Prepare a presentation for new hire orientation that addresses the organization's three types of revenue sources: Medicaid, Medicare, and managed care. For each revenue source, explain the purpose of the program, how the organization is reimbursed, and the benefits of the program.

Introduction: Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in sequence.

Healthcare finance has changed dramatically with the advent of the Affordable Care Act (ACA) in 2010. Its effects continue to impact organizations and individuals. The healthcare industry has transitioned to a unique and complex entity as a result of the ACA's legal and regulatory ramifications. The shift in delivery systems requires healthcare leaders to possess new skill sets (Office of the Legislative Counsel, 2010).

Healthcare leaders at all levels within an organization must be comfortable with financial statements and basic accounting principles. As an early careerist, you may be involved in conversation to evaluate existing and new healthcare service lines. You may be asked to participate in various financial activities, such as team budgeting activities and development of a departmental budget. As a mid or advanced careerist, you may be evaluating higher-level organization financing options, determining cash flow needs, or presenting financial information to the CEO and board.

Finally, one of the number one things that you will do as a healthcare leader is manage expenses. There are many variables to managing expenses in healthcare, from managing fixed assets, payroll and capital expenses. You will look at the classifications of expenses and costs, and review depreciation and how that is calculated. You will also review the difference between variable and fixed costs in healthcare and how those can be managed effectively.

Regardless of your position within the organization, understanding healthcare finance is a critical success factor for effective and responsible healthcare leadership.

Reference

Office of the Legislative Counsel. (2010). Compilation of patient protection and Affordable Care Act. http://housedocs.house.gov/energycommerce/ppacacon.pdf

Scenario: Sustainable healthcare organizations today need to balance the clinical and fiscal facets of the operation. People at all levels in a healthcare organization need to understand how the organization makes money (accounts receivable) and how it chooses to allocate or spend these resources (accounts payable).

Early careerists in a healthcare organization may participate in any or all of the following financial activities:

• Evaluate existing and new healthcare service lines.
• Develop a departmental budget.
• Provide input to strategic planning or finance department meetings.

Mid-level or advanced careerists may be asked to:

• Evaluate higher-level organization financing options.
• Anticipate cash flow needs.
• Present financial information to the CEO and board.

For the purpose of this assessment, assume you are a manager in a healthcare organization. Your organization likes to educate employees about the organization's fiscal operations from the very start—at new hire orientation. You have been asked to prepare a presentation for new hire orientation that addresses the organization's three types of revenue sources: Medicaid, Medicare, and managed care.

Preparation: You will prepare a presentation with speaker notes and slides on the three revenue sources for healthcare organizations: Medicare, Medicaid, and managed care. The last three slides of your presentation should cover the quality metrics for each revenue source and include a 3–5 minute audio recording. You may use PowerPoint or Kaltura to record your presentation. The audience for your presentation is new hires attending orientation.

• Conduct independent research on Medicare, Medicaid, and managed care.
  • See the "Merit-Based Incentive Payment System (MIPS): Participation Options Overview" resource from the Quality Payment Program website by the Centers for Medicare & Medicaid Services.
    • Merit-Based Incentive Payment System (MIPS).
  • Focus your research on current resources available through scholarly and/or authoritative sources. This resource will help you identify scholarly and authoritative sources:
    • Health Administration Master's Program (MHA) Library Guide.

Instructions:   Create a 12–15 slide PowerPoint presentation with speaker notes. Incorporate the information you gained from your independent research on Medicare, Medicaid, and managed care in the presentation.

Also include a recorded narrative for the last three slides of your PowerPoint presentation. These slides should cover the quality metrics for each revenue source, and include a 3–5 minute audio recording explaining the quality metrics you have noted. Your audio narration can be recorded directly on the last three slides of the PowerPoint document, or recorded as a separate Kaltura screen recording of the last three slides with audio narration.

Please be sure to address all of the following headings and answer all of the questions underneath each heading in your presentation:

Introduction: Healthcare Revenue Sources—Medicare, Medicaid, and Managed Care (2–3 slides)

• What are the three main types of healthcare revenue sources?
  • Note: Find ways to engage your audience in the first few minutes of your presentation. Can you open with a startling statistic or a compelling quote or question? Feel free to be creative when labeling your slides.

