NUR 621 Healthcare Reimbursement Training Paper

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The purpose of this assignment is to discuss how different insurance providers reimburse health care organizations for services.

You are the nursing administrator at a community hospital providing a training for your unit directors.

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Create a 12- to 14-slide PowerPoint Presentation (excluding the title and reference slides) addressing the following:

Discuss how Medicare, Medicaid, and private insurance reimburse health care organizations.
Describe the differences between cost, charge, and payment.
Explain Diagnostic Related Groups (DRGs) and provide at least two examples.
Discuss how insurance reimbursement affects private pay patients (those with no insurance).

Include at least 3 peer-reviewed resources.

Additionally, include a title side, reference slide, comprehensive speaker’s notes, and graphics that are relevant to the content, visually appealing, and placed appropriately.

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

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Healthcare Reimbursement Training – Rubric

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Rubric Criteria

Total100 points

Criterion	1. Unsatisfactory	2. Insufficient	3. Approaching	4. Acceptable	5. Target
Medicare, Medicaid, and Private Insurance Medicare, Medicaid, and Private Insurance	0 points Does not discuss how Medicare, Medicaid, and/or private insurance reimburse health care organizations.	16 points Unclearly discusses how Medicare, Medicaid, and private insurance reimburse health care organizations.	17.6 points Partially discusses how Medicare, Medicaid, and private insurance reimburse health care organizations.	18.4 points Clearly discusses how Medicare, Medicaid, and private insurance reimburse health care organizations.	20 points Thoroughly discusses how Medicare, Medicaid, and private insurance reimburse health care organizations.
Cost, Charge, and Payment Cost, Charge, and Payment	0 points Does not describe the differences between cost, charge, and/or payment.	16 points Incomprehensibly describes the differences between cost, charge, and payment.	17.6 points Somewhat describes the differences between cost, charge, and payment.	18.4 points Succinctly describes the differences between cost, charge, and payment.	20 points Comprehensively describes the differences between cost, charge, and payment.
Diagnostic Related Groups Diagnostic Related Groups	0 points Does not explain Diagnostic Related Groups.	16 points Ineffectively explains Diagnostic Related Groups with an example.	17.6 points Broadly explains Diagnostic Related Groups with at least two examples.	18.4 points Effectively explains Diagnostic Related Groups with at least two examples.	20 points Expertly explains Diagnostic Related Groups with at least two examples.
The Effects of Insurance Reimbursement on Private Pay Patients The Effects of Insurance Reimbursement on Private Pay Patients	0 points Does not discuss how insurance reimbursement affects private pay patients.	16 points Inaccurately discusses how insurance reimbursement affects private pay patients.	17.6 points Ambiguously discusses how insurance reimbursement affects private pay patients.	18.4 points Accurately discusses how insurance reimbursement affects private pay patients.	20 points Insightfully discusses how insurance reimbursement affects private pay patients.
Speaker Notes Speaker Notes	0 points Speaker notes are not included.	4 points Speaker notes are incomplete or incorrect.	4.4 points Speaker notes are included but lack explanation and relevant supporting details.	4.6 points Speaker notes are complete and include explanation and relevant supporting details.	5 points Speaker notes are thorough and include substantial explanation and relevant supporting details.
Presentation of Content Presentation of Content	0 points The content lacks a clear point of view and logical sequence of information. Presentation includes little persuasive information. Sequencing of ideas is unclear.	4 points The content is vague in conveying a point of view and does not create a strong sense of purpose. Presentation includes some persuasive information.	4.4 points The presentation slides are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.	4.6 points The content is written with a logical progression of ideas and supporting information, exhibiting a unity, coherence, and cohesiveness. Presentation includes persuasive information from reliable sources.	5 points The content is written clearly and concisely. Ideas universally progress and relate to each other. The project includes motivating questions and advanced organizers. The project gives the audience a clear sense of the main idea.
Mechanics of Writing Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.	0 points Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.	4 points Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.	4.4 points Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.	4.6 points Few mechanical errors are present. Suitable language choice and sentence structure are used.	5 points No mechanical errors are present. Skilled control of language choice and sentence structure are used throughout.
Format/Documentation Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.	0 points Appropriate format is not used. No documentation of sources is provided.	4 points Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.	4.4 points Appropriate format and documentation are used, although there are some obvious errors.	4.6 points Appropriate format and documentation are used, with only minor errors.	5 points No errors in formatting or documentation are present. Selectivity in the use of direct quotations and synthesis of sources is demonstrated.

