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 impacts 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.
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 tot n mon Regulatory Requirement 1
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
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?
