Healthcare Insurance Programs

Module Four Project Preparation Guidelines and Rubric
Overview
In this module, you learned about how governmental and nongovernmental health insurance models impact financial 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 financial 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 financial impact of regulatory requirements on healthcare organizations.
This assignment will help you assess organizational 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 differentiate among various payer regulations and reporting requirements.
Directions
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.]
o Explanation of requirement: [Add relevant text here.]
o Financial impact of requirement on federal payer: [Add relevant text here.]
o Financial impact on state payer: [Add relevant text here.]
o 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.
Specifically, you must address the following rubric criteria:

1. Common Regulatory Requirement #1: Analyze the financial 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 financial 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 financial 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 financial 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 financial performance. You may not use any of the regulatory requirements you identified 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 financial 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 financial 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 financial 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 beneficial 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 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 section of the course for additional support.