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What are the Health Insurance Marketplaces, and how do consumers enroll in health insurance?

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NUR 3805 Dimensions of Professional Nursing Practice

Health Care Reform Paper

Purpose: The Patient Protection and Affordable Care Act (ACA) was a sweeping health reform statute signed into law by President Obama in March of 2010. The ACA is the most significant government expansion and regulatory overhaul of the health system since the advent of Medicare and Medicaid.  The intent of the law is to expand insurance coverage, control health care costs, and to improve healthcare delivery systems.  Even as the ACA rolls out, much of the population (including nurses) lack understanding of the ACA, and question the value of the law in achieving its intended results. This assignment gives students the opportunity to explore how healthcare is organized and financed, and discuss how the Affordable Care Act affects population health, patient care quality and safety, and the practice of nursing.

Prepare: Complete the “Health Care Reform” study guide, watch videos and read the articles provided in the module.

Content: For the Health Care Reform PAPER, select ONE of the following questions that addresses/explores one aspect of the ACA. Write a brief (2-3 page) paper in APA format that provides a clear description that answers the question, AND reflect on why this information is important to you in your practice as a nurse, as a family member and/or as member of your community.

Choose ONE topic/question:

1. Describe the Affordable Care Act (ACA), including the major goals and features of the law. How does the ACA differ from government-run healthcare in other countries?

2. What are the Health Insurance Marketplaces, and how do consumers enroll in health insurance? How do the exchanges work?

3. Describe the Medicare program, including eligibility, and program elements (Parts A, B, C, D). Describe Medicare expenditures for the most recent year.

4. Describe the Medicaid program, including eligibility by age and income. Explain Medicaid Expansion programs proposed under the ACA, and the current status of expansion programs in the United States.

5. One of the goals of the ACA is to decrease the number of uninsured people. How well has this goal been achieved? What population groups have been impacted the most by this increased coverage?

6. Define the concept of Hospital Value-based Purchasing (also known as pay-for-performance or performance-based reimbursement.  Provide examples of how hospitals are affected by value-based purchasing policies.

7. Define Medical Homes and Accountable Care Organizations.  How can these approaches improve population health, improve the quality of healthcare and lower costs?

Format: Apply APA format and style guidelines to write a 2- to 3-page paper, which should include a minimum of three references, one or more of which is an article from a peer-reviewed journal. No abstract is required for this paper.

Discussion:

See Discussion assignment instructions; students will post one substantive post and one substantive peer response to the following question: What does the Affordable Care Act mean for nursing? Base your initial post on information described in your Health Care Reform paper, supplemented by the Luther and Hart article (and/or more resources)! Grading will be evaluated by the Discussion Board Grading Rubric.

Health Care Reform Paper Grading Rubric

Criteria Ratings
Explain concepts introduced in question, including and citing reliable sources (government organizations, reliable foundations, peer-reviewed journal articles). Narrative demonstrates understanding of concepts and programs described; information cited from reliable sources =50 Description of concepts lacks accuracy or clarity or extensive use of quotations = 35 Minimal description of concepts introduced in question; sources are not adequately cited and/or are not reliable =10
Why this information is important to you Thoughtful reflections of why healthcare program or reform is important to you as a nurse, as a family member and/or as member of your community = 30 Little reflection on what was presented in the paper or extensive use of quotations = 15 Minimal or missing reflection = 0
APA and Scholarly Writing Follows APA style and format with rare and minor exceptions; scholarly and objective writing = 20 APA and writing have a few mistakes OR body of paper exceeds 3 pages by one additional page = 10 More than a few APA errors; OR body of paper exceeds 4 pages = 0
Possible Points = 100

Explain the difference between Medicare and Medicaid billing.

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H07 Medical Coding I

Directions:  Be sure to make an electronic copy of your answer before submitting it to Ashworth College for grading.  Unless otherwise stated, answer in complete sentences, and be sure to use correct English spelling and grammar.  Sources must be cited in APA format.  Your response should be two (2) to four (4) pages in length; refer to the “Assignment Format” page for specific format requirements.

 

Lesson 1, 2, 3, and 4 of this course has covered a wide variety of topics. Thus far, you have learned a great deal of information on health insurance, medical contracts, HIPAA, physician and hospital medical billing, and Medicare and Medicaid.

 

For this writing assignment, please explain why the following course objectives are important for medical billers and coder to understand:

 

1.      Understand the history and impact of health insurance on health care reimbursement process and recognize various types of health insurance coverage.

 

2.      Identify the key elements of a managed care contract and identify the role HIPAA plays in the health care industry.

 

3.      Recognize and explain the different components of physician and hospital billing and differentiate between the two types of services.

 

4.      Explain the difference between Medicare and Medicaid billing.

 

 

Please include at least 3 scholarly articles within your response. Overall response will be formatted according to APA style and the total assignment should be between 2-4 pages not including title page and reference page.

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    h07eassignment4.docx

Analyze how performance and quality measures are aligned to the organizations mission, vision, strategic and operational plans.

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Note I have attached QI paper 1-3 with teachers comment on what to do for the following papers. Please read over and follow the instuctions below for this assignment base off of the 3 previous papers, please if you can not do assignment please do not accept assignment. It is important that I get a good grade.

 

 

Combine all four parts of the QI plan into one document, making sure to include instructor feedback. Organize the plan as you would present it to the organization’s board of directors for approval. Use the QI Plan Template as a guide.

In the QI Plan Template, complete the following:

  • Evaluate various data collection and display tools used in performance measurement.
  • Evaluate tools used to measure and report data.
  • Analyze various improvement methodologies for integrating quality improvement strategies into performance measurements.
  • Analyze the impact of information technology applications on performance measures.
  • Analyze the use of internal and external benchmarking and milestones in managing the utilization of quality indicators.
  • Evaluate criteria and tasks for developing quality improvement plans.
  • Analyze how performance and quality measures are aligned to the organizations mission, vision, strategic and operational plans.
  • Evaluate strategies for meeting regulatory and accreditation standards within health care organizations.
  • Evaluate measures used to monitor and revise quality program implementation.
  • Evaluate barriers that can interfere with the implementation of quality measures.
  • Evaluate strategies to ensure successful implementation of quality measures.

Write a 350- to 700-word executive summary related to your QI plan which includes an evaluation of the  following:

  • Evaluate the current state of QI at the organization, its organizational and operational QI structure, authority, mission, methodology, and tools used.
  • Recommend how the organization will achieve its objectives over the long term.
  • Evaluate challenges that may impact the future of health care quality improvement.
  • Evaluate effect of health care quality improvement on operational and financial performance.

Format your paper according to APA guidelines.

Cite 5 peer-reviewed, scholarly, or similar references to support your paper.

Click the Assignment Files tab to submit your QI Plan and your Executive Summary.

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    brenda_abayomi_qi_plan_part_one_1.doc

Should each department have a manager that reports to the same director?

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Discussion Question 1: Strategies to Minimize Risk

Risk can be minimized, but not eliminated. Give an example of a risk management solution being taken too far, and explain how you would judge how far is too far. Give another example of a situation where you must accept a certain level of risk because the risk cannot be controlled for any further.

 

Discussion Question 2: Risk Management and Organizational Structure

Organizations have tried several different approaches for creating an organizational structure that supports collaboration between the risk management and quality management departments. Which structure do you think would be most effective? Should the departments be combined? Should each department have a manager that reports to the same director? Is there a better alternative? Be sure to explain your answer.