21 Mar Follow rubric verbatim *****I have the references you chose to use for assignment attached What to Submit Submit your report as a 3- to 5-page Microsoft Word document with
Follow rubric verbatim
*****I have the references you chose to use for assignment attached
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.
3/19/24, 10:46 AM Assignment Information
https://learn.snhu.edu/d2l/le/content/1504815/viewContent/29866815/View 1/4
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:
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.
3/19/24, 10:46 AM Assignment Information
https://learn.snhu.edu/d2l/le/content/1504815/viewContent/29866815/View 3/4
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
3/19/24, 10:46 AM Assignment Information
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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%
,
4
2-2 Project Preparation
Content
Strategic Planning
· Benzaghta, M. A., Elwalda, A., Mousa, M. M., Erkan, I., & Rahman, M. (2021). SWOT analysis applications: An integrative literature review. Journal of Global Business Insights, 6(1), 55-73.
· Nguyen, T. L. H., & Nagase, K. (2019). The influence of total quality management on customer satisfaction. International journal of healthcare management, 12(4), 277-285.
Healthcare Reimbursement
· Fainman, E. Z., & Kucukyazici, B. (2020). Design of financial incentives and payment schemes in healthcare systems: A review. Socio-Economic Planning Sciences, 72, 100901.
· Guo, P., Tang, C. S., Wang, Y., & Zhao, M. (2019). The impact of reimbursement policy on social welfare, revisit rate, and waiting time in a public healthcare system: Fee-for-service versus bundled payment. Manufacturing & Service Operations Management, 21(1), 154-170.
Revenue Cycle Process
· Atluri, H., & Thummisetti, B. S. P. (2023). Optimizing Revenue Cycle Management in Healthcare: A Comprehensive Analysis of the Charge Navigator System. International Numeric Journal of Machine Learning and Robots, 7(7), 1-13.
· Johnson, M., Albizri, A., & Harfouche, A. (2023). Responsible artificial intelligence in healthcare: Predicting and preventing insurance claim denials for economic and social wellbeing. Information Systems Frontiers, 25(6), 2179-2195.
Reimbursement Compliance
· Lin, J. C., Kavousi, Y., Sullivan, B., & Stevens, C. (2020). Analysis of outpatient telemedicine reimbursement in an integrated healthcare system. Annals of vascular surgery, 65, 100-106.
· Van Erp, J., Wallenburg, I., & Bal, R. (2020). Performance regulation in a networked healthcare system: from cosmetic to institutionalized compliance. Public Administration, 98(1), 46-61.
Relevance
Strategic Planning:
1. Benzaghta et al. (2021) offer a structured approach to SWOT analysis, facilitating the identification of organizational factors crucial for strategic planning in healthcare.
2. Nguyen and Nagase (2019) emphasize the significance of Total Quality Management (TQM) in guiding strategic decisions towards improving patient care outcomes and organizational performance.
Healthcare Reimbursement:
1. Fainman & Kucukyazici (2020) provide insights into diverse reimbursement strategies, aiding in the selection of appropriate payment models to enhance revenue collection within healthcare organizations.
2. Guo et al. (2019) highlight the impact of reimbursement policies on healthcare delivery efficiency and patient satisfaction, supporting informed decision-making in reimbursement management.
Revenue Cycle Process:
1. Fainman & Kucukyazici (2020) provide insights into diverse reimbursement strategies, aiding in the selection of appropriate payment models to enhance revenue collection within healthcare organizations.
2. Guo et al. (2019) highlight the impact of reimbursement policies on healthcare delivery efficiency and patient satisfaction, supporting informed decision-making in reimbursement management.
Reimbursement Compliance:
1. Fainman & Kucukyazici (2020) provide insights into diverse reimbursement strategies, aiding in the selection of appropriate payment models to enhance revenue collection within healthcare organizations.
2. Guo et al. (2019) highlight the impact of reimbursement policies on healthcare delivery efficiency and patient satisfaction, supporting informed decision-making in reimbursement management.
Credibility
The credibility of the selected sources is supported by their publication in well-known academic journals characterized by the rigorous peer review process. Some of the journals in which these sources are published include the “Journal of Global Business Insights”, the “International Journal of Healthcare Management” and the “Annals of Vascular Surgery”. Thus this ensures that the research was carefully assessed and reviewed by the experts before being placed before Furthermore, all these three resources are newly published, which ensures the provision of recent information and developments in healthcare management and reimbursement, which is extremely important in health care which is constantly changing. Moreover, the authors, among them Benzaghta, Nguyen, Fainman, and Lin, are affiliated with prominent academic institutions, using their expertise and experience to support the study’s legitimacy. Their commitment to scientific rigor in research methodologies, data analysis, and publication of results also adds more credibility to the information presented. By following the ethical academic norms including citation of sources, detailed descriptions of methodologies and discussions on limitations, these sources stress the reliability and worth of the outcome, heightening their value in the academic and professional horizons.
Gap Assessment
In assessing the gaps in the research study, we understand that the included resources provide essential information on strategic planning, health care reimbursement, revenue cycle, and compliance with reimbursement practice. Nevertheless, we need to engage in further study on some areas to get a holistic understanding of the topics. Thus, it is necessary that the research focus on the SWOT analysis strategies that are applicable in healthcare organizations in more details with the use of case studies or practical examples from the literature review of Benzaghta et al. (2021). In a similar way that the selected resources present the various reimbursement policies and compliance components, more research could be conducted to analyze trends including value-based reimbursement and regulations that affect reimbursement compliance. So, in order to address these gaps, further research can be conducted by checking other scholarly journal articles, organization reports or guidelines generated by reputable sources such as government agencies or professional group. Moreover, holding discussions with the experts of the field or compiling an empirical study enables us to reach the primary data and not only get an idea about the practices and problems of healthcare facilities but also understand this subject more in-depth.
