One type of health insurance that can be challenging on submitting a reimbursement and obtaining payment is a health maintenance organization (HMO) when a patient is seeking care from a non-HMO provider unless it’s in an emergency. A patient that has an HMO plan must seek care and services only from their primary care physician (PCP) (HMOs, PPO, & POS Plans, 2019). The patient’s PCP must authorize another physician for other care through a referral for the patient to see that specific physician. If a referral hasn’t been approved or authorized by the PCP or non-emergency care isn’t approved, the patient will be held responsible for the payment in full of any services that are rendered (HMOs, PPO, & POS Plans, 2019). 

There are also some hospitals that don’t accept reimbursements from patients that have health insurance coverage that doesn’t reimburse them enough unless it’s in an emergency (Torrey, 2018). 

Reimbursements for post-acute treatments and services has been remaining to be a work in progress for two reasons. The first is because of the tight deadlines that wasn’t allowing adequate time on developing the systems with many of them exhibiting improper imperfections (Newhouse, 2005). The inpatient hospitals prospective payment system (PPS) had been underdeveloped for more than a decade and a form of this was already used by some states before it had been introduced into Medicare.

The second reason is in the architecture of the separate payment systems for each type of post-acute provider. Many of these types of patients can be potentially served by many types of providers (Newhouse, 2005). For example, a patient that has had a stroke can get physical or speech therapy in a rehabilitation hospital, hospital outpatient department, skilled nursing facility, or at home with a home health agency. But these payment systems are not all neutral among these sites because the reimbursements for the same patient that is receiving the same services at different sites can be different. Rehabilitation and skilled nursing facilities are paid per day and the home health agencies are paid per 60-day episodes (Newhouse, 2005). Generally, the short-stay patients will be in a rehabilitation facility and long-stay patients will be in a skilled nursing facility. Each facility has a function of payment based on the average cost of patients that are in that type of facility. The average cost will substantially vary based on the characteristics of the patients and the intensity of treatments will also vary because of the rehabilitation centers will generally provide more intense treatments while having the highest reimbursement rates (Newhouse, 2005). 

Unit 5 – Individual Project 

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Assignment Overview

Type: Individual Project

Unit:  HR Plan Performance and Evaluation

Due Date:  Tue,1/15/19

Grading Type: Numeric

Points Possible:  250

Points Earned: 

Deliverable Length:  Body of report should be 40-50 pages excluding title, references page(s), and any appendices

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Assignment Details

 Assignment Description

Step 1: Begin Assembly of Human Resources Report to the Board of Directors

Assemble the reports generated in Units 1–4 into a new, comprehensive report that will be completed in this assignment. This step should include aggregation of the following sections:

• Title Page
• Executive Summary [Placeholder: this is completed in Step 3]
• Table of Contents [Placeholder: this is completed in Step 4]
• Section 1: Current Human Resources Environment
• Section 2: Company’s Human Resources Posture
• Section 3: Comparator Group Human Resources Posture
• Section 4: Company’s Human Resources Competitive Position
• Section 5: Recommendations and Expected Impact[Placeholder: this is completed in Step 2]
• References [Placeholder: this is completed in Step 4]
• Appendices [Placeholder: this is completed in Step 4]

Step 2: Recommendations and Expected Impact

Based on the work completed in Units 1–4, develop at least 1 recommendation in each of the areas listed below that are designed to improve the company’s competitive human resources position. Be sure to include a detailed description of the recommendation, an overview of how the recommendation would be implemented, and a discussion of the expected impact of each recommendation.

1. Benefits and Compensation
2. Diversity
3. Employee Relations
4. Talent Management
5. Technology

Step 3: Executive Summary

Develop an overview (2–3 pages) presenting key points from all five sections of the report. Executive summaries are always included in reports to the board of directors as a courtesy, to allow them to quickly assess the overall report and facilitate discussion. The executive summary should be concise, factual, and professional in tone.

Step 4: Finalize Assembly of the Human Resources Report to the Board of Directors

Finalize assembly of the report, inserting the Executive Summary, Table of Contents, and the Section 5 Recommendations. Make sure the References listing is aggregated from all prior work. The final References listing should be alpha order, with citations in APA format. The Appendicesshould be ordered to correspond with the final report.

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