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week 4 233

Unit 4 Assignment – Managed Care Reimbursement Methods

Submit Assignment

  • Due Aug 4 by 11:59pm
  • Points 100
  • Submitting a text entry box,

    a website
    url, a media recording, or a file upload

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 pts

Level 5

Identifies a creative, focused, and manageable topic clearly addressing important points.

9.0 pts

Level 4

Identifies a manageable topic that addresses important points.

8.0 pts

Level 3

Identifies a focused topic that addresses important points.

7.0 pts

Level 2

Identifies a topic that while doable, is too narrowly focused.

6.0 pts

Level 1

Identifies a topic that is far too general and wide-ranging as to be doable.

0.0 pts

Level 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 pts

Level 5

Uses in-depth information from relevant sources representing multiple points of views (3 or more) or research aspects (3 or more).

13.5 pts

Level 4

Describes in-depth information from relevant sources representing at least two points of view or research aspects.

12.0 pts

Level 3

Explains information from relevant sources representing at least two points of view or research aspects.

10.5 pts

Level 2

Relates information from relevant and irrelevant sources. No clear point of view(s) of approach(es) are identified.

9.0 pts

Level 1

Tells information from irrelevant sources representing a single point of view or does not identify points of view or approaches.

0.0 pts

Level 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 pts

Level 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 pts

Level 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 pts

Level 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 pts

Level 2

Demonstrates a limited ability in identifying a problem statement/thesis statement/topic statement or related contextual factors.

9.0 pts

Level 1

Demonstrates the ability to explain contextual factors but does not provide a defined statement.

0.0 pts

Level 0

There is no evidence of a defined statement.

15.0 pts

This criterion is linked to a Learning OutcomeAnalysisPRICE-P

15.0 pts

Level 5

Organizes and compares evidence to reveal insightful patterns, differences, or similarities related to focus.

13.5 pts

Level 4

Organizes and interprets evidence to reveal patterns, differences, or similarities related to focus.

12.0 pts

Level 3

Organizes and describes evidence according to patterns, differences, or similarities related to focus.

10.5 pts

Level 2

Organizes evidence, but the organization is not effective in revealing patterns, differences, or similarities.

9.0 pts

Level 1

Describes evidence, but it is not organized and/or is unrelated to focus.

0.0 pts

Level 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 pts

Level 5

Assembles a conclusion that is a logical interpretation from findings.

18.0 pts

Level 4

Constructs a conclusion that is logical from inquiry findings.

16.0 pts

Level 3

Identifies a conclusion specifically from and responds specifically to the findings.

14.0 pts

Level 2

Produces a general conclusion that, because it is so general, also applies beyond the scope of the inquiry findings.

12.0 pts

Level 1

States an ambiguous or unsupportable conclusion from findings.

0.0 pts

Level 0

States an illogical conclusion from findings.

20.0 pts

This criterion is linked to a Learning OutcomeLimitations and Implications

15.0 pts

Level 5

Insightfully discusses in detail relevant and supported limitations and implications.

13.5 pts

Level 4

Examines relevant and supported limitations and implications.

12.0 pts

Level 3

Discusses relevant and supported limitations and implications.

10.5 pts

Level 2

Presents relevant and supported limitations and implications.

9.0 pts

Level 1

Presents limitations and implications, but they are unsupported.

0.0 pts

Level 0

Presents limitations and implications, but they are irrelevant.

15.0 pts

This criterion is linked to a Learning OutcomeWriting

5.0 pts

Level 5

The paper exhibits an excellent command of written English languageconventions. The paper has no errors in mechanics, grammar, or spelling.

4.5 pts

Level 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 pts

Level 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 pts

Level 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 pts

Level 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 pts

Level 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 pts

Level 5

The required APA elements are all included with correct formatting, including in-text citations and references.

4.5 pts

Level 4

The required APA elements are all included with minor formatting errors, including in-text citations and references.

4.0 pts

Level 3

The required APA elements are all included with multiple formatting errors, including in-text citations and references.

3.5 pts

Level 2

The required APA elements are not all included and/or there are major formatting errors, including in-text citations and references.

3.0 pts

Level 1

Several APA elements are missing. The errors in formatting demonstrate limited understanding of APA guidelines, in-text-citations, and references.

0.0 pts

Level 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

 
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