Government-sponsored health plans
answer the following questions in full detail and answer by letter
A. Discuss the components of each of the following insurance plans:
• Fee for service (indemnity) plans
• Managed care plans
• High-deductible health plans/healthcare savings accounts
B. Discuss the restrictions of each of the following insurance plans:
• Fee for service (indemnity) plans
• Managed care plans
• Government-sponsored health plans (i.e., Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP), Military/TRICARE, Indian Health Service).
• High-deductible health plans/healthcare savings accounts
C. Discuss the reimbursement process for each of the following insurance plans:
• Fee for service (indemnity) plans
• Managed care plans
• Government-sponsored health plans (i.e., Medicaid, State Children’s Health Insurance Program (SCHIP), Military/TRICARE, Indian Health Service).
• High-deductible health plans/healthcare savings accounts
D. Discuss the inpatient and outpatient reimbursement processes for Medicare.
F. Analyze the impact the Recovery Demonstration Project had on Medicare and Medicaid.
G. Analyze the impact of anti-kickback statutes of both Stark II and the Medicare and Medicaid Program Protection Act of 1987 on healthcare providers.
H. Discuss how third-party payment calculations impact healthcare reimbursement in healthcare organizations.
I. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.
RUBRIC
A. COMPONENTS OF INSURANCE PLANS:
| NOT EVIDENT
A discussion is not provided. |
APPROACHING COMPETENCE
The discussion contains some inaccuracies about the components of each of the given insurance plans, or the discussion lacks key details about each plan. |
COMPETENT
The discussion is logical and correctly details the components of each of the given insurance plans. |
B. RESTRICTIONS OF INSURANCE PLANS:
| NOT EVIDENT
A discussion is not provided. |
APPROACHING COMPETENCE
The discussion contains some inaccuracies about the restrictions of each of the given insurance plans, or does not discuss the restrictions for each of the given insurance plans. |
COMPETENT
The discussion is logical and accurately discusses the restrictions of each of the given insurance plans. |
C. REIMBURSEMENT PROCESS:
| NOT EVIDENT
A discussion is not provided. |
APPROACHING COMPETENCE
The discussion of the reimbursement process for each of the given insurance plans contains some inaccuracies or the reimbursement process is not discussed for each of the given insurance plans. |
COMPETENT
The discussion for each of the given insurance plans accurately addresses the reimbursement process with key details about each process. |
D. MEDICARE REIMBURSEMENT PROCESS:
| NOT EVIDENT
A discussion is not provided. |
APPROACHING COMPETENCE
The discussion of the inpatient and outpatient reimbursement processes contains some inaccuracies or either the inpatient or outpatient reimbursement process is not provided. |
COMPETENT
The discussion accurately addresses both the inpatient and outpatient reimbursement processes for Medicare. |
E. IMPACT OF MEDICARE AND MEDICAID PATIENT AND PROGRAM PROTECTION ACT:
| NOT EVIDENT
An analysis is not provided. |
APPROACHING COMPETENCE
The analysis of the impact of the Medicare and Medicaid Patient and Program Protection Act of 1987 on Medicare and Medicaid is illogical or poorly supported. |
COMPETENT
The analysis of the impact of the Medicare and Medicaid Patient and Program Protection Act of 1987 on Medicare and Medicaid is logical and well supported. |
F. IMPACT OF RECOVERY DEMONSTRATION PROJECT:
| NOT EVIDENT
An analysis is not provided. |
APPROACHING COMPETENCE | COMPETENT
The analysis of the impact of the Recovery Demonstration Project is logical and well supported. |
G. ANTI-KICKBACK STATUTES:
| NOT EVIDENT
An analysis is not provided. |
APPROACHING COMPETENCE
The analysis of the impact of the anti-kickback statutes on either the Stark II or Medicare and Medicaid Program Protection Act of 1987 on healthcare providers is illogical or poorly supported. |
COMPETENT
The analysis of the impact of anti-kickback statutes on both Stark II and the Medicare and Medicaid Program Protection Act of 1987 on healthcare providers is logical and well-supported. |
H. THIRD-PARTY PAYMENT CALCULATIONS:
| NOT EVIDENT
A discussion is not provided. |
APPROACHING COMPETENCE
The discussion contains inaccuracies about how third-party payment calculations impact healthcare reimbursement in healthcare organizations. |
COMPETENT
The discussion accurately addresses how third-party payment calculations impact healthcare reimbursement in healthcare organizations. |
I. APA SOURCES:
| NOT EVIDENT
The submission does not include in-text citations and references according to APA style for content that is quoted, paraphrased, or summarized. |
APPROACHING COMPETENCE
The submission includes in-text citations and references for content that is quoted, paraphrased, or summarized but does not demonstrate a consistent application of APA style. |
COMPETENT
The submission includes in-text citations and references for content that is quoted, paraphrased, or summarized and demonstrates a consistent application of APA style. |
PROFESSIONAL COMMUNICATION:
| NOT EVIDENT
Content is unstructured, is disjointed, or contains pervasive errors in mechanics, usage, or grammar. Vocabulary or tone is unprofessional or distracts from the topic. |
APPROACHING COMPETENCE
Content is poorly organized, is difficult to follow, or contains errors in mechanics, usage, or grammar that cause confusion. Terminology is misused or ineffective. |
COMPETENT
Content reflects attention to detail, is organized, and focuses on the main ideas as prescribed in the task or chosen by the candidate. Terminology is pertinent, is used correctly, and effectively conveys the intended meaning. Mechanics, usage, and grammar promote accurate interpretation and understanding. |
Answer preview
Managed-care plans operate in network restrictions with users receiving services only from limited providers. The use of this plan requires a selection of the providers in a specific specialty to regulate the services received. A well-defined, organized system is mandated to provide health services to the beneficiaries (Kongstvedt, 2019). State policies require all the providers who meet the selection criteria to have an opportunity for participation in the plan.
Government-Sponsored Health Plans
Each of the individual healthcare plans sponsored by the government has restrictions on eligibility. Individuals eligible for Medicare plans include those above 65years, young with disabilities, and those in end-stage renal disease (Smith et al., 2003). Individuals are also eligible for social security. Medicaid is available to many poor people who require special healthcare needs.
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Government-sponsored health plans
