Research paperHealth care reimbursement

Herzing NU 451 Unit 4 Assessment

Under a DRG the payment is fixed before the care happens. That single fact generates the benefits, the problems and both of the nurse-manager's levers.

Editorial process

Last reviewed · August 25, 2026

Written by

Maren Caldwell

MSN, RN, CNE

Medical-surgical nursing, pharmacology and NCLEX preparation

Reviewed by

Dr. Tessa Redmond

DNP, RN, CNE

Evidence-based practice and clinical education

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Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

A fixed payment set in advance explains everything else

Everything in this paper follows from one structural fact: under a diagnosis-related group the hospital is paid a predetermined amount for a case, and that amount does not change if the patient stays longer or consumes more. Payment shifts financial risk from the payer to the provider, which is exactly what it was designed to do when it replaced cost-based reimbursement that paid more for doing more. Say that in the origin section rather than giving a date, because the purpose is the reason the mechanism looks the way it does. The benefits then follow directly, in predictability for the payer and an incentive toward efficiency, and so do the problems: pressure on length of stay, the risk of early discharge, upcoding incentives, and inadequate payment for genuine outliers. Each of those is a direct consequence of a payment that stops responding to what the case consumes, and framing them that way keeps the paper coherent.

The nurse-manager question has two halves that pull against each other, and answering both honestly is what a marker is looking for. Managing costs means influencing what the case consumes: length of stay through discharge planning that starts at admission, supply and medication use, avoidable complications, and readmissions that now carry their own penalty. Maximising reimbursement means influencing what the case is paid, which is almost entirely a documentation question, since the DRG assigned depends on the documented principal diagnosis, comorbidities and complications, and a real comorbidity that was managed but never recorded lowers the payment without lowering the cost. Be careful to frame that as accuracy rather than optimisation, because the same paragraph written carelessly describes upcoding, and saying where the line sits is worth a sentence of its own. That sentence protects the whole section, because the two practices are only distinguishable by intent and by whether the record supports what was coded.

Likely learning objectives

Explain DRG payment as a transfer of financial risk to the provider.
Derive the benefits and problems of the method from that one fact.
Separate cost management from documentation-driven reimbursement.
Distinguish accurate documentation from upcoding.

Assignment instructions

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Review every instruction before using the planning guidance that follows.

Healthcare Reimbursement Paper Instructions Healthcare is reimbursed in a variety of ways. The prospective payment method is one of those ways. This paper will be about the prospective payment method where diagnosis-related groupings (DRGs) forms the basis for payment. Research and explain the origin, purpose, and description of DRGs. Include what payment is based on. Identify the benefits and problems with reimbursement via this method. Explain how you as a nurse-manager can help manage costs and maximize your facility’s reimbursement from DRGs. The paper should contain an opening, a body, and a conclusion, and be 3-4 pages long. 3-4 professional references are required.

Course-wide instructions that accompany this question

ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. Herzing NU 451 Unit 4 Assessment One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

What NU 451 Unit 4 requires

01A 3-4 page paper with an opening, a body and a conclusion.
02The origin, purpose and description of diagnosis-related groupings.
03What payment is based on.
04The benefits and problems of reimbursement via this method.
05How a nurse-manager can help manage costs and maximise the facility's reimbursement from DRGs.
063-4 professional references.