Health Care Financial Management for Nurse Managers: Applications in Hospitals, Long-Term Care, Home Care, and Ambulatory Care

, by Dunham-Taylor, Janne; Pinczuk, Joseph Z.

Note: Supplemental materials are not guaranteed with Rental or Used book purchases.

ISBN: 9780763734756 | 0763734756
Cover: Paperback
Copyright: 8/12/2005

Buy New

Print on Demand: 2-4 Weeks. This item cannot be cancelled or returned.

$61.02

This text applies financial concepts to various health care settings, details how reimbursement varies between these settings, and teaches nurse managers how to effectively manage financial data specific to each setting. The chapters on long-term care explain the Resident Assessment Instrument (RAI), including the Minimum Data Set (MDS), as well as how to best manage long term care resources. The home care chapters explore how home care is financed, and how to administrate financial resources in a home health agency. In the chapters on ambulatory care, the text discusses the ins and outs of reimbursement in primary care.

Preface

xvii

Contributors

xix

Part I Hospital Issues

(178)

Overview of Hospital-Based Care

(84)

Jane K. Walker

Introduction

(1)

Classification of Hospitals

(11)

General versus Specialty

(1)

Teaching versus Community

(3)

Ownership---For-Profit, Not-for-Profit, Government

(1)

Critical Access Hospitals

(5)

The Changing Health Care Environment

(2)

Reimbursement Issues

(9)

Outpatient Reimbursement

(1)

Inpatient Observation Patients

(1)

Observation Status Fraud

(1)

Staffing Implications of Observation Patients

(1)

Patient Classification Systems

(4)

What Things Impact the Bottom Line for Hospitals?

(6)

Different Strokes for Different Folks

(2)

Payor Mix

(2)

Impact of Labor Costs on Budgeting

(1)

Outsourcing Operational Management Personnel/Improvements

(1)

Supply Issues

(1)

Physician Issues

(8)

Trending Toward a Shortage?

(1)

Physician Alliances and Contracts

(1)

Other Physician Practice Patterns

(3)

Gain Sharing

(1)

Medical Directorships

(1)

I Said Stark, not Stork

(1)

Technological Advances in Physician Practice

(1)

Nursing Issues

(17)

Career Choices

(1)

Some Stats and Contributing Factors

(1)

Impact on Patient Care

(1)

Magnet Hospital Program

(1)

Working with the Number Crunchers

(1)

Case Management

(2)

Case Management Types

(1)

Critical Pathways

(1)

Variances in Critical Pathways

(5)

Outcomes Research and Management

(1)

Utilization Management---Precertification, Utilization Review, Discharge Planning, and Retrospective Review

(4)

Compliance, Quality, Evaluation, Accreditation, and Risk Management Issues

(25)

Compliance and Risk Management

(1)

Performance Evaluation and Improvement Measures

(1)

What Is Benchmarking?

(1)

Benchmarking in Hospital-Based Health Care

(2)

What Is the Balanced Scorecard?

(2)

The Balanced Scorecard in Hospital-Based Health Care

(2)

Other Evaluation Measures---Quality (TQM, CQI, QI, and QA)

(8)

Accreditation

(4)

HIP What?

(3)

HIPAA Compliance

(1)

Conclusion

(1)

References

(7)

Using Inpatient Tools to Predict Cost and Measure Performance

(30)

Louise Gifford

Introduction

(2)

Financial Responsibilities in Nursing

(1)

Building the Labor Budget

(8)

Direct Care Labor Costs

(8)

Labor Budget Implementation Plan

(11)

Acuity

103

(1)

Monitoring and Analyzing the Labor Budget

104

(3)

Reporting Justification

107

(2)

Materials and Supplies

109

(5)

Assessment of Needs

109

(1)

Developing the Budget Worksheet

110

(1)

Monthly Monitoring of the Budget

111

(3)

Summary

114

(2)

References

116

(1)

Ignoring the Patient Classification System---Another Way to Staff

117

(40)

Kathryn W. Wilhoit

Jane M. Mustain

Introduction to Nursing Hours per Patient Day-Based Staffing

117

(1)

Personal Reflections: Why Choose This Method

118

(1)

Making Staffing Decisions Without Using a Patient Classification System

119

(7)

Nurse Manager/Expert

119

(1)

Budget

120

(1)

Benchmarking

120

(6)

Nurse Consultant

126

(1)

Facility-Specific Historical Data

126

(1)

Determining Staff Mix

126

(1)

Selected Unit of Measurement: Nursing Hours per Patient Day

127

(1)

Calculation of Unit-Specific Total Patient Days

128

(1)

Daily Staffing Needs Calculation

129

(1)

Calculation of NHPPD

130

(1)

Budgeted NHPPD

130

(1)

Targeted NHPPD

130

(1)

Core Staffing Plan Development

131

(2)

Direct versus Indirect Care Hours

132

(1)

Developing a Core Staffing Plan

133

(5)

Step 1

134

(1)

Step 2

135

(1)

Step 3

135

(3)

Step 4

138

(1)

Determining Staff Mix

138

(3)

Measuring Success

141

(4)

