| Course | NR 533 Financial Management in Healthcare Organizations |
|---|---|
| Week | 7 |
| Paper type | Reimbursement brief |
| Length | About 1,130 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Nurse Executive |
| Updated | September 2026 |
Free sample paper for NR 533 Week 7
Reimbursement Brief: One Palliative Care Day Charged at $3,400 to Five Payers, Five Different Deposits After Contractual Allowances, and Which of Them Cover the $1,583 the Day Actually Costs
Student Name
College of Nursing, Chamberlain University
NR 533: Financial Management in Healthcare Organizations
Instructor Name
Month Day, Year
Reimbursement Brief: One Palliative Care Day Charged at $3,400 to Five Payers, Five Different Deposits After Contractual Allowances, and Which of Them Cover the $1,583 the Day Actually Costs
Purpose
The monthly statement for the inpatient palliative care unit I manage shows revenue at the hospital's charge of $3,400 per patient day. That figure is almost never collected. What the hospital actually receives depends on who pays, and the difference between the charge and the payment, the contractual allowance, is recorded by the finance office, not on the unit's statement. As a result, the unit's revenue line looks as if every day earns more than twice its cost, when for most payers it does not. This brief works through what the hospital collects for one day on the unit from each of its five payer groups, compares each with the cost of a day and shows what the comparison means for the unit's decisions.
Why Charges and Payments Differ
Hospital charges are set in a chargemaster and bear little relation to what most payers pay. An analysis of U.S. hospital pricing described chargemaster prices as list prices with little relation to what most payers pay, with actual payments set by negotiation with private insurers and by administered rates for public programs, so that the same service is paid at very different amounts depending on the payer (Reinhardt, 2006). For a nursing unit, the practical consequence is that the charge is useful only as a billing entry. The payment is what covers costs.
What Each Payer Pays
Medicare inpatient. Most Medicare patients on the unit are hospital inpatients paid under the inpatient prospective payment system, which pays a fixed amount per stay based on the diagnosis-related group, not per day. To compare with other payers, the finance office divides the part of each Medicare payment attributed to the palliative unit stay by the days spent on the unit. Over the last year, this averaged $1,440 per day. Because the payment is per stay, a longer stay on the unit lowers the payment per day.
Hospice general inpatient contract. Patients enrolled in the Medicare hospice benefit whose pain or other symptoms have outgrown what can be controlled at home, for a short period are admitted under a contract with their hospice. The hospice is paid by Medicare at its general inpatient rate and pays the hospital the contracted rate, which Medicare rules allow hospices to arrange with certified hospitals (Centers for Medicare & Medicaid Services [CMS], n.d.). Our contract rate is $1,150 per day, all-inclusive except physician services.
Medicaid managed care. The state's Medicaid plans pay a negotiated per diem of $1,080.
Commercial insurance. Commercial plans pay per diem rates averaging $2,350 across our contracts.
Self-pay and charity. Uninsured patients are covered by the hospital's financial assistance policy, and collections average about $90 per day.
The Comparison
Table 1 compares the charge, the payment and the contractual allowance for each payer with the unit's full cost per day of $1,583, taken from the unit's cost worksheet, which includes direct costs and allocated overhead.
Table 1
Charge, Payment and Margin per Patient Day by Payer
| Payer | Share of patient days | Charge | Payment per day | Contractual allowance | Margin on full cost |
|---|---|---|---|---|---|
| Medicare inpatient | 38% | $3,400 | $1,440 | $1,960 | -$143 |
| Hospice contract | 33% | $3,400 | $1,150 | $2,250 | -$433 |
| Medicaid managed care | 14% | $3,400 | $1,080 | $2,320 | -$503 |
| Commercial | 11% | $3,400 | $2,350 | $1,050 | +$767 |
| Self-pay and charity | 4% | $3,400 | $90 | $3,310 | -$1,493 |
| Blended | 100% | $3,400 | $1,340 | $2,060 | -$243 |
What the Comparison Shows
Only commercial insurance covers the full cost of a day. Weighted by the unit's payer mix, the hospital collects about $1,340 per day, which covers the unit's direct costs of about $1,040 this year but not the allocated overhead. On a full-cost basis, the average day loses about $243.
The hospice contract is the largest single problem. Hospice days are a third of the unit's volume and rising, since one referring hospice closed its inpatient facility, and each loses about $433 on full cost. The contract rate was set four years ago and has not been adjusted for pay increases since. Even on direct cost alone, it now covers only about $110 above the day's direct expense, and next year's budget, with merit increases and drug inflation, will narrow that further.
Medicaid days lose the most per day among insured patients. These rates are set by the state's plans and are difficult to change at the unit level.
What the Unit Can and Cannot Change
The unit cannot change payment rates, and it should not try to choose patients by payer. It can supply the evidence that others need to change them, and it can control its own costs. Its manager can also make sure that the unit's documentation supports the payments it is owed, for example by recording the symptoms that justify general inpatient hospice care each day, since a hospice cannot pay for days it cannot justify to Medicare. Three steps follow from the brief.
First, the hospice contract comes up for renewal in nine months. I will give the finance office the unit's cost worksheet and this brief so that the negotiation starts from the actual cost of a day. A rate at least equal to full cost, about $1,580 at current prices, would change the unit's position more than any internal saving could.
