IntroductionReimbursement for services rendered by providers (physicians, physician assistants, and other providers) is generally made under one of two payment types: fee-for-service or episode of care reimbursement. Fee-for-service methodology is based on the premises that providers receive payment for each service rendered and is based on a set amount or price for each service. Included in this methodology are self-pay payments, retrospective payments, and managed care contracts.Under the episode of care methodology, providers receive one lump sum for all services provided related to a given condition or disease. Understanding each method of payment, its benefits and drawbacks, as well as its impact on cost control and resource utilization is important for those working in the health industry, as reimbursement impacts many decisions made about budgets, forecasts, strategy, and service line capacities.In this assessment, you will demonstrate your understanding of various reimbursement options within the context of a new patient consult. For this assessment, assume the role of a reimbursement specialist for a large primary care office. While you are aware that your providers are reimbursed in several different ways, the providers are uncertain as to what each reimbursement type means for the practice in terms of collections. They have requested that you outline the different reimbursement options to which the practice is subject for the providers in the group.Demonstration of ProficiencyBy successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:Competency 1: Compare current trends and traditional methods of payment in the health care industry.Explain payment options for uninsured patients, including how the patient would qualify for each option.Competency 2: Assess health care reimbursement.Describe drawbacks of the fee-for-service reimbursement model.Describe drawbacks of the capitation reimbursement model as it relates to providing comprehensive services.Describe how pay-for-performance impacts reimbursement rates.Describe how resource-based relative value scale or case-based payment encourages an overuse of services.Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with the expectations of health care professionals.Adhere to the rules of grammar, usage, and mechanics.Apply APA formatting to in-text citations and references.InstructionsThis assessment is based on the following scenario:Patient scenario: Your office is seeing a new patient for the first time (new patient consults are $500). In your role as the reimbursement specialist for a large primary care office, outline the different reimbursement options to which the practice is subject for the providers in the group.Support your assertions with at least three academic sources. This may require you to do additional independent research. You may wish to consult the Health Care Administration Undergraduate Library Research Guide before you begin any additional research.This assessment has two parts.Part 1: Provider Reimbursement OptionsPresent (at least) the four main reimbursement options that your provider in the scenario would likely have for a new patient consult. Describe the options and comment on potential drawbacks or additional considerations to take into account with each model. Also, consider the likelihood and challenges of recouping the entirety of the consult charges for the patient.Relevant scoring guide criteria:Describe drawbacks of the fee-for-service reimbursement model.“Describe” means to give an account in words of (someone or something), including all the relevant characteristics, qualities, or events.Describe drawbacks of the capitation reimbursement model as it relates to providing comprehensive services.Describe how pay-for-performance impacts reimbursement rates.Describe how resource-based relative value scale or case-based payment encourages an overuse of services.Adhere to the rules of grammar, usage, and mechanics.“Grammar” refers to the basic rules for how sentences are constructed and how words combine to make sentences (for example, word order, case, and tense).“Usage” refers to correct word choice and phrasing, particularly with regard to the meanings of words and phrases.“Mechanics” refers to correct use of capitalization, punctuation, and spelling.Apply APA formatting to in-text citations and references.Be sure to include a separate References page.One potential way to organize this part would be as follows:Fee-for-service.What is it?Consider health care spending and cost control; what are the drawbacks of this model?Capitation.What is it?What are the potential drawbacks of this model for the physicians who are driven to provide comprehensive services to their patients?Pay for performance.What is it?How does this model impact reimbursement rates?Resource-based relative value scale or case-based payment.What is it?How can this model potentially encourage an overuse of services?Part 2: Payment Options for Uninsured PatientsIdentify and explain the potential payment options that would be available to the patient and your care provider if the patient in for the new patient consult had been uninsured. Also, be sure to discuss the ways that a patient could qualify for specific payment options, as well as the rationale for the associated appointment charge.Relevant scoring guide criteria:Explain payment options for uninsured patients, including how the patient would qualify for each option.