,
4
2-2 Project Preparation
Content
Strategic Planning
· Benzaghta, M. A., Elwalda, A., Mousa, M. M., Erkan, I., & Rahman, M. (2021). SWOT analysis applications: An integrative literature review. Journal of Global Business Insights, 6(1), 55-73.
· Nguyen, T. L. H., & Nagase, K. (2019). The influence of total quality management on customer satisfaction. International journal of healthcare management, 12(4), 277-285.
Healthcare Reimbursement
· Fainman, E. Z., & Kucukyazici, B. (2020). Design of financial incentives and payment schemes in healthcare systems: A review. Socio-Economic Planning Sciences, 72, 100901.
· Guo, P., Tang, C. S., Wang, Y., & Zhao, M. (2019). The impact of reimbursement policy on social welfare, revisit rate, and waiting time in a public healthcare system: Fee-for-service versus bundled payment. Manufacturing & Service Operations Management, 21(1), 154-170.
Revenue Cycle Process
· Atluri, H., & Thummisetti, B. S. P. (2023). Optimizing Revenue Cycle Management in Healthcare: A Comprehensive Analysis of the Charge Navigator System. International Numeric Journal of Machine Learning and Robots, 7(7), 1-13.
· Johnson, M., Albizri, A., & Harfouche, A. (2023). Responsible artificial intelligence in healthcare: Predicting and preventing insurance claim denials for economic and social wellbeing. Information Systems Frontiers, 25(6), 2179-2195.
Reimbursement Compliance
· Lin, J. C., Kavousi, Y., Sullivan, B., & Stevens, C. (2020). Analysis of outpatient telemedicine reimbursement in an integrated healthcare system. Annals of vascular surgery, 65, 100-106.
· Van Erp, J., Wallenburg, I., & Bal, R. (2020). Performance regulation in a networked healthcare system: from cosmetic to institutionalized compliance. Public Administration, 98(1), 46-61.
Relevance
Strategic Planning:
1. Benzaghta et al. (2021) offer a structured approach to SWOT analysis, facilitating the identification of organizational factors crucial for strategic planning in healthcare.
2. Nguyen and Nagase (2019) emphasize the significance of Total Quality Management (TQM) in guiding strategic decisions towards improving patient care outcomes and organizational performance.
Healthcare Reimbursement:
1. Fainman & Kucukyazici (2020) provide insights into diverse reimbursement strategies, aiding in the selection of appropriate payment models to enhance revenue collection within healthcare organizations.
2. Guo et al. (2019) highlight the impact of reimbursement policies on healthcare delivery efficiency and patient satisfaction, supporting informed decision-making in reimbursement management.
Revenue Cycle Process:
1. Fainman & Kucukyazici (2020) provide insights into diverse reimbursement strategies, aiding in the selection of appropriate payment models to enhance revenue collection within healthcare organizations.
2. Guo et al. (2019) highlight the impact of reimbursement policies on healthcare delivery efficiency and patient satisfaction, supporting informed decision-making in reimbursement management.
Reimbursement Compliance:
1. Fainman & Kucukyazici (2020) provide insights into diverse reimbursement strategies, aiding in the selection of appropriate payment models to enhance revenue collection within healthcare organizations.
2. Guo et al. (2019) highlight the impact of reimbursement policies on healthcare delivery efficiency and patient satisfaction, supporting informed decision-making in reimbursement management.
Credibility
The credibility of the selected sources is supported by their publication in well-known academic journals characterized by the rigorous peer review process. Some of the journals in which these sources are published include the “Journal of Global Business Insights”, the “International Journal of Healthcare Management” and the “Annals of Vascular Surgery”. Thus this ensures that the research was carefully assessed and reviewed by the experts before being placed before Furthermore, all these three resources are newly published, which ensures the provision of recent information and developments in healthcare management and reimbursement, which is extremely important in health care which is constantly changing. Moreover, the authors, among them Benzaghta, Nguyen, Fainman, and Lin, are affiliated with prominent academic institutions, using their expertise and experience to support the study’s legitimacy. Their commitment to scientific rigor in research methodologies, data analysis, and publication of results also adds more credibility to the information presented. By following the ethical academic norms including citation of sources, detailed descriptions of methodologies and discussions on limitations, these sources stress the reliability and worth of the outcome, heightening their value in the academic and professional horizons.
Gap Assessment
In assessing the gaps in the research study, we understand that the included resources provide essential information on strategic planning, health care reimbursement, revenue cycle, and compliance with reimbursement practice. Nevertheless, we need to engage in further study on some areas to get a holistic understanding of the topics. Thus, it is necessary that the research focus on the SWOT analysis strategies that are applicable in healthcare organizations in more details with the use of case studies or practical examples from the literature review of Benzaghta et al. (2021). In a similar way that the selected resources present the various reimbursement policies and compliance components, more research could be conducted to analyze trends including value-based reimbursement and regulations that affect reimbursement compliance. So, in order to address these gaps, further research can be conducted by checking other scholarly journal articles, organization reports or guidelines generated by reputable sources such as government agencies or professional group. Moreover, holding discussions with the experts of the field or compiling an empirical study enables us to reach the primary data and not only get an idea about the practices and problems of healthcare facilities but also understand this subject more in-depth.
