Health Care Reimbursement Training Plan

NUR-621 Health Care Reimbursement Training Plan

Health Care Reimbursement Training Plan

Health Care Reimbursement Training Plan





Enhancing Effectiveness


Health Care Reimbursement Training
Training Summary and Focus In the nursing profession, attaining competency is an essential part of the health care system. Professional skills are required in the health care system to optimize the quality of health care services. Enhancing the effectiveness of the workers implies that this training would focus on addressing how nurses can enhance their effectiveness in care through financial reimbursements obtained from Medicaid and Medicare, and private insurance programs (Oliver et al., 2020). These skills play an essential role in the health care system in the US as it defines the primary objective of the US health care system (Penner, 2017).
Specific Learning Target(s)/Objectives Objective 1: Explaining Public Insurance to nurses

The need to improve the health care delivery method while reducing the cost of health care has compelled the US government to develop a financial system that takes care of the health care costs. The programs developed by the US government include Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) (Altman & Frist, 2015). These programs are essential in the performance of major health care activities in the US. Besides, they have an impact on the taxpayers because of the budget allocation made by the government of these programs each financial year. The three major health care programs insure citizens at different levels. For instance, Medicare is the insurance cover for older people above 65 years in the US, while Medicaid and young adults generate while CHIP is for children across the US.

Objective 2: Risks and Uncertainties when working with healthcare reimbursements.

The effectiveness of the health care system in the US comes from public and private reimbursements. However, these types of health reimbursement come with varying levels of uncertainties. The process of healthcare reimbursement comes in two different forms. The first category is private players that entails an employer-based cover and personal purchased insurance. The private providers require a deductible that can reimburse funds directly to the provider. The second category is the public players representing Medicare Medicaid, representing 25 percent of all the US health care systems. Each insurer, either public or private, has regulations that affect their cover.

Training Outline The training will focus on how the public insurance programs are designed to facilitate value-based care on increasing quality and reducing the cost of health care (Garrison & Towse, 2017).

Training objectives for Medicaid Program

This program supports the ACA act that aids in expanding health coverage to all US citizens to receive better health care. The need to meet the expansion of health care efforts to many people and in areas that have not experienced this program is a mission of the government to reduce cost and increase the accessibility of health care.

Training objective on Medicare program

The program offers plans for outpatient services and inpatient services. The program focuses on value-based care and transformation to other alternative payments methods. The program focuses on under bundled payment methods to reduce cost.

Resources, Materials, Equipment, and Technology This training will use various instructional materials such as presentation, content, and delivery system.

The instructional materials proposed for use in this training will be written and demonstrated using visual aids to heighten the trainees’ understanding.

The technology applied in training nurses will involve Electronic Medical Records (EMRs), medical supplies, and computers.

References Altman, D., & Frist, W. H. (2015). Medicare and Medicaid at 50 years: perspectives of beneficiaries, health care professionals and institutions, and policymakers. Jama314(4), 384-395. doi:10.1001/jama.2015.7811

Garrison, L. P., & Towse, A. (2017). Value-based pricing and reimbursement in personalized healthcare: introduction to the basic health economics. Journal of Personalized Medicine7(3), 10.

Oliver, T. L., Qi, B. B., Shenkman, R., Diewald, L., & Smeltzer, S. C. (2020). Weight sensitivity training among undergraduate nursing students. Journal of Nursing Education59(8), 453-456.

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders. Springer Publishing Company.

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Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be

Health Care Reimbursement Training Plan

Health Care Reimbursement Training Plan

at least 250 words.

Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.

One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.

I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.

In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).

Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).

Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.

I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.

As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.

It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.


Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.