“Explain” means to make (an idea, situation, or problem) clear to someone by describing it in more detail or revealing relevant facts or ideas.Adhere to the rules of grammar, usage, and mechanics.Apply APA formatting to in-text citations and references.One potential way to organize this part would be:Medicaid.How does the patient qualify?Financing options.What is this method?Self-pay.How would the patient be charged? A percentage of commercial contracts or a percentage of Medicare?Charity care.How would you screen a patient for charity care?What process would you implement to qualify a patient for charity care?Additional Submission RequirementsStructure: Use the Reimbursement Options template [DOC] provided. Include a title page and references page when submitting your assessment.Length: 3–5 pages, plus title and references pages.References: Cite at least three current scholarly or professional resources.Your textbook can be one of the three.Format: Use APA style for references and citations only. Refer to:APA Style Paper Tutorial [DOCX].Additional APA resources located in the courseroom navigation panel.Font: Times New Roman font, 12 point, double-spaced.SCORING GUIDEUse the scoring guide to understand how your assessment will be evaluated.VIEW SCORING GUIDECRITERIANON-PERFORMANCEBASICPROFICIENTDISTINGUISHEDDescribe drawbacks of the fee-for-service reimbursement model.Does not identify any drawbacks of the fee-for-service reimbursement model.Attempts to describe drawbacks of the fee-for-service reimbursement model, but the description is inaccurate or incomplete.Describes drawbacks of the fee-for-service reimbursement model.Explains drawbacks of the fee-for-service reimbursement model, including the likelihood and challenges of recouping the entirety of the consult charges for the patient.Describe drawbacks of the capitation reimbursement model as it relates to providing comprehensive services.Does not identify any drawbacks of the capitation reimbursement model as it relates to providing comprehensive services.Attempts to describe drawbacks of the capitation reimbursement model as it relates to providing comprehensive services, but the description is inaccurate or incomplete.Describes drawbacks of the capitation reimbursement model as it relates to providing comprehensive services.Explains drawbacks of the capitation reimbursement model as it relates to providing comprehensive services, including the likelihood and challenges of recouping the entirety of the consult charges for the patient.Describe how pay-for-performance impacts reimbursement rates.Does not identify how pay-for-performance impacts reimbursement rates.Attempts to describe how pay-for-performance impacts reimbursement rates, but the description is inaccurate or incomplete.Describes how pay-for-performance impacts reimbursement rates.Explains how pay-for-performance impacts reimbursement rates, including examples supported by citations to professional or scholarly literature.Describe how resource-based relative value scale or case-based payment encourages an overuse of services.Does not attempt to identify how resource-based relative value scale or case-based payment encourages an overuse of services.Attempts to describe how resource-based relative value scale or case-based payment encourages an overuse of services, but the description is inaccurate or incomplete.Describes how resource-based relative value scale or case-based payment encourages an overuse of services.Explains how resource-based relative value scale or case-based payment encourages an overuse of services and provides specific examples and sources.Explain payment options for uninsured patients, including how the patient would qualify for each option.Does not attempt to describe payment options for uninsured patients.Attempts to describe payment options for uninsured patients, but the description is inaccurate or incomplete.Explains payment options for uninsured patients, including how the patient would qualify for each option.Explains payment options for uninsured patients, including how the patient would qualify for each option, and provides examples and relevant resources to support the examples.Adhere to the rules of grammar, usage, and mechanics.Does not adhere to the rules of grammar, usage, and mechanics.Errors in grammar, usage, and mechanics inhibit readability and comprehension and detract from good scholarship.Adheres to the rules of grammar, usage, and mechanics.Exhibits strict and nearly flawless adherence to the rules of grammar, usage, and mechanics.Apply APA formatting to in-text citations and references.Does not apply APA formatting to in-text citations and references.Applies APA formatting to in-text citations and references incorrectly or inconsistently, detracting noticeably from good scholarship.Applies APA formatting to in-text citations and references.Exhibits strict and nearly flawless adherence to APA formatting of in-text citations and references.

