Insurance and reimbursement methodologies

Health insurance and reimbursement methodologies are some of the basic foundations of understanding health care finance. Health care administrators must have a basic understanding of these areas to successfully run their respective departments and/or organizations. Interestingly enough, most consumers have no concept
of how their benefits are designed, implemented, and paid for. Understanding health insurance from a financial
perspective is one aspect to review. Aligning the insurance with networks, co-pays, co-insurance, and deductibles from a structural perspective and connecting the dots with providers and payors complicates
matters even further. Hopefully, this section will clarify these complexities.
Module Objectives
At the end of this module students will be able to:
Review the history of setting charges. (CO1, CO4)
Define the various methods of setting charges.(CO2, CO4)
Describe the impact of cost shifting. (CO1)
Review methods of reimbursement to providers. C01,C04)

Sample Solution

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Neurologic alterations

Describe and discuss the medical management, communication/teaching for patients and families, cultural considerations, and provide three relevant priority nursing interventions with rationales for the following conditions:
Increased intracranial pressure
Skull fractures
Spinal cord injury
Cerebrovascular disease
Status epilepticus

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Theater

*In an interview with Lauren Yee on The Great Leap, Yee said the following:
“Basketball is just an incredibly apt metaphor for I think both politics and diplomacy and also the personal struggles of these characters. Somebody described the philosophy of basketball to me as people trying to
create enough personal space around them for them to make the shot. That everyone on the court — every pass, every shot, every everything, is in service of you trying to lose your defender long enough to make the
shot. And that feels like it has something in common with the struggles of real life. I think every day, everyone is hustling to carve out a little world for themselves — like a space in which they can succeed and feel
comfortable and thrive.”
With this in mind, discuss your reaction to The Great Leap. Questions you might consider, but don’t have to, include: How was basketball incorporated into this production? Who was your favorite character, and why?
How is this play using dramatic techniques like rhythm, comedic writing, and humor to share a message or messages? How is it drawing on Chinese history? What themes do you think are present in the world of this
play?

Sample Solution

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Essay – Representing a Democracy

Research the background of your Congressional representatives based on your address listed with CU – two senators and a member of the House of Representatives. Find out about their previous occupation(s), political
experience, family, income, education, and other relevant demographics. What percentage of the vote did they receive to win in their last election? What are two policy issues areas they are interested in? How do these
areas reflect their ideologies? ( my zip code 60634 )
Here is a link to get you started:
https://www.govtrack.us/congress/members (Links to an external site.) (Links to an external site.)
Write an essay. Start by identifying all three of your representatives. Then, pick the representative you are most
interested in and explain why they interest you. Present the information you found in your research required
above in the essay.
( whichever YOU choose!)
Writing Requirements (APA 7th ed. format)
Length: 4 full pages (not including title page or references page)
1-inch margins
Double spaced
12-point Times New Roman font
Title page
References page (minimum of 2 scholarly sources beyond those provided)
side notes:
-all 3 representatives should be identified in an essay ( paragraph for each).
-you can follow each representative (personal info, income…etc) from the link provided above.
When you click on each representative there will be links (to your right side) where it takes you to their internal
side.
-When listing a representative’s finance- make sure to include the year of the estimated net worth.

Sample Solution

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