Healthcare Reimbursement Systems

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. The similarity report that is provided when you submit your task can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

Tasks may not be submitted as cloud links, such as links to Google Docs, Google Slides, OneDrive, etc., unless specified in the task requirements. All other submissions must be file types that are uploaded and submitted as attachments (e.g., .docx, .pdf, .ppt).

A. Discuss the components of each of the following insurance plans:

• fee for service (indemnity) plans

• managed care plans

• government-sponsored health plans (i.e., Medicare, Medicaid, and other government payers).

• high-deductible health plans/healthcare savings accounts

B. Discuss the restrictions of each of the following insurance plans:

• fee for service (indemnity) plans

• managed care plans

• government-sponsored health plans (i.e., Medicare, Medicaid, and other government payers).

• high-deductible health plans/healthcare savings accounts

C. Discuss the reimbursement process for each of the following insurance plans:

• fee for service (indemnity) plans

• managed care plans

• government-sponsored health plans (i.e., Medicaid and other government payers).

• high-deductible health plans/healthcare savings accounts

D. Discuss the inpatient and outpatient reimbursement processes for Medicare, including DRGs (diagnostic related groups), APS (ambulatory payment systems), PPS (perspective payment systems), and RBRVS (resource-based relative value scale).

E. Discuss the history of Stark II, including its impact on the awareness of anti-kickback practices.

F. Analyze the impact of the Anti-Kickback Statute on healthcare providers who participated with Medicare.

G. Discuss how third-party payment calculations, through contracted rates and prospective payment rates, affect healthcare reimbursement in healthcare organizations.

H. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

I. Demonstrate professional communication in the content and presentation of your submission.

File Restrictions
File name may contain only letters, numbers, spaces, and these symbols: ! – _ . * ‘ ( )
File size limit: 200 MB
File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z