Implementing a Unit-Specific NHPPD-Based Staffing Plan

145

(1)

Discussion of Sample Unit Staffing Plan

146

(1)

Evaluation of This Staffing Method

147

(7)

Daily Review and Revision

147

(1)

Trending of Staffing Data

148

(1)

Bi-Weekly Review

149

(1)

Monthly and Longer-Term Review

149

(4)

Chief Nursing Executive Evaluation

153

(1)

Conclusions: Judging This Plan's Success

154

(2)

References

156

(1)

Acuity-Based Flexible Nursing Budgets

157

(22)

Coy L. Smith

Introduction

157

(2)

Variable, Fixed, and Overhead Expenses

159

(2)

Variable Cost Centers and Products

161

(1)

Establishing the Variable Budget

161

(1)

Projecting Budgeted Volumes

162

(2)

Developing the Variable and Fixed Salary Budget

164

(7)

Comments Related to the Variable Salary Budgets

171

(1)

Staff Mix

171

(1)

Prudent Budget Methodology

171

(1)

Budgetary Decision Making and Negotiation

172

(1)

Variable Non-Salary Line Items

172

(1)

Fixed Supply Component

173

(1)

The Final Variable Budget

174

(1)

Conclusion

175

(2)

References

177

(2)

Part II Long-Term Care Issues

179

(92)

Managing Long-Term Care Resources

181

(38)

Frances W. ``Billie'' Sills

Susie Hutchings

Introduction

181

(5)

Who Needs Long-Term Care?

186

(3)

Types of Long-Term Care Facilities

189

(1)

Ownership

189

(1)

Accountability in Long-Term Care

190

(2)

The Federal Long-Term Care Survey and Regulation Process

192

(7)

Resident Rights, Quality of Life, and Quality of Care

192

(1)

Staffing and Services

193

(1)

Resident Assessment

193

(1)

Federal Standards and Survey Procedures

194

(1)

Enforcement Procedures

194

(3)

Avoidable or Unavoidable Issues

197

(2)

Investigating Resistants Use

199

(1)

The Future of Governmental Guidance Regarding Surveys

199

(3)

Ethical Decision-Making in Long-Term Care

202

(2)

The Use of Agents and Directives

204

(1)

Withholding or Withdrawing Medical Treatment

204

(1)

``Do Not Transfer'' and ``Do Not Hospitalize'' Decisions

205

(1)

Reimbursement in Long-Term Care

205

(3)

Private Pay

206

(1)

Medicare

206

(1)

Medicaid

207

(1)

Veterans Administration (VA)

207

(1)

Other Models

207

(1)

The Budgetary Process

208

(1)

Staffing and Scheduling

209

(2)

Nursing's Role in Long-Term Care

211

(2)

American Nurses Credentialing Center (ANCC) Magnet Program: Recognizing Excellence in Nursing Services

213

(1)

Key Players in Long-Term Care Facilities

213

(1)

Conclusion

214

(1)

References

214

(1)

Helpful Websites

215

(1)

Appendix Nursing Assistant Mentor Program Curriculum

216

(3)

The Resident Assessment Instrument (RAI): The Minimum Data Set (MDS)

219

(24)

Steven B. Littlehale

Cheryl Field

Diane L. Brown

Historical Background

220

(3)

The Resident Assessment Instrument (RAI)

223

(7)

The Minimum Data Set

224

(3)

Assessment Reference Dates and Corresponding Dates for Payment

227

(2)

Triggers and Resident Assessment Protocols

229

(1)

The Current 44 RUG-III Categories

230

(8)

Determination of Facility-Specific Per Diem Rates

230

(2)

Inpatient Rehabilitation Post-Payment System

232

(1)

Development of MDS 3.0---Original Timeline 2005

232

(1)

The Care Plan

233

(1)

Utilization Review

233

(1)

Key Elements for Accurate Assessment

234

(1)

Reliability and Validity of the MDS v2.0

235

(1)

The Consequences of Inaccurate Assessment

235

(3)

Implications for Nurse Administrators

238

(1)

Strategies for PPS Operations Management

238

(3)

Get Smart with ARD Dates!

239

(1)

Put Expectations in Writing

239

(1)

Check and Change Documentation Systems

240

(1)

Communication

240

(1)

Interdisciplinary Team (IDT) Function

241

(1)

Conclusion

241

(1)

References

241

(2)

An Interdisciplinary Approach to the MDS

243

(28)

Amy M. Cripps

Brief History

243

(1)

Overview of the Minimum Data Set

244

(1)

Skillable Services

245

(4)

Specifics of Resource Utilization Groups

249

(6)

Other Medicare-Required Assessments

255

(1)

Case Study

256

(2)

Resident Assessment Instrument

258

(3)

Minimum Data Set

259

(1)

Resident Assessment Protocols

260

(1)

Plan of Care

260

(1)

Connection to Quality Indicators

261

(1)

Avoiding Fraud

262

(1)

Conclusion

263

(1)

References

263

(1)

Resources

264

(1)

Appendix Minimum Data Set (MDS)--Version 2.0

265

(6)

Part III Home Care Issues

271

(52)

Introduction to Home Health Care

273

(18)

Gail Gerding

Karen Cober

Introduction

273

(1)

History and Growth of an Industry

274

(3)

Qualifying for Home Health Care

277

(1)

Types of Services Provided in Home Care

278

(2)

Who Pays For Home Health?

