Fundamentals of Healthcare Financial Management: A Practical Guide to Fiscal Issues and Activities

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ISBN: 9780071346719 | 0071346716
Cover: Hardcover
Copyright: 7/1/1999

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Highland Park Hospital, IL. Structured around a typical year in the financial life of a fictional healthcare facility. Each chapter covers a differ- ent month and the activities typically performed during that month. Includes vignettes describing events and their impact on the hospital's bottom line. For administrators.

Preface

January

(25)

What Is Healthcare?

(2)

What Is Management?

(1)

What Is Financial Management?

(1)

Why Is Financial Management Important?

(1)

Ridgeland Heights Medical Center

(4)

The Primary Statistics

(1)

Managed Care Inroads

(1)

RHMC's Actions to Counter Dwindling Inpatient Census

(1)

RHMC Decision Time

(1)

Financial Management Implications

(1)

Pro Forma Development

(4)

Net Present Values and Internal Rates of Return

(1)

Volume Assumptions

(1)

Revenue and Expense Assumptions

(3)

Living with the Finance Committee's and Board of Director's Calendar

(5)

Routine Matters

(2)

Periodic Review Matters

(1)

Year-End Closing

(5)

February

(27)

Accounting Principle and Practices

(1)

Objectives of Financial Reporting

(1)

Basic Accounting Concepts

(2)

Basic Financial Statements of a Healthcare Organization

(1)

Uses of Financial Information

(1)

The Financial Statements

(12)

Balance Sheet

(2)

Statement of Operations

(7)

Statement of Changes in Net Assets (or Equity)

(1)

Statement of Cash Flows

(1)

Notes to the Financial Statements

(1)

Preparing for the Auditors

(3)

Analysis of Sensitive Accounts

(2)

February Finance Committee Special Reports

(5)

Bond Debt Status

(3)

Health Insurance Annual Review

(2)

March

(27)

Strategic Financial Planning---5 Year Projections

(4)

Strategic Planning

(2)

Converting Vision (Strategic Plan) into Financial Reality---Market Share, New Services and the Medical Staff

(1)

Medical Staff Issues

(1)

RHMC Strategic Financial Planning

(7)

Volume Assumptions

(2)

Payor Mix

(1)

Rates and Reimbursements

(4)

Operating Expense Implications

(1)

Ratio Analysis

(10)

Bonding Related Ratios

(1)

Other Ratios

(4)

Operational Ratios

(4)

The Capital Plan and Its Relationship to the Strategic Plan

(5)

Capital Affordability

(2)

April

(28)

Medicare and Medicaid Net Revenue Concepts

(4)

The History of Medicare and Medicaid

(1)

Impacts of Medicare and Medicaid on Provider Net Revenues

(2)

Implication to Ridgeland Heights Medical Center

(1)

Calculation of Medicare and Medicaid Contractual Adjustments

(6)

Medicare Net Revenue Concepts

(2)

Medicaid Net Revenue Concepts

(3)

Implications of the Balanced Budget Act of 1997

(2)

Impact of the Balanced Budget Act on Medicaid

(1)

Overall Impact of the Balanced Budget Act on Ridgeland Heights Medical Center

(1)

Managed Care Net Revenue Concepts

(5)

Preparation of the Medicare and Medicaid Cost Report

100

(3)

Ratio of Costs to Charges (RCC)

103

(2)

Implications and Sensitivities of Medicare Cost Reporting

104

(1)

Presentation of Audited Financial Statement to the Finance Committee

105

(3)

Implications of Management Letter Comments Proposed by the Auditors

106

(2)

May

108

(25)

Fundamentals of Accounts Receivable Management

109

(13)

Precertification, Preregistration, and Insurance Verification

110

(2)

Documentation Capture

112

(1)

Coding and Reimbursement

113

(1)

Timeliness of Coding

114

(1)

Fraud and Abuse Issues Related to Billing Issues

115

(4)

Managed Care Arrangements and Negotiations

119

(1)

Monitoring Results

119

(3)

Patient Registration---Which Division Should It Report to?

122

(2)

Calculation of Allowance for Doubtful Accounts and Bad Debt Expenses

124

(4)

Calculation of Allowance for Contractual Adjustments

128

(5)

June

133

(26)

Budget Preparations---The Beginning

134

(4)

Budget Calendar

138

(5)

Which Month Should the Budget Be Presented to the Board of Directors for Approval?

141

(1)

Budget Calendar Time Frames

141

(2)

Budget Calendar Steps

143

(1)

Volume Issues

143

(5)

Historical Perspective

144

(1)

Demographic Changes

144

(1)

New Services

145

(1)

Physician Issues and Inputs

145

(1)

Wishful Thinking

146

(1)

June 1---Volume Kick-Off Meeting

146

(1)

June 26---Approve Projected 1999 and Budgeted 2000 Inpatient and Outpatient Volumes

147

(1)

Capital Budgeting---June

148

(5)

Accounting and Finance Department Responsibilities

153

(3)

June Finance Committee Special Agenda Items

156

(3)

Human Resources Report

156

(1)

Pension Status and Actuary Report Review

157

(2)

July

159

(31)

Budget Preparations---The Middle Months

160

(17)

Which Is a Better Budgeting Technique---Top Down or Bottom Up?

