirement for each of the three payers?

What are the penalties for not meeting this requirement for each of the three payers?

2. Common Regulatory Requirement #2: Analyze the �nancial incentives and penalties of a second regulatory requirement common to all three types of payers—federal, state, and third

party—including a brief description of the requirement. Refer to the guiding questions for the “Common Regulatory Requirement #1” rubric criteria for additional guidance.

3. Common Regulatory Requirement #3: Analyze the �nancial incentives and penalties of a third regulatory requirement common to all three types of payers—federal, state, and third party

—including a brief description of the requirement. Refer to the guiding questions for the “Common Regulatory Requirement #1” rubric criteria for additional guidance.

4. Federal Unique Regulatory Requirement: Analyze the impact of at least one unique regulatory requirement for federal payers on the organization’s strategic planning and �nancial

performance. You may not use any of the regulatory requirements you identi�ed as a common regulatory requirement. Consider the following questions to guide your response:

What is the impact of each requirement on the organization’s strategic planning?

What is the impact of each requirement on the organization’s �nancial performance?

5. State Unique Regulatory Requirement: Analyze the impact of at least one unique regulatory requirement for state payers on the organization’s strategic planning and �nancial

performance. Refer to the guiding questions for the “Federal Unique Regulatory Requirements” in number 4 above for additional guidance.

6. Third-Party Unique Regulatory Requirement: Analyze the impact of at least one unique regulatory requirement for third-party payers on the organization’s strategic planning and

�nancial performance. Refer to the guiding questions for the “Federal Unique Regulatory Requirements” in number 4 above for additional guidance.

7. Maximum Strategic Impact: Evaluate which of the three unique regulatory requirements has the maximum strategic impact on the operations of the organization. Consider the following

questions to guide your response:

Which plan is the most bene�cial for the sustainability of the organization, and why?

What kinds of operational impact would the best plan have on the organization?

All the claims in your deliverable should be evidence based. Your citations 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 �ve years. You are required to cite a minimum of �ve 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 section of the course for additional support.

What to Submit

Submit your report as a 3- to 5-page Microsoft Word document with double spacing, 12-point Times New Roman font, and one-inch margins. Sources should be cited according to APA style.

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Module Four Project Preparation Rubric

Criteria Exemplary (100%) Pro�cient (90%) Needs Improvement (70%) Not Evident (0%) Value

Common Regulatory

Requirement #1

Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Analyzes the �nancial

incentives and penalties of any

one regulatory requirement

common to all three types of

payers —federal, state, and

third party— including a brief

description of the requirement

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 15

Common Regulatory

Requirement #2

Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Analyzes the �nancial

incentives and penalties of a

second regulatory requirement

common to all three types of

payers —federal, state, and

third party— including a brief

description of the requirement

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 15

Common Regulatory

Requirement #3

Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Analyzes the �nancial

incentives and penalties of a

third regulatory requirement

common to all three types of

payers —federal, state, and

third party— including a brief

description of the requirement

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 15

Federal Unique Regulatory

Requirement

Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Analyzes the impact of at least

one unique regulatory

requirement for federal payers

on strategic planning and

�nancial performance of the

organization

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 10

State Unique Regulatory

Requirement

Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Analyzes the impact of at least

one unique regulatory

requirement for state payers on

strategic planning and �nancial

performance of the

organization

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 10

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Criteria Exemplary (100%) Pro�cient (90%) Needs Improvement (70%) Not Evident (0%) Value

Third-Party Unique

Regulatory Requirement

Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Analyzes the impact of at least

one unique regulatory

requirement for third-party

payers on strategic planning

and �nancial performance of

the organization

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 10

Maximum Strategic Impact Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Evaluates which of the three

unique regulatory

requirements has the maximum

strategic impact on the

operations of the organization

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 10

Articulation of Response Exceeds pro�ciency in an

exceptionally clear and

insightful manner

Clearly conveys meaning with

correct grammar, sentence

structure, and spelling,

demonstrating an

understanding of audience and

purpose

Shows progress toward

pro�ciency, but with errors in

grammar, sentence structure,

and spelling, negatively

impacting readability

Submission has critical errors in

grammar, sentence structure,

and spelling, preventing

understanding of ideas

5

Scholarly and Professional

Sources

Incorporates more than �ve

scholarly, current (within the

last �ve years) sources, or use

of sources is exceptionally

insightful

Incorporates �ve scholarly,

current (within the last �ve

years) sources that support

claims

Incorporates fewer than �ve

scholarly, current (within the

last �ve years) sources, or not

all sources support claims

Does not incorporate sources 5

APA Style Formats in-text citations and

reference list according to APA

style with no errors

Formats in-text citations and

reference list according to APA

style with fewer than �ve

errors

Formats in-text citations and

reference list according to APA

style with �ve or more errors

Does not format in-text

citations and reference list

according to APA style

5

Total: 100%