278

(2)

Types of Home Care Agencies

280

(2)

Characteristics of Home Care Users

282

(2)

Diagnosis

283

(1)

Reason For Discharge

283

(1)

Case Mix

283

(1)

Why the Change in Home Health Reimbursement?

284

(1)

OASIS and the Prospective Payment System

284

(2)

Home Health Coding

286

(1)

Summary

286

(1)

References

287

(4)

Putting It All Together: Managing Resources in a Home Health Agency

291

(32)

Karen Cober

Introduction

291

(1)

Barriers to Budgeting Success

292

(2)

Agency Types

294

(2)

The For-Profit Agency

294

(1)

The Not-for-Profit Agency

295

(1)

Agency Case Mix and Size

295

(1)

Is the Agency Freestanding or Hospital-Based?

296

(3)

New or Established?

297

(1)

Niche versus One-Stop-Shop

298

(1)

Budget Types

299

(3)

The Budgeting Process

301

(1)

Revenue

302

(5)

Payor Type

303

(1)

Charges and Reimbursement

304

(2)

How Many? How Sick? Who Pays?

306

(1)

Expenses

307

(3)

Costing Out a Service

308

(2)

Staffing and Salary Expense

310

(7)

Direct Expense: FTEs

310

(1)

Staffing Models

310

(1)

Staff Reimbursement Models

311

(2)

Productivity and FTEs

313

(2)

Indirect Expense

315

(2)

Defending Your Budget

317

(1)

Budget Variances: Evaluating the Budget Throughout the Year

318

(2)

Conclusion: Future Challenges

320

(1)

References

321

(1)

Helpful References and Websites

321

(2)

Part IV Ambulatory Care Issues

323

(78)

Nurse Practitioner Reimbursement in Primary Care

325

(46)

Carol Lee Logan

Introduction

325

(1)

Primary Care Settings

326

(3)

Private Practice Offices/Contracted Services

326

(1)

Rural Health Clinic

326

(1)

Federally Qualified Health Center

327

(1)

Rural Health Clinic versus Federally Qualified Health Center

327

(2)

Who Reimburses Advanced Nurse Practitioners?

329

(3)

Medicare

329

(1)

Medicaid

330

(1)

Commercial Indemnity Insurers

331

(1)

Managed Care Organizations

331

(1)

Business/Agency Contracts

331

(1)

Credentialing Requirements

332

(1)

An Introduction to Third Party Reimbursement

332

(3)

Basic Steps of Medical Billing

334

(1)

Administrative Operations

335

(15)

Policies and Procedures

335

(3)

Forms and Documents

338

(1)

Fee Schedules

339

(2)

Procedure Coding with CPT and HCPCS

341

(1)

Key Points Regarding Current Procedural Terminology (CPT) and Health Care Financing Administration Common Procedure Coding System (HCPCS)

341

(1)

Structure of CPT and HCPCS

342

(1)

Current Procedural Terminology (CPT) Modifiers

343

(1)

National Level II HCPCS

343

(1)

National Level II Modifiers

344

(1)

Procedure Coding

344

(4)

Diagnosis Coding with ICD-9-CM

348

(2)

Third-Party Reimbursement---Dealing with Insurance Carriers

350

(1)

Medicare

350

(1)

Medicaid

350

(1)

Commercial Third-Party Payers

351

(1)

Managed Care Organizations (MCO)

351

(1)

Conclusion

351

(1)

References

352

(1)

Appendix A

353

(3)

Appendix B

356

(1)

Appendix C-1

357

(2)

Appendix C-2

359

(1)

Appendix C-3

360

(3)

Appendix C-4

363

(1)

Appendix C-5

364

(2)

Appendix D

366

(2)

Appendix E

368

(3)

Managing Resources/Budgeting in Ambulatory Care

371

(30)

Beth A. Cherry

Introduction

371

(1)

Preparing the Capital Budget

372

(1)

Preparing the Operating Budget

372

(2)

Components of a Budget

374

(8)

Revenue

374

(1)

Expenses: Salaries and Benefits

374

(3)

Expenses: Supplies and Equipment

377

(1)

Expenses: Indirect Costs

377

(1)

Contribution Margins

377

(5)

Net Income

382

(1)

Volume Projections

382

(1)

Visits

382

(1)

Procedures and Surgeries

383

(1)

Determining Reimbursement Rates

383

(4)

Charges and Costing Out of Services

387

(8)

Understanding the Budget Sheet

395

(3)

Understanding Relative Value Units (RVU)

398

(1)

Patient Satisfaction and Impact on the Budget

398

(1)

Conclusion

399

(1)

References

399

(2)

Index

401

Please wait while the item is added to your bag...

FREE SHIPPING

Amazon no longer offers textbook rentals. We do!

Health Care Financial Management for Nurse Managers: Applications in Hospitals, Long-Term Care, Home Care, and Ambulatory Care

Summary

Table of Contents

Supplemental Materials