·         To help the new employees and stakeholders in the organization to learn and identify the types of health insurance such as Medicare, Medicaid and Private Insurance and how each of the health insurance reimburse money to the healthcare organizations.

·         To understand the role of healthcare insurance in the delivery of healthcare services.

Reimbursement is repaying of monies spent by an individual of an institution.  If a person is sent by their employer on official duties, they embark on a trip and pays all the bills. Later, they are compensated by being repaid the all the expenses incurred during the trip. In healthcare, this kind of compensation is done through private insurance, Medicare and Medicaid.

a.       Explain the concept of health insurance

Under this topic, the trainer will expound on the need for health insurance, basic characteristics of insurance (pooling of losses, risk transfer, indemnification, and payment only for random losses), moral hazard, and adverse selection.

b.      Introduction to Medicare, Medicaid, and Private Insurance.

This subtopic will explain to the trainees the differences between the three insurance plans (Medicare is for persons who are 65 years or older with certain disabilities, Medicaid is an assistance program for low income earners with each state defining persons eligible for it, Private insurance plans for self-insurers who pay for future costs of health through a medical policy). Health Care Reimbursement Training Plan Essay

c.       Methods used to reimburse healthcare organizations from each health insurance plans.

This section will explain the reimbursement structures under each health insurance plan. The four parts of Medicare reimbursement structure namely Part A, Part B, Part C and Part D will be explained, the services covered by each part and the rates and systems used to compute the amount of compensation to be reimbursed.  In addition, under Medicare whose reimbursement structure depends on state and state regulations, the fee-for service reimbursement program, managed care plans models (comprehensive risk based, limited benefits plan, and primary management care plans) will be discussed. Under the private insurance medical insurance policy cards, types of private insurance plans for individuals, groups and the ratio of the co-payment will be discussed.

d.      Importance of medical coding in health insurance reimbursement.

Under this section, medical codes, health services and their associated payment rates, codes and importance of coding will be discussed.

e.       Role of healthcare insurers in the provision of healthcare.

Under this subtopic, the part played by health insurance firms in provision of health will be expounded.

f.       Steps taken by firms in the reimbursement process.

Under this section, the steps taken by organizations claiming reimbursement such as recording payment details, assigning of medical codes, claim submissions, assessment of the payer’s response, and audit of claims will be discussed.

The resources and materials required for this training will include a laptop, projector, writing pads, pens, fountain pens, duster, white board, reference books and a public address system.

Training instruction will be done through formal presentation, small groups question and answer session and live classroom training.

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders. New York, NY: Springer Publishing Company, LLC.

Matsuoka, Y., &Fukai, K. Medical Health Insurance Systems in Europe,             USA,   Canada, and Australia.

Whedon, J., Tosteson, T. D., Kizhakkeveettil, A., & Kimura, M. N. (2017).             Insurance reimbursement for complementary healthcare             services. The    Journal of Alternative and Complementary             Medicine, 23(4), 264-267.