1. Third Party ReimbursementBy
Chris Bookheimer

2. Objectives
The participant will be able to identify what third party reimbursement means and name three primary sources.
The participant will be able to state two third party payment models.
The participant will be able to verbalize why reduced reimbursement can have an impact on nursing care in their agency/unit at the end of the seminar presentation.
The participant will be able to verbalize two nursing practice changes that can be implemented into their work environment to optimize agency reimbursement at the conclusion of the seminar.

3. Outline

4. Outline Continued…

5. Outline conclusion

6. Pre-Quiz
In health care reimbursement 3rd party is the provider of care? T/F
Health care as we know it was first established in 1969? T/F
One example of a payment model is the affordable care act? T/F
Ida Orlando developed The Theory of Bureaucratic Caring? T/F
Two issues related to quality and safety are _________ and _________.
Two reasons for loss of reimbursement are inadequate _________ and inadequate _________.
QSEN guidelines include these three recommendations for optimizing reimbursement by nurses: _________, __________, __________.
These ANA professional standards of practice can easily be applied to the third party reimbursement issue: ____________, __________, __________, ________ ________, __________.

7. What is Third Party Reimbursement
1st Party = Patient 2nd Party = Healthcare Provider 3rd Party = Insurer

8. History of Insurance
(Casto & Layman, 2006)

9. Examples of Current Payment Models
Accountable Care Organizations
Medical Home Model
(Korda & Eldridge, 2011)

10. Accountable Care Organizations
(Hart, 2012) (Cadmus, 2011)

11. Medical Home Model
(Korda & Eldridge, 2011)

12. Relevance to Nursing
Nurses are the key to providing safe, quality, and cost-effective care. This is accomplished through assessment practices and care delivery practices
(Hart, 2012) (Korda & Eldridge, 2011)

13. Theory Theory of Bureaucratic Caring: Marilyn Anne Ray
Self-Efficacy Theory: Alberta Bendura
Nursing Process Theory: Ida Jean Orlando
(Nursingplanet, 2012) (Parker, 2010) (Tomey & Alligood, 2009)

14. Health Care Environment
Policies
Quality and Safety
Root Cause Analysis: Loss of revenue/reimbursement related to Nursing Process and Care Delivery

15. Policy: Affordable Care Act
(Korda & Eldridge, 2011)

16. Quality and Safety Budget Cuts Staffing Shortages
Physicians Not Taking Medicaid
Education
Increased Patients
Electronic Health Records
(King, 2012) (McBridge, Delaney, & Tietze, 2012)

17. Root Cause Analysis

18. Root Cause Analysis
Inadequate
Training
Apathy
Inadequate
Staffing
Loss of Reimbursement and Revenue related to Nursing Process and Care Delivery
Communication
Knowledge of
Resources
(Cadmus, 2011) (Korda & Eldridge, 2011) (Larkin, Lorenz, Rack, & Shatzer, 2012)

19. Inferences and Implications
Assessment Practices
Care Delivery Practices

20. Recommendations For quality and Safety Improvements
Quality and Safety Education for Nurses
Patient Centered Care
Evidence-Based Practice
Quality Improvement
Informatics
(QSEN, 2012) (Larkin, Lorenz, Rack, & Shatzer, 2012) (McBridge, Delaney, & Tietze, 2012)

21. Recommendations Continued
American Nurses Association Scope & Standards of Practice
Quality of Practice
Collaboration
Research
Resource Utilization
Leadership
(ANA, 2010)

22. Post Quiz
In health care reimbursement 3rd party is the provider of care? F
Health care as we know it was first established in 1969? F
One example of a payment model is the affordable care act? F
Ida Orlando developed The Theory of Bureaucratic Caring? F
Two issues related to quality and safety are ___Budget cuts______ and ____Staffing shortages_____.
Two reasons for loss of reimbursement are inadequate ___Training______ and inadequate _____Staffing____.
QSEN guidelines include these three recommendations for optimizing reimbursement by nurses: ______Patient centered care___, ________Quality improvement__, _______Informatics___.
These ANA professional standards of practice can easily be applied to the third party reimbursement issue: ______Quality of Practice______, ___Collaboration_______, ____Research______, ____Resource____ ______Utilization__, ____Leadership______.

23. References

24. References continued

25. References continued