Assignment 2 - LearnScape Episode: “Rates Negotiation Process”

Assignment 2

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LearnScape Episode: “Rates Negotiation Process”

Complete the Jones and Bartlett Navigate 2 Episode 2: “Rates Negotiation Process” (refer to the syllabus for purchase instructions). During this episode, you will encounter several questions requiring you to demonstrate your knowledge of Health Care Finance (See example questions below). After answering these questions, save the responses as a Word document.  Use the Word document you have created to write a 4-5 page APA formatted paper analyzing payment mechanisms to hospitals & health plan contract negotiations as described on the grading rubric.

Assessing Your Understanding

What were you thinking?

 I'm thinking, if we agree on a higher price to charge my Hospital's inpatients, we'll make up the difference if you stay at 5%.

 Well, looking beyond the rate for a few minutes and talking about some of the contract language, actually.

We’ll let you charge patients for services outside our plan, but we still want to retain the right to lease out our plan to other networks.

 I'm not sure I can do that if you're still unwilling to budge on your rate. Leasing your plan out means more of a loss from inpatients from other networks, you know.

 Sounds good to me!

What did you learn about contract negotiations that might be helpful in the future?

 I learned that rates shouldn't be the only focus in contract negotiation. Sometimes, altering the language in key areas can have a huge impact.

 I learned that some people just need to be worn down over two or three meetings.

What are you trying to determine when you construct the Hospital Cost Index and compare it to industry averages?

 That would be part of determining pricing reasonableness.

 You are trying to determine performance metrics.

Do you remember what the three main factors are that influence pricing?

 Yes. Bundled Services, Fee schedules, and Return on Investment (ROI)

 Yes. Net Income, Competitive Position, Market Structure.

What about basic methods of payment for hospitals? Can you describe the cost-payment basis?

 A cost-payment basis uses the provider's cost as a basis and it is something that is negotiated beforehand, the provider's ratio of cost to charges multiplied by the total charges for a specific claim.

 Yes, it's when you bundle all of the services for a specific condition into one code and then payment is based on an agreed fee schedule for that code.

Assignment 2 Rubric

Competency      45 points            41 points   37 points            0 points Points Earned

Payment for Hospitals    Analyzes the basic methods for payment for hospitals.            Describes the basic methods for payment for hospitals.              Describes only one basic method for hospital payment.    Does not describe a basic method for hospital payment.           /45

Contract Negotiations    Analyzes the important considerations for health plan contract negotiations

              Describes the important considerations for health plan contract negotiations

              Describes only one important consideration for health plan contract negotiations       Does not describe the important considerations for health plan contract negotiations           /45

Competency      5 points 4 points 3 point              0 points Points Earned

Grammar, spelling, and punctuation              There are no errors in grammar, spelling, and punctuation              There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning              There are major errors in grammar, spelling, and punctuation that do not reflect scholarly writing              NA         /5

APA Compliance              The paper meets APA format guidelines      There are minor APA format errors       There are significant errors in format   NA              /5

Total Points