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5 pages/β‰ˆ1375 words
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Style:
APA
Subject:
Health, Medicine, Nursing
Type:
Research Paper
Language:
English (U.S.)
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Topic:

Health Equity and Social Determinants of Health-Orientation Manual

Research Paper Instructions:

COMPETENCIES
7070.12.3 : Applying Healthcare Interventions
The graduate applies healthcare interventions that meet professional ethical guidelines, within the scope of practice, and align with the social and economic conditions of the population they serve.
7070.12.6 : Equity and Regulations
The graduate analyzes the impact of various healthcare financial models and regulatory policies on the social and economic disparities across diverse populations.
INTRODUCTION
For any health or behavioral health professional to be successful, particularly health services coordinators (HSCs), the scope of the professional’s role and requisite resources for each practice setting must be understood by the professional, including the following:
• unique job functions and skills
• organizational and community resources
• financial resources
• industry ethical codes and legal requirements
This information is especially vital for maneuvering and appropriately interacting with clients and populations at risk for the social determinants of health (SDOHs).
SCENARIO
You are the manager of a department employing HSCs in a health or behavioral health setting. You will create a robust, current, and comprehensive orientation manual for newly hired HSC’s. You will then create the content for each chapter by following the corresponding prompts in the Requirements section. This manual will provide the necessary foundational knowledge and practice expectations, while promoting compliance with all pertinent regulations. The orientation manual will contain a working knowledge of the information needed to demonstrate mastery for a range of client situations across the five domains of the SDOHs.
Note: The five domains of the SDOHs are economic stability, education, social and community context, health and healthcare, and neighborhood and built environment.
REQUIREMENTS
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. The originality report that is provided when you submit your task can be used as a guide.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
A. Provide a title page, table of contents, and chapter headings as follows for the orientation manual described in the scenario:
• Chapter 1: Medicare/Medicaid
• Chapter 2: HMO/PPO Plans
• Chapter 3: Role of the HSC
• Chapter 4: Community Resources and Programs
Chapter 1: Medicare/Medicaid
B. Discuss the Medicare reimbursement process by doing the following:
1. Describe three Medicare reimbursement requirements.
2. Describe three methods that are in place to ensure your facility remains compliant with Medicare reimbursement requirements.
3. Describe three Medicare reimbursement regulations.
C. Discuss the Medicaid reimbursement process by doing the following:
1. Describe three Medicaid reimbursement requirements.
2. Describe three methods that are in place to ensure your facility remains compliant with Medicaid reimbursement requirements.
3. Describe three Medicaid reimbursement regulations.
Chapter 2: HMO/PPO Plans
D. Choose an HMO or PPO plan, and discuss compliance regulations by doing the following:
1. Describe standard mechanisms for an appeal for denial of coverage.
2. Discuss reimbursement limitations.
Chapter 3: Role of the HSC
E. Discuss the HSC’s role across practice settings by doing the following:
1. Describe four job tasks for the HSC.
2. Describe how the job tasks from part E1 apply to working with clients at risk for each of the five domains of the SDOHs.
3. Discuss three ethical dilemmas that may be encountered in the HSC role.
a. Justify how each of the 3 examples could be considered ethical dilemmas.
Chapter 4: Community Resources and Programs
F. Discuss community resources and programs by doing the following:
1. Discuss how three existing community resources in your area could help mitigate the negative effects or enhance the positive effects of one SDOH.
2. Describe two community resources that are needed in your area to help mitigate the negative effects or enhance the positive effects of the SDOH from part F1.
a. Explain two reasons why the community resources from part F2 could mitigate the negative effects of the SDOH in your area.
b. Explain two reasons why they could enhance the positive effects of the SDOH in your area.
G. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

Research Paper Sample Content Preview:

Health Equity and Social Determinants of Health-Orientation Manual
Student’s Name
Institutional Affiliation
Course Name and Number
Professor’s Name
Date
Health Equity and Social Determinants of Health-Orientation Manual
Table of Contents
Chapter 1: Medicare/Medicaid …………………………………………………………… 2
Chapter 2: HMO Plans……………………………………………………………………. 4
Chapter 3: Role of HSC…………………………………………………………………... 5
Chapter 4: Community Resources and Programs………………………………………… 6
Chapter 1: Medicare/Medicaid
Medicaid reimbursement process
If a person chooses a Medicare-approved healthcare provider, they usually do not have to claim. Specific Medicare Advantage coverage requires members to select an in-network physician. If a person decides on a non-participating practitioner, they may be required to make an insurance claim and notify Medicare of the charges (Roberts et al., 2019). The part of the expenditures not covered by Medicare, and any related out-of-pocket fees, would be the individual's responsibility.
A person with traditional Medicare will rarely get a charge from a medical professional. Nevertheless, the law mandates that practitioners submit claims to Medicare promptly. The healthcare expenses are subsequently reimbursed promptly to the healthcare provider by Medicare. In most cases, the insured individual will not be required to contribute the cost of health care in full before filing a claim for reimbursement(Roberts et al., 2019). Health practitioners have agreed to take the Medicare-approved reimbursement level for their activities in exchange for a fee. Dependent on their doctor's Medicare eligibility, a person may be required to contribute in advance and file a claim for reimbursement.
Because Medicare requires providers to submit claims to the agency, the facility must apply for reimbursement. If the facility fails to file within the time frame, a person must fill out the Patient Petition for Healthcare Payment Form and read the directions(Roberts et al., 2019). The institution must also include itemized bills and a letter stating why it is filing a request on its own. The facility must accept Medicare allocation to prevent charging upfront, potentially far more than the Medicare-approved rate.
Additionally, the Medicare Physician Fee Schedule (PFS), which provides reimbursement rates for even more than 12,500 distinct eligible programs, is used by the Centers for Medicare Services (CMS) to compensate practitioners for treatment provided to Medicare Part B enrollees. Medicare Part A payments for acute healthcare inpatient admissions are dependent on predetermined r...
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