| Course | HI215 Reimbursement Methodologies |
|---|---|
| Unit | Unit 2 |
| Paper type | Payer comparison |
| Length | About 550 words, 4 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BS in Health Information Management |
| Updated | October 2026 |
Free sample paper for HI215 Unit 2
Seven Rows, Seven Ways to Price the Same Hospital: A Unit 2 Payer Comparison Setting Medicare, Medicaid, TRICARE, Workers' Compensation and Two Commercial Contracts Against Their Methods, Units and Rate Setters
[Student Name]
Purdue University Global
HI215: Reimbursement Methodologies
Unit 2 Payer Comparison
[Instructor Name]
[Date]
The hospital, its physician group and the contract terms are composite; the payment methods and the sources cited are real.
Scope
Setting: a composite 180-bed community hospital and its employed 40-physician group. Services compared: inpatient stays, outpatient hospital services and physician office visits.
The Comparison
Each row gives payer, method, unit, rate setter and claim form.
1. Medicare, inpatient hospital: prospective payment by diagnosis-related group. Unit: the case. Rate set by the federal government through annual rulemaking (42 C.F.R. § 412.64, 2024). Institutional claim.
2. Medicare, physician services: resource-based relative value fee schedule. Unit: the service, by code. Rates set nationally through relative values, geographic adjustments and a conversion factor (42 C.F.R. § 414.22, 2024). Professional claim.
3. Medicaid: varies by state. In this composite state, inpatient stays are paid by an all-patient diagnosis-related group system and physician services by a state fee schedule. Unit: case for hospital, service for physicians. Rates set by the state Medicaid agency within federal rules. Both claim types.
4. TRICARE, the military health plan: inpatient stays paid by a diagnosis-related group system modeled on Medicare's, and professional services by a maximum allowable charge schedule. Unit: case and service. Rates set by the Defense Health Agency.
5. Workers' compensation: state fee schedule for both hospital and physician services. Unit: service, with some states using case rates for inpatient stays. Rates set by the state workers' compensation agency.
6. Commercial plan A: negotiated per diem for inpatient days and a percentage of Medicare for outpatient and physician services. Unit: day and service. Rate set by contract.
7. Commercial plan B: percentage of billed charges, 58 percent, for hospital services and a negotiated fee schedule for physicians. Unit: charge and service. Rate set by contract.
Government payers publish their rates; commercial payers negotiate theirs. That single difference decides where a hospital can bargain and where it can only comply.
What the Grid Shows
Methods split along two lines. First, who sets the rate: the government publishes Medicare, Medicaid, TRICARE and workers' compensation rates, while commercial rates are negotiated and confidential. Second, the unit: cases and days for hospital stays, services for physicians and outpatient work, and charges where contracts still allow it. A hospital's financial office treats published rates as fixed and focuses its negotiation on rows six and seven. The physician rows rest on the relative value approach introduced into Medicare physician payment after research that measured the resources each service requires (Hsiao et al., 1988). Plenty of commercial contracts now set physician rates by marking up the Medicare schedule, so negotiated prices still move with public ones.
Why This Matters to Health Information Staff
The claim form and the coding that drive each row differ. Inpatient diagnosis coding sets the payment for rows one, three, four and sometimes five; procedure coding sets it for physician rows; and for row seven, every charge on the bill affects the amount. Staff who understand which unit a payer counts know which errors cost money.
References
42 C.F.R. § 412.64 (2024). https://www.ecfr.gov/current/title-42/section-412.64
42 C.F.R. § 414.22 (2024). https://www.ecfr.gov/current/title-42/section-414.22
Hsiao, W. C., Braun, P., Dunn, D., Becker, E. R., DeNicola, M., & Ketcham, T. R. (1988). Results and policy implications of the resource-based relative-value study. The New England Journal of Medicine, 319(13), 881-888. https://doi.org/10.1056/NEJM198809293191331
What the HI215 Unit 2 assignment asks for
Unit 2 generally asks you to compare several payers' reimbursement methods in a structured grid. Define the setting first, since the same payer often uses different methods for hospital and physician services. Choose rows that cover the main methods rather than listing every insurer. For each payer, give the method, the unit of payment, who sets the rate and the claim form used. After the grid, explain the patterns it reveals, such as which rates are published and which are negotiated. Connect the methods to health information work, especially which codes drive payment under each. Use published descriptions for commercial methods, since actual contracts are confidential. Cite the regulations or agencies behind government rates, and label any composite contract terms you invent for the example.