Medicare (3–4 slides)

• What is Medicare's purpose?
• What benefits do Medicare program participants receive?
• What steps do healthcare organizations take to be reimbursed for the Medicare services they provide?
  • Consider creating a flow chart to illustrate the major steps in the process.
• What challenges do healthcare organizations face in terms of reimbursement?
• What data and/or quality metrics does the organization need to provide for reimbursement?
• How long does it take to receive reimbursement?

Medicaid (3–4 slides)

• What is Medicaid's purpose?
• What benefits do Medicaid program participants receive?
• What steps do healthcare organizations take to be reimbursed for the Medicaid services they provide?
  • Consider creating a flow chart to illustrate the major steps in the process.
• What challenges do healthcare organizations face in terms of reimbursement?
• What data and/or quality metrics does the organization need to provide to be reimbursed?
• How long does it take to receive reimbursement?

Managed Care (3–4 slides)

• What is managed care's purpose?
• What benefits do managed care program participants receive?
• What steps do healthcare organizations take to be reimbursed for the managed care services they provide?
  • Consider creating a flow chart to illustrate the major steps in the process.
• What challenges do healthcare organizations face in terms of reimbursement?
• What data and/or quality metrics does the organization need to provide for reimbursement?
• How long does it take to receive reimbursement?

Conclusion (2–3 slides)

• What key information do you want new hires to retain from your presentation?
  • Consider creating a grid or job aid that highlights critical information about each revenue source all in one place.
  • Include the quality metrics for each revenue source.
• How can you close your presentation in a memorable way?

Practice and Record Your Conclusion

• Record a narrative of the last three slides of your presentation. These slides should cover the quality metrics for each revenue source. To complement those slides, please include a 3–5 minute audio recording explaining the quality metrics you have noted. Your audio can be done directly into the PowerPoint presentation or using Kaltura in a separate recording.
  • Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact [email protected] to request accommodations.
• Listen to your audio prior to submitting to ensure it is loud enough.
• Upload your slides, speaker's notes and recording (if it is a separate file from the PowerPoint) to the assessment area.

Additional Requirements : Your assessment should also meet the following requirements:

• Written communication: Your slides need to include bullet points highlighting the key concepts. As a best practice, each slide should contain no more than 5–7 bullet points and no more than 5–7 words per bullet point. Use speaker notes to include additional information. Appropriately balance text and visuals. Make sure your content is clear, persuasive, well-organized and free of errors in grammar, punctuation, and spelling.
• Title slide: Develop a descriptive title for your presentation of 5–15 words. It should stir interest, yet maintain professional decorum.
• Length: 12–15 slides with speaker notes and a 3–5 minute audio narration during the final three slides.
  • If you use Kaltura, you can upload your recording to the courseroom, or provide a working link your faculty can access.
• Font and font size: Appropriate size and weight for presentations, generally 24–28 points for headings and no smaller than 18 points for bullet-point text.
• Reference slide: Include a minimum of three citations to current scholarly and or authoritative sources in a final reference slide. These sources need to be from your independent research, over and above the resources in the suggested reading list for this assessment. Current means they can be no more than five years old.
• APA format: Ensure in-text citations and references adhere to current APA format. For an APA refresher, review the Evidence and APA section of the Writing Center.

Competencies measured :By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and rubric criteria:

• Competency 1: Develop financial strategies to address dynamic environmental forces.
  • Explain the purpose of healthcare reimbursement programs.
  • Explain the data and/or quality metrics that the organization needs to provide for reimbursement. Prepares a 3–5 minute audio overlay regarding metrics.
• Competency 2: Analyze the cost and revenue implications for organizational changes due to environmental forces.
  • Analyze the reimbursement process that healthcare organizations must undertake.
  • Explain the challenges that healthcare organizations face in terms of reimbursement, including how long it takes to be reimbursed.
• Competency 4: Communicate in a manner that is scholarly, professional, and consistent with expectations for professionals in health care administration.
  • Write content clearly and logically with the correct use of grammar, punctuation, and mechanics.
  • Format citations and references using the APA style.