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Healthcare Payment Systems & Business Structure Discussion

Healthcare Payment Systems & Business Structure Discussion

Healthcare Payment Systems & Business Structure Discussion

Part 1

Discussion Prompt 1-3 Paragraphs
Complete the Week 4 discussion prompt.

What is the difference between the reimbursement cycle in most healthcare facilities and the coding process in long-term care facilities such as nursing homes or home health?

Support your ideas with at least one scholarly source other than your text, and use terminology you learned this week. Cite and reference your sources using APA Style.


Part 2 (Please Separate this part to a different Word Document)

Week 4 Assignment: Mini Paper on Healthcare Business Structure and Payments

Objective: Apply knowledge of business structure and payment systems.

Choose one of the business types discussed last week and create a fictitious healthcare organization. Think about whether the business would be a sole proprietorship, a partnership, etc., and how patients might pay for services. Submit a paper about the organization, including its structure, the insurance and payment types accepted, and the patient mix. Keep in mind that even though the business is fictitious, all elements must work together realistically so that it could actually function.

The business structure types are:

  • Sole proprietor partnership
  • Limited liability company
  • Limited liability partnership
  • C corporation, S corporation, or not-for-profit corporation
  • Professional corporation

Patient mix refers to patient age ranges, types of treatment required, and, importantly, how the patient pays for the services such as:

  • Out-of-pocket insurance
  • Medicare
  • Medicaid
  • Tricare
  • Veterans administration

Below is an example of a fictitious healthcare organization description. Begin your paper with this information and then elaborate and explain how all of the pieces would function together to keep the business running.

Campbell Long-Term Care is a not-for-profit sole proprietorship facility. The building has 60 beds, and is split into two sections. In one part of the building, the facility takes patients who are in rehabilitation under private insurance or out-of-pocket. There are also ten patients who received outpatient rehabilitation under Medicare Part B. The other half of the building is reserved for senior patients needing long-term care services who are mainly covered under Medicare Part A. Some patients also have private insurance or pay out-of-pocket. The building is specialized to provide ventilator machines, a service that is covered under Medicare Part A, for patients who require that service.

Other examples could describe an OB/GYN practice, or a children’s pediatric group.

Submit a one- to two-page paper in APA Style, including a title page and a reference list. You must cite and reference at least two sources. You may use your textbook as a source.

You will also create a Panopto video summarizing and explaining your business (not reading your paper) to upload for your week 5 discussion board. Look ahead to the discussion board for details, and plan your time accordingly so that you can post your video on time!


*****(Below is just for FYI, I will be posting next week)*****

Week 5 Assignment: Filing Insurance Claims Infographic

Objective: Teach employees of a hospital billing and coding department how to accurately file a Medicare insurance claim.


After you read the chapters assigned this week, create an infographic on the topic of filing insurance claims to present to new employees of a hospital billing and coding department. In turn, the employees will use the same information to answer billing questions from community members.

The information should be presented in a way that is easy for community members to follow, but it must also be accurate and thorough. Do not oversimplify to the point of losing valuable information.

Use APA Style. You must cite and reference at least one source on your infographic. Submit your assignment as a PDF.


8 Helpful Resources for Creating Beautiful Infographics

Visit this website to explore popular infographic tools. You do not need to purchase anything. Many resources include free trials or free limited versions. Review the terms carefully so that you are able to download and save your work.

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