How this HI215 Unit 2 example is built
The comparison opens with a scope note naming the hospital and physician group and the services compared. Seven numbered rows follow, each giving method, unit, rate setter and form, with citations for Medicare's inpatient and physician payment rules. A highlighted line contrasts published and negotiated rates. The analysis explains the grid's two dividing lines, cites the research behind relative value payment, and notes how commercial physician rates often track Medicare's schedule, with a margin note on interpretation. A closing section links each method to the coding that drives it, with a final margin note tying the grid to the health information role. Every row uses the same order of facts, so differences between payers stand out at a glance.
Reading the HI215 Unit 2 grading rubric
Instructors grading payer comparisons usually reward accuracy and coverage. Points go to correct methods, units and rate setters for each payer, and to a sensible selection of rows that spans the main approaches. Credit rises for analysis after the grid that identifies patterns rather than repeating rows. Linking methods to the codes that drive payment shows applied understanding. Clear labeling of composite contract terms and citations for government methods add marks. A readable grid with consistent columns helps graders check quickly. Comparisons that confuse facility and professional methods for the same payer, or that omit the rate setter, tend to lose points on this rubric. A short paragraph explaining why each row was chosen also helps, since graders want to see that the selection was deliberate.
HI215 Unit 2 help from the desk
Students often list insurers by name without describing how each actually pays, which makes the grid a directory rather than a comparison. Focus on methods. Another frequent error is assuming a payer uses one method for everything, when hospitals and physicians are usually paid differently. Do not describe a specific commercial contract as fact; use typical structures. Remember that Medicaid varies by state, and say which state's approach you describe. Avoid rows that duplicate a method already covered. Keep the analysis short and pointed. If your prompt names particular payers or a setting, share it and we can build the grid and analysis around them.
Get an HI215 Unit 2 example written to your instructions
Send the Unit 2 instructions and your rubric, and list the payers your prompt names if it narrows the field; some sections want only government programs. The comparison is then built around those payers, grid and analysis both, every rate source dated, inside 24-48h. State-specific Medicaid methods are used where a state is named. A first custom sample costs nothing. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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HI215 Unit 2 questions, answered
Do I need to include every payer my state has?
No. Seven rows appear in the example because they cover the main methods, and adding a second preferred provider contract with the same structure adds length without adding a comparison. Where your prompt lists specific payers, those rows come first. If it leaves the choice open, choose payers that differ in method, since the grid is scored on contrast rather than on coverage.
Where do commercial payment methods come from if contracts are private?
From published descriptions of common contract structures rather than from any one insurer's terms. The example describes a preferred provider contract priced as a multiple of Medicare and marks the multiplier as illustrative. Textbooks and industry surveys describe per diems, case rates and percent-of-charges arrangements in general terms, which is enough for a comparison whose subject is method.
Should the claim form column list form names?
Yes, where the form is standard. Facility claims and professional claims travel on different forms, and the example names each one, adding the electronic transaction where the prompt asks for it. A column that says only paper or electronic misses the point, because the form follows who is billing, and that is exactly what the column is testing.
Where can I find a free HI215 Unit 2 sample paper?
The full Unit 2 grid of seven payers, with the analysis of methods and units, is open on this page.
Why does the same payer pay hospitals and physicians differently?
Because facility costs and professional work are priced by separate systems, such as diagnosis-related groups for inpatient stays and a relative value fee schedule for physician services.