Managed Care Reimbursement Methods Discussion
Managed Care Reimbursement Methods Discussion
Unit 4 Assignment – Managed Care Reimbursement Methods
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Due Aug 4 by 11:59pm
Points 100
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Managed care is a system of health care delivery that aims to provide a generalized structure and focus when managing the use, access, cost, quality, and effectiveness of health care services. There are various ways in which the managed care organization reimburses hospitals for their services. Examples of Managed Care Reimbursement Methods include the following:
Percent-of-charge payment
Per diem payment
Case rate payment (DRGs and MS-DRGs)
Ambulatory Patient Grouper (APG)
Ambulatory Payment Classification (APCs)
Other types of reimbursement (carve-out, stop-loss, and withhold pools)
Instructions
Create a Venn Diagram (with a minimum of 4 points) to compare and contrast two of the Managed Care Reimbursement methods listed above.
Review the video “How to Create a Venn Diagram in Word and PowerPoint” in Supplemental Resources prior to completing this part of the assessment.
Summarize your findings in a one-page paper. In your summary, explain how each method is different and provide an example of when it is appropriate for an organization to use each method.
Submit both parts of this assessment in the same document.
Rubric
Unit 4 Assignment – Managed Care Reimbursement Methods
Unit 4 Assignment – Managed Care Reimbursement Methods
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeTopic
10.0 ptsLevel 5
Identifies a creative, focused, and manageable topic clearly addressing important points.
9.0 ptsLevel 4
Identifies a manageable topic that addresses important points.
8.0 ptsLevel 3
Identifies a focused topic that addresses important points.
7.0 ptsLevel 2
Identifies a topic that while doable, is too narrowly focused.
6.0 ptsLevel 1
Identifies a topic that is far too general and wide-ranging as to be doable.
0.0 ptsLevel 0
Does not clearly identify a topic or identifies a topic that is not relevant to the assignment.
10.0 pts
This criterion is linked to a Learning OutcomeExisting Knowledge, Research, and/or Views
15.0 ptsLevel 5
Uses in-depth information from relevant sources representing multiple points of views (3 or more) or research aspects (3 or more).
13.5 ptsLevel 4
Describes in-depth information from relevant sources representing at least two points of view or research aspects.
12.0 ptsLevel 3
Explains information from relevant sources representing at least two points of view or research aspects.
10.5 ptsLevel 2
Relates information from relevant and irrelevant sources. No clear point of view(s) of approach(es) are identified.
9.0 ptsLevel 1
Tells information from irrelevant sources representing a single point of view or does not identify points of view or approaches.
0.0 ptsLevel 0
Information is irrelevant to the topic. No clear point of view/approaches.
15.0 pts
This criterion is linked to a Learning OutcomeContent
15.0 ptsLevel 5
Demonstrates the ability to construct a clear and insightful problem statement/thesis statement/topic statement with evidence of all relevant contextual factors.
13.5 ptsLevel 4
Demonstrates the ability to construct a problem statement, thesis statement/topic statement with evidence of most relevant contextual factors, and problem statement is adequately detailed.
12.0 ptsLevel 3
Begins to demonstrate the ability to construct a problem statement/thesis statement/topic statement with evidence of most relevant contextual factors, but problem statement is superficial.
10.5 ptsLevel 2
Demonstrates a limited ability in identifying a problem statement/thesis statement/topic statement or related contextual factors.
9.0 ptsLevel 1
Demonstrates the ability to explain contextual factors but does not provide a defined statement.
0.0 ptsLevel 0
There is no evidence of a defined statement.
15.0 pts
This criterion is linked to a Learning OutcomeAnalysisPRICE-P
15.0 ptsLevel 5
Organizes and compares evidence to reveal insightful patterns, differences, or similarities related to focus.
13.5 ptsLevel 4
Organizes and interprets evidence to reveal patterns, differences, or similarities related to focus.
12.0 ptsLevel 3
Organizes and describes evidence according to patterns, differences, or similarities related to focus.
10.5 ptsLevel 2
Organizes evidence, but the organization is not effective in revealing patterns, differences, or similarities.
9.0 ptsLevel 1
Describes evidence, but it is not organized and/or is unrelated to focus.
0.0 ptsLevel 0
Lists evidence, but it is not organized and/or is unrelated to focus.
15.0 pts
This criterion is linked to a Learning OutcomeConclusion
20.0 ptsLevel 5
Assembles a conclusion that is a logical interpretation from findings.
18.0 ptsLevel 4
Constructs a conclusion that is logical from inquiry findings.
16.0 ptsLevel 3
Identifies a conclusion specifically from and responds specifically to the findings.
14.0 ptsLevel 2
Produces a general conclusion that, because it is so general, also applies beyond the scope of the inquiry findings.
12.0 ptsLevel 1
States an ambiguous or unsupportable conclusion from findings.
0.0 ptsLevel 0
States an illogical conclusion from findings.
20.0 pts
This criterion is linked to a Learning OutcomeLimitations and Implications
15.0 ptsLevel 5
Insightfully discusses in detail relevant and supported limitations and implications.
13.5 ptsLevel 4
Examines relevant and supported limitations and implications.
12.0 ptsLevel 3
Discusses relevant and supported limitations and implications.
10.5 ptsLevel 2
Presents relevant and supported limitations and implications.
9.0 ptsLevel 1
Presents limitations and implications, but they are unsupported.
0.0 ptsLevel 0
Presents limitations and implications, but they are irrelevant.
15.0 pts
This criterion is linked to a Learning OutcomeWriting
5.0 ptsLevel 5
The paper exhibits an excellent command of written English languageconventions. The paper has no errors in mechanics, grammar, or spelling.
4.5 ptsLevel 4
The paper exhibits a good command of written English language conventions. The paper has no errors in mechanics or spelling with minor grammatical errors that impair the flow of communication.
4.0 ptsLevel 3
The paper exhibits a basic command of written English language conventions. The paper has minor errors in mechanics, grammar, or spelling that impact the flow of communication.
3.5 ptsLevel 2
The paper exhibits a limited command of written English language conventions. The paper has frequent errors in mechanics, grammar, or spelling that impede the flow of communication.
3.0 ptsLevel 1
The paper exhibits little command of written English language conventions. The paper has errors in mechanics, grammar, or spelling that cause the reader to stop and reread parts of the writing to discern meaning.
0.0 ptsLevel 0
The paper does not demonstrate command of written English language conventions. The paper has multiple errors in mechanics, grammar, or spelling that cause the reader difficulty discerning the meaning.
5.0 pts
This criterion is linked to a Learning OutcomeAPAPRICE-I
5.0 ptsLevel 5
The required APA elements are all included with correct formatting, including in-text citations and references.
4.5 ptsLevel 4
The required APA elements are all included with minor formatting errors, including in-text citations and references.
4.0 ptsLevel 3
The required APA elements are all included with multiple formatting errors, including in-text citations and references.
3.5 ptsLevel 2
The required APA elements are not all included and/or there are major formatting errors, including in-text citations and references.
3.0 ptsLevel 1
Several APA elements are missing. The errors in formatting demonstrate limited understanding of APA guidelines, in-text-citations, and references.
0.0 ptsLevel 0
There is little to no evidence of APA formatting and/or there are no in-text citations and/or references.
5.0 pts
Total Points: 100.0
Managed Care Reimbursement Methods Discussion