Second, I will ask finance to add net revenue by payer to the unit's monthly report, alongside the charge. Financial management texts recommend that managers see the revenue their units actually generate, since decisions about volume and services depend on it (Finkler et al., 2013). A statement that shows only charges invites the wrong conclusions.
Third, the unit will continue to hold down the costs it controls, especially pharmaceutical waste, which fell after the change to shorter infusion bags.
A Note on What the Numbers Leave Out
These figures describe the unit alone. Palliative care's financial value to the hospital lies partly in other units, since comfort-care patients who move from intensive care to the palliative unit free the hospital's most expensive beds. The unit's losses on hospice and Medicaid days should be weighed against that effect, and against the hospital's mission to care for dying patients regardless of payer. The purpose of the brief is not to argue that some patients should be turned away. It is to make sure that decisions about the unit are made with the real revenue in view, rather than a charge that nobody pays.
References
Centers for Medicare & Medicaid Services. (n.d.). Medicare benefit policy manual: Chapter 9, coverage of hospice services under hospital insurance. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c09.pdf
Finkler, S. A., Jones, C. B., & Kovner, C. T. (2013). Financial management for nurse managers and executives (4th ed.). Elsevier.
Reinhardt, U. E. (2006). The pricing of U.S. hospital services: Chaos behind a veil of secrecy. Health Affairs, 25(1), 57-69. https://doi.org/10.1377/hlthaff.25.1.57
What the NR 533 Week 7 assignment asks for
For Week 7 you usually examine how a nursing service is reimbursed. Prompts ask for the payers involved, how each pays (per stay, per day, per service), the difference between charges and payments, the effect of payer mix and implications for the unit. Start from the charge on the unit's statement and show what each payer actually pays after contractual allowances. Convert per-stay payments to a per-day equivalent if other payers pay per day, and say how. Compare each payment with the cost of the service. Weight by payer mix. Separate what the unit can influence from what it cannot. Use a table. Cite reimbursement policy and pricing sources in APA 7.
How this NR 533 Week 7 example is built
The brief opens with the gap between the charge on the unit's statement and what is collected. A short section explains, with a study of hospital pricing, why charges and payments differ. Each payer is then described: Medicare paid per stay and converted to a daily figure, the hospice contract under Medicare's general inpatient rules, Medicaid and commercial per diems and charity care. Table 1 sets payer share, charge, payment, allowance and margin on full cost side by side. The analysis identifies the hospice contract as the largest problem. Three actions follow: cost evidence for the renegotiation, net revenue on the statement and continued cost control, with documentation that supports payment.
NR 533 Week 7 rubric: what full points look like
Reimbursement brief rubrics typically reward accurate description of payment methods, correct treatment of charges, allowances and net revenue, analysis of payer mix, comparison with cost and realistic implications. Graders favor briefs that convert payments to a common basis and show the method. Comparing payments with a documented cost figure shows integration of earlier work. Identifying the payer that matters most, by volume and margin, demonstrates analysis. Recommendations that recognize what a unit manager can influence, such as documentation and cost, show judgment. Correctly cited policy sources support accuracy. A clear comparison table is usually expected. Noting what documentation the unit must keep so payers can pay correctly shows practical understanding of reimbursement.
Common NR 533 Week 7 mistakes, and how to avoid them
A common mistake is treating charges as revenue, which makes almost any unit look profitable. Use net payments. Another is mixing per-stay and per-day payments without converting them. Students also describe payment systems in general without applying them to one service. Keep it to one day or one case. Avoid inventing specific national rates when a contract or local figure is what matters; label composite figures clearly. Do not recommend choosing patients by payer. Say instead what documentation, contracting or reporting could change. Finally, weight results by payer mix, since an average of five rates ignores how many days each payer actually pays for. Keep the brief short enough that a director can read it before a contract meeting.
Get a NR 533 Week 7 example written to your instructions
Send the element list and whichever payer categories your section wants covered, and a custom example comes back inside 24-48h with every rate sourced in the line that uses it. The first one is free. Where a figure has to be assumed, it is labeled as an assumption rather than quietly presented as fact.
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NR 533 Week 7 questions, answered
Where do net revenue figures come from for coursework?
Published payment rates, a summarized contract term you are permitted to describe, or an assumption you declare in the line that uses it. Exact negotiated rates are commercially sensitive and no assignment requires them. What is required is that each figure has a named origin and that the same origin holds across every payer category in the table.
Is this brief about policy?
It is not, and drafting it as though it were costs the most marks here. A policy version would ask whether some payment method produces good care across a whole system. This one asks what a named service collects inside one organization, and what the answer does to a single cost center that somebody has to manage next quarter.
How do I show a mix shift without inventing data?
Move the shares by a modest amount you name as hypothetical, hold everything else constant, and report the arithmetic that results. Sections accept a stated scenario readily. What they reject is a shift presented as a forecast with nothing behind it, so label it as an illustration in the sentence introducing it.
Where can I find a free NR 533 Week 7 sample paper?
The five-payer brief and its comparison table make up the NR 533 Week 7 sample, and the whole of it is reproduced openly above. If your service is paid differently, send us the payers and rates you know and a brief tracing charge to deposit can be written.
What is a contractual allowance in NR 533?
The difference between the hospital's charge and what a payer has agreed to pay. The sample shows allowances from $1,050 to $3,310 on the same $3,400 charge, depending on the payer.