Organizational AssessmentGoal:To analyze an organizational chart.I am and Icu nurse Content Requirements:Identify the type of organizational structure.From the organizational chart, discusses the various lines of communication and reporting. Identify what you have observed to be the formal and informal reporting lines; who the real leaders in this organization are; and issues of power and control. Describe how social and cultural influences of your community are integrated into the delivery of care in your organizationDescribe how generational differences influence organizational culture.Incorporate the organization’s mission, vision and strategic plan; including what the future looks like for the organization.Discuss how nursing fits into the organization, both now and into the future.Submission Instructions:The paper is to be clear and concise, and students will lose points for improper grammar, punctuation and misspelling.The paper is to be 3 - 4 pages in length, excluding the title, abstract and references page.Incorporate a minimum of 2 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.Journal articles and books should be referenced according to current APA style (the library has a copy of the APA Manual).Your paper should be formatted per current APA and references should be current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions)

NEED REVISIONApply leadership principles and decision making in the provision of quality nursing care and healthcare team coordination.Demonstrate a basic understanding of organizational structure, mission, vision, philosophy, and values.Utilize an iterative cycle of clinical judgment, including prioritization and delegation.Demonstrate professionalism and civility.REFLECTIVE QUESTIONSHow do your leadership and management attributes influence your professional identity and clinical judgment?How would your preceptor describe your leadership and management attributes?How did you feel about using the clinical judgment model in the practicum setting?Feedback from instructor :Reflection 5 – Professional Development this was such a fun reflection to read because it encompasses some of the most central themes of our nursing profession. I believe this is one of the defining principles that make nursing a profession over an occupation. Of course, there are several elements to discern the difference, but seeing you thread in these concepts is so critical. I can’t wait to see what additions you make and share further on your immersion with your preceptor based on my added questions below. I create these questions to help further develop your thinking on how these core statements truly cultivate your leadership practice. This module has us focus on developing our unique professional nursing identity while using clinical judgment for sound approaches. The red feedback below is the areas I need you to expand upon to pass the reflection, whereas the green feedback you passed. When you make your edits, please do so in a new color, so it is easy for us both to identify your growth. Activity Statements and Reflection QuestionsCriterion 1: Apply leadership principles and decision making in the provision of quality nursing care and healthcare team coordination.How did you see leadership principles impact decisions around quality nursing care?Can you further explain a solid example from practice? Check out this great article: https://drive.google.com/open?id=1BTZjvG515l7LbBPRinlO4xrn1FxurI9eHow did you see leadership principles impact healthcare team coordination?Did you see an example where your mentor coordinated care using a leadership principle? Indeed, the patient is central to this process. Check out this article for support: https://drive.google.com/open?id=1plDYJc7BkdXMoUK-01BiribGMto1iSuuCriterion 2: Demonstrate a basic understanding of the organizational structure, mission, vision, philosophy, and values.AWESOME job addressing each of the elements- these sometimes can be hard to find!! THANK YOU for your hard work on this. This is a wonderful article to read on this: https://drive.google.com/open?id=1Om-7AXVypyjhxXvlznIj1aGiuDBc2QjFDid you see any of these elements within your immersion or daily practice? If so, please describe which ones and how they were present.Thank you!! I see your examples above. Check out this great article: http://images.healthcare.pressganey.com/Web/PressGaneyAssociatesInc/%7B275e266e-efd1-46f3-b5d4-d88b659e8c40%7d_2018_pg_px_white_paper.pdCriterion 3: Utilize an iterative cycle of clinical judgment, including prioritization and delegation.How did you feel about using the clinical judgment model in the practicum setting?Great job sharing your experience on this topic. Check out this great article: https://drive.google.com/open?id=1rE3pEfDc_qE8B53Oh16c_NDRkXIZ7zny How did you see it impact prioritization?This is a strong example of the importance of prioritization. Awesome job. Check out this article that goes over the importance of prioritization: https://drive.google.com/open?id=1-ApSQaYYVDB-yj-j5E1Gjik9mrhL0hYk How did you see it impact delegation?Can you share an example where you delegated as a leader or saw your preceptor delegate? Check out this great article for further information to support this topic: https://drive.google.com/open?id=1_AjyBfXz8K8LEQvbYcGIVNPHxQazeLHtCriterion 4: Demonstrate professionalism and civility.How did you specifically use professionalism with this immersion? Please provide a solid example from your preceptorship.These are solid examples. I want you to build off of these now as you continue on your leadership journey and carve in specific professional attributes you wish to see in a nurse leader. Kudos!! This is an older article but still one of the best ones on cultivating professionalism: https://drive.google.com/open?id=1EcnBPNhNevZpEYqWFwmBJwnXW1Ssejpy How did you demonstrate civility within this immersion? Please explain an experience related to civility that you saw in your leadership immersion.Can you share an example of civility being present in the selected setting? Your preceptor would be a great resource on this and could share their experiences. I hope after further expanding on your above ideas, you will see your professional nurse leader identity emerging and growing through these rich immersions. As always, please reach out, and we can have a scholarly conversation to continue your growth as a nurse leader!!