HA565 Types of Health Insurance Project
Order ID |
53563633773 |
Type |
Essay |
Writer Level |
Masters |
Style |
APA |
Sources/References |
4 |
Perfect Number of Pages to Order |
5-10 Pages |
Description/Paper Instructions
HA565 Types of Health Insurance Project
HA565, Types, Health, Insurance, Project
Glandon, G. L., Slovensky, D. J., & Smaltz, D. H. (2014). Information Systems for Healthcare Management. Chicago, IL: Health Administration Press. Chapter 13 “HIT Value Analysis”
Brown, G. D., Pasupathy, K. S., & Patrick, T. B. (2012). Health Informatics: A Systems Perspective. Chicago, Ill: Health Administration Press. Chapter 14 “Strategic Valuation of Enterprise Information Technology Architecture”
Bullard, K. L. (2016). Cost-Effective Staffing for an EHR Implementation. Nursing Economic$, 34(2), 72-76.
In not less than 200 respond
Imagine you are employed as an account professional in a health care organization. Which type of health insurance do you feel would be the most challenging to submit for reimbursement and in obtaining cooperation in obtaining payment?
In two different paragraphs using their references give your personal opinion to Samantha Thompson and Marivette Bedoya
Marivette Bedoya
There are many different types of insurance plans, HMO, PPO, POS, and EPO, all of these are managed healthcare plans. Each type of health insurance plan will offer different options to obtain services, these services are obtained through a network (Horvath, 2019).
The health insurance network or service providers associated with your plan can make a difference for you because it may limit which doctors you can visit, or where you can get service.
Managed care plans work better for the individual person because in the long run they are more cost effective. Indemnity/reimbursement plans will usually see more out-of-pocket charges (deductibles and co-payments) and they many times place caps on the number of benefits you can receive over the course of your lifetime.
Indemnity plans give you more freedom or flexibility, than managed care plans do in terms of using the healthcare provider of your choosing. So, depending on what a person wants, the choice between managed care and indemnity plans ultimately depends on your personal circumstances and preferences. If your goal is to minimize costs, you’re probably better off with a managed care plan.
References:
Horvath, S. (2019, October 1). What is Health Insurance? Retrieved from https://www.benzinga.com/money/what-is-health-insurance/
Samantha Thompson
The following are the top 3 reasons that a practice doesn’t get paid for services performed.
“The patient isn’t eligible for the service provided. With the changing landscape of health insurance coverage, individuals and employees change insurance frequently, or key items in their coverage are excluded by their new plan. Demographic or other identifying information for the patient is missing or incorrect; this includes the spelling of the patient’s name, their exact address, Social Security number, and birth date, among other data.
The codes and modifiers on the claim form do not conform to the requirements of the patient’s insurance plan” (Medscape,2020). I believe that getting reimbursement from State covered insurance (Medicaid) is the most difficult. Medicaid has its own rules on what it deems medically necessary.
Many times, there is a formulary that dictates the way the person needs to be treated and that doesn’t sit well with the doctors because they have their own plan of care. However, if the doctor deviates from the State mandated plan to prove that their plan is the correct course of action, Medicaid will not pay and the patient is stuck with the hefty bill or the practice has to write the services off.
References:
Medscape, (2020). Collecting Effectively through Third Party Payers and Patients. Retrieved from: https://www.medscape.com/courses/section/870036
RUBRIC
QUALITY OF RESPONSE |
NO RESPONSE |
POOR / UNSATISFACTORY |
SATISFACTORY |
GOOD |
EXCELLENT |
Content (worth a maximum of 50% of the total points) |
Zero points: Student failed to submit the final paper. |
20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. |
30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. |
40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. |
50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. |
Use of Sources (worth a maximum of 20% of the total points). |
Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. |
5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. |
10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. |
15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. |
20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. |
Grammar (worth maximum of 20% of total points) |
Zero points: Student failed to submit the final paper. |
5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors |
10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors |
15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. |
20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. |
Structure of the Paper (worth 10% of total points) |
Zero points: Student failed to submit the final paper. |
3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. |
5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper |
7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. |
10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. |
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