Table of Contents
Hospital Reimbursement: Concepts and Principles

Purpose of this book (Prologue)

• 1) Fundamentals of Accounting
  Provide a background and history of the accounting profession, describe typical accounting services, detail the financial concepts and terminology that apply to healthcare, define the ratios used within financial analysis, describe the four basic financial statements, explain the significance of budgeting and explain the importance of using sensitivity analysis and the relative sales value method.
• 2) Types of Hospitals/Conceptual Framework
  Provide a brief history of the hospital/health care field, explain the difference between for-profit, not-for-profit and governmental hospitals, define 501(C) (3) status, discuss unrelated business income, clarify the certificate of need process and explain the difference between senior management and the board of directors.
• 3) Hospital Revenue Cycle
  Describe the patient access and registration functions, explain the hospital billing process, define a hospital payer mix, explain the different types of insurance carriers, discuss case management and utilization review, illustrate hospital contracting, define health care fraud and provide a background of the RAC and the Form 990.
• 4) Hospital Services
  Discuss the differences between inpatient and outpatient services, describe the billing and reimbursement methodology of numerous hospital departments such as cardiology and radiology, define observation days, distinguish between nursing home and hospice care, explain administrative days and swing beds
• 5) Medicare
  Provide a historical background of Medicare, describe Parts A through D, explain both the inpatient and outpatient prospective payment system, illustrate the blend rate computation, describe the Medicare DSH and IME Add-On computations, clarify how a DRG cost outlier is formulated, detail the Medicare pass-through payment and explain the eligible days of a Medicare patient.
• 6) Medicaid
  Provide a historical background of Medicaid, describe the Medicaid blend rate and per diem reimbursement methodology, define the Medicaid HMO concept, explain the hierarchy of indigent care, illustrate the Medicaid cost settlement concept, explain the Medicaid DSH computation and discuss how the GME and teaching supplement payments are formulated.
• 7) Other Insurance Providers
  Discuss managed care and the difference between a HMO and a PPO, clarify the difference between charity care and bad debt, define workers compensation, define and explain a VA hospital, discuss both the Blue Cross/Blue Shield and TRICARE reimbursement methodologies.
• 8) Governmental Cost Reporting
  Provide an overview of the Medicare and Medicaid cost settlement methodology, detail and explain the numerous worksheets within the cost report, clarify why certain costs are excluded and included, formulate a mock cost report from a sample trial balance.
• 9) Statement of Operations (Income Statement)
  Illustrate how gross revenue is formulated, describe how and why a contractual/reserve is created, discuss the use of an aging schedule, explain classification of expenses, discuss the concept of bad debt expense, justify the use of responsibility accounting and monthly variance analysis.
• 10) Statement of Financial Position (Balance Sheet)
  Define current assets and current liabilities, discuss hospital related receivables, inventories and investments, explain tax exempt debt, clarify the differences between unrestricted, temporarily restricted and permanently restricted assets, discuss the statement of cash flows.
• 11) Coding
  Explain the purpose of the CDM, illustrate hospital pricing, define a SIM/FIM code, explain the benefits of an electronic medical record (EMR), describe an ICD-9-CM code, differentiate between CPT-4 and HCPCS codes, explain the monetary significance of coding accuracy.
• 12) Managing the Month End Close Process
  Discuss and detail the month end close process, explain the purpose of adjusting journal entries and balance sheet reconciliations, explain the benefits of a participative management approach and illustrate the significance of job enrichment and job rotation strategies.
• 13) Calculating the Financial Impact of Hospital Length of Stay
  Discuss how decreasing patient days can possibly decrease costs and improve net income, illustrate how decreasing days can also negatively affect revenue and provide a reimbursement model that reveals the potential loss or gain by decreasing patient days.
• 14) Future of Health Care Accounting
  Provide an overview of the stability and benefits that the health care accounting field provides, explain the emergence of the Accountable Care Organization, discuss the bundled payment model and examine the future of health care reform.
• 15) Incorporating Faith Into the Workplace (Epilogue)
  Provide an overview to why a hospital accountant should incorporate ones religious beliefs into the workplace.