Criterion

1. Unsatisfactory

2. Insufficient

3. Approaching

4. Acceptable

5. Target

Medicare, Medicaid, and Private Insurance

0 points

Does not discuss how Medicare, Medicaid, and/or private insurance reimburse health care organizations.

16 points

Unclearly discusses how Medicare, Medicaid, and private insurance reimburse health care organizations.

17.6 points

Partially discusses how Medicare, Medicaid, and private insurance reimburse health care organizations.

18.4 points

Clearly discusses how Medicare, Medicaid, and private insurance reimburse health care organizations.

20 points

Thoroughly discusses how Medicare, Medicaid, and private insurance reimburse health care organizations.

Cost, Charge, and Payment

0 points

Does not describe the differences between cost, charge, and/or payment.

16 points

Incomprehensibly describes the differences between cost, charge, and payment.

17.6 points

Somewhat describes the differences between cost, charge, and payment.

18.4 points

Succinctly describes the differences between cost, charge, and payment.

20 points

Comprehensively describes the differences between cost, charge, and payment.

Diagnostic Related Groups

0 points

Does not explain Diagnostic Related Groups.

16 points

Ineffectively explains Diagnostic Related Groups with an example.

17.6 points

Broadly explains Diagnostic Related Groups with at least two examples.

18.4 points

Effectively explains Diagnostic Related Groups with at least two examples.

20 points

Expertly explains Diagnostic Related Groups with at least two examples.

The Effects of Insurance Reimbursement on Private Pay Patients

0 points

Does not discuss how insurance reimbursement affects private pay patients.

16 points

Inaccurately discusses how insurance reimbursement affects private pay patients.

17.6 points

Ambiguously discusses how insurance reimbursement affects private pay patients.

18.4 points

Accurately discusses how insurance reimbursement affects private pay patients.

20 points

Insightfully discusses how insurance reimbursement affects private pay patients.

Speaker Notes

0 points

Speaker notes are not included.

4 points

Speaker notes are incomplete or incorrect.

4.4 points

Speaker notes are included but lack explanation and relevant supporting details.

4.6 points

Speaker notes are complete and include explanation and relevant supporting details.

5 points

Speaker notes are thorough and include substantial explanation and relevant supporting details.

Presentation of Content

0 points

The content lacks a clear point of view and logical sequence of information. Presentation includes little persuasive information. Sequencing of ideas is unclear.

4 points

The content is vague in conveying a point of view and does not create a strong sense of purpose. Presentation includes some persuasive information.

4.4 points

The presentation slides are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.

4.6 points

The content is written with a logical progression of ideas and supporting information, exhibiting a unity, coherence, and cohesiveness. Presentation includes persuasive information from reliable sources.

5 points

The content is written clearly and concisely. Ideas universally progress and relate to each other. The project includes motivating questions and advanced organizers. The project gives the audience a clear sense of the main idea.

Mechanics of Writing

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.

4 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

4.4 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

4.6 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.

5 points

No mechanical errors are present. Skilled control of language choice and sentence structure are used throughout.

Format/Documentation

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

0 points

Appropriate format is not used. No documentation of sources is provided.

4 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.

4.4 points

Appropriate format and documentation are used, although there are some obvious errors.

4.6 points

Appropriate format and documentation are used, with only minor errors.

5 points

No errors in formatting or documentation are present. Selectivity in the use of direct quotations and synthesis of sources is demonstrated.