161

(1)

July 1---Issuance of the Budget Calendar

162

(1)

July 11---Computer Gross Revenues and Contractual Adjustments

163

(2)

July 14---Review Salary and Nonsalary Assumptions

165

(4)

July 15---Review Gross Revenues and Contractual Adjustments and Validate Payor Mix

169

(1)

July 18---Review 2000 Budgeted Income Statement, Determine Price Increase Targets, and Revise Salary and Nonsalary Assumptions

170

(5)

July 25---Issue 1999 Projected/2000 Budgeted Worksheets to Department Managers

175

(2)

Capital Budget---July

177

(2)

Regulatory and Legal Environment

179

(3)

Medicare/Medicaid Fraud and Abuse

180

(2)

Other Regulatory and Business Compliance Issues

182

(3)

Corporate Compliance

185

(2)

Accreditation Issues

187

(2)

Patient Satisfaction Issues

189

(1)

August

190

(24)

Capital Budget---August

191

(9)

August 11---Detailed Discussion and Training for All Proposals Over $100,000

192

(3)

August 12---Discussion of All Pool Proposals with the Pool Evaluators

195

(1)

Funding Availability

196

(1)

Noncriteria-Based Capital Funding

197

(1)

August 12--15---Evaluate Proposals Online

198

(1)

August 22--25---Various Pool Consensus Meetings with Pool Evaluators

198

(1)

August 25---Consensus Meeting for All Proposals Over $100,000

198

(2)

August 26--28---Revise Ratings, If Necessary, on the Reviewer's Desktop

200

(1)

Operating Budget

200

(3)

August 15---Department Managers Need to Return Their Operating Budget Worksheets to Their Vice Presidents

200

(2)

August 18--28---Review of the Proposed Operating Budget by the Divisional Vice Presidents and then Return to Finance

202

(1)

Budget Variance Analysis

203

(2)

Budget Variance Parameters

205

(1)

Flexible Budgeting

205

(1)

Cost Accounting and Analysis

205

(7)

There Is no Such Thing as ``True'' Cost!

207

(5)

August Finance Committee Special Agenda Items

212

(2)

Review Next Year's Budget Assumptions

212

(1)

Annual Materials Management/Inventory Level Review

212

(2)

September

214

(30)

Operating Budget

216

(10)

September 9---Validate or Adjust Budget Assumptions and Semifinal Budget Approval by the Administrators

217

(5)

September 17---Final Review and Approval of the Operating Budget and Review of the Human Resources Committee Package

222

(1)

September 18--October 14---Prepare First Draft Through Final Copy of the 2000 Budget for the Finance Committee

222

(1)

Operating Budget System of the Near Future

223

(3)

Capital Budget---September

226

(1)

September 4---Meeting to Discuss Results of Main Strategic Capital Budget Evaluations and Final Administrative Approval of 2000 Capital Budget

226

(1)

Cash Budget

226

(2)

Physician Practice Management

228

(16)

General Concepts

228

(6)

Management Services Organizations

234

(3)

Patient Throughput

237

(2)

Equity-Based Physician Practice Management Companies

239

(1)

Hospital Owned PPMCs

240

(4)

October

244

(27)

Information Systems Implications to Healthcare Financial Management

246

(3)

Y2K Implementation

249

(2)

Information Technology Strategic Plan Initiatives

251

(6)

Selection of a New Healthcare Information System

251

(3)

Financial Implications to RHMC

254

(2)

How Improvements to Clinical Systems Benefit RHMC's Financial Outcomes

256

(1)

Impact of the Internet

257

(1)

Budget Presentation to the Board Finance Committee

258

(11)

October Finance Committee Special Agenda Items

269

(2)

November

271

(29)

Preparation and Delivery of the Budget Results back to the Department Managers

273

(7)

Budgeting and Spreading Contractual Adjustments by Department

274

(6)

Issues Involving RHMC's Cost Structure

280

(3)

How to Improve the Organization's Cost Structure

283

(8)

Enhance Communication with Physicians

284

(1)

Standardize the Organization's Supplies

284

(2)

Reduce Utilization of Services and Supplies

286

(3)

Obtain Best Pricing for Supplies and Products

289

(1)

Establish and Implement Optimum Productivity and Staffing Levels

290

(1)

Materials Management in Healthcare

291

(3)

Benefits of Tax Status to Healthcare Organizations

294

(3)

Preparation and Implications of the Annual IRS 990 Report

297

(3)

December

300

(39)

More Y2K at the Year End

303

(1)

More Y2K Contingency Planning

304

(1)

Getting Ready for Year-End Reporting...Again!

305

(1)

Open Heart Surgery Pro Forma

305

(11)

Development of Volumes and Revenues

306

(9)

Financial Conclusion---Open Heart Surgery Program

315

(1)

December Finance Committee Agenda Routine Items

316

(3)

Review Malpractice Insurance Coverages

316

(1)

Review and Approve Auditors and Their Fees for the Current Year

316

(2)

Finance Committee Annual Achievements

318

(1)

Looking Into the Future of Healthcare Finance

319

(20)

General Macro Healthcare Trends

319

(3)

Industry Payor Trends

322

(8)

Industry Segment Trends

330

(4)

Healthcare Information Technology Trends

334

(2)

Other Healthcare Trends

336

(3)

About The Author

339

(1)

Index

340

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Fundamentals of Healthcare Financial Management: A Practical Guide to Fiscal Issues and Activities

Summary

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