The Revenue Cycle
The revenue cycle is made of six stages which include service provision, documenting of services, establishment of charges for the rendered services, preparing a claim, submitting claims to the payer, and payment collections. Services rendered include physical samples, medication prescriptions, and ordering any tests for treatment. The information is documented in the second step for billing. The charges will then be initiated at the third stage and the fourth stage will involve the preparation of the bill and claim. Claims are submitted to the payer where they are processed for payment through software and lastly collected for payment.
A1. HIM Work
Health and Information Management staff have a critical function in using their skills throughout the reimbursement and coding process. The staff can ensure correct coding and correct documentation in order to support the submission of a claim. They can offer additional support during auditing and error free claims (Skurka, 2017).
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A2. Coding and Billing
This process begins through the collection of data for the submission of a claim and its reimbursement and is completed upon payment of the services. The coder should ensure that the claim is submitted correctly and revenues are correct. Revenue losses may occur if the coding and billing services is not captured accurately.
A3. The Operating Revenue
This revenue collected throughout the continuous running of a business is known as the operating revenue. The operating revenue will affect the amount of services charged on a continuous basis and the amount of services rendered for the specific revenue. An organization should set appropriate goals and objectives to ensure proper operation revenue management.
Evaluation of Financial Conditions
Evaluation of the financial positioning of a business can be done through analyzing of the financial reporting. Balance scorecards and dashboards can be implemented during the evaluation. Additionally, operational margins may also be measured through analysis of operational activities and non-operational margins.
B1. Profitability and Risk
Review of the different aspects of the financial statement of a business entity such as the assets, liabilities, and capital can provide an analysis of the profits and risks inherent in the business. Financial ratios can such as the profitability ratio and debt ratio can also be calculated to determine the profitability of an organization and the level of risk created by debt (Robinson et al., 2015).
B2. Financial Viability of Healthcare Organizations
The financial viability will be influenced by several factors such as healthcare provider prices, hospital expenses, technology, waste management, and taxes. The financial viability is based on the having excess revenue over experiences and being able to meet commitment to creditors while being profitable.
Financial Decision-Making
The process of making financial decisions involves taking courses of action that can steer an organization towards a specific path. The organization can undertake financial decisions based on a capital budgeting or long-term approach, capital structure, or working capital which can affect operations of the healthcare organization.
Fraud and Abuse Regulations
Regulations that deal with fraud and abuse were formulated to prevent any possible abuse or inappropriate acts undertaken when handling financial operations. The regulations ensure that financial decisions made do not exploit users of healthcare such as ensuring appropriate billing and use of federal services rendered (Staman, 2014).
D1. Stark II Importance
The Stark II law prohibits medical practitioners from giving patient referrals to a specific health services when there is a relationship between the physician and that entity. This law is important to prevent physicians having a conflict of interest and showing bias when proposing treatment options to patients.
D2. Anti-Kickback
The statute forbids exchanging of payment or any compensation whatsoever service referral towards Medicare, a federal program. The statute protects service providers’ beneficiaries from being influenced by money on decisions for referral. This can guard against poor service quality and increased costs.
D3. False Claims Act
The act makes it illegal for an individual to create a false record or false claim dealing when dealing with federal programs in health care. The act is important in preventing stealing of money and recovering money from U.S. government contractors that may be acquired illegally.
Healthcare Pricing
Some of the issues that can affect healthcare prices include the market structure, the desired revenue, the market structure, and competitive position. The market is determined by sellers and buyers and their specific healthcare plans. The desired revenue can be used to provide a revenue estimate for the organization while the competitive position is based on whether a service is regarded as being of high quality or not.
Financial Planning and Strategic Planning
Financial planning enables budgeting of funds to meet the organizational goals while strategic planning entails the path that a business may want to undertake. Both are involved in definition of objectives, data analysis, plan implementation, and monitoring of results of a business.
F1. Financial Plan Development
The development of a financial plan is done through a series of steps that include assessment of the financial position, assessment of historical growth, debt policy definition, pan development that aligns with specific needs, and assessing the growth rate in equity to identify whether the outcomes can be achieved.
F1A. HIM Manager Interaction
The HIM manager ought to have a close communication with the financial sector regarding various issues of financial planning and revising the plan. The HIM manager ought to provide support regarding auditing of claims, claim denials, and any other financial records or data.
Financial Management Control Process
The financial management control process includes several phases programming, budgeting, planning, accounting, analysis and reporting (Theriou, 2015). Planning involves laying out the financial strategy of the organization. Programming phase involves making decisions regarding the sizes and types of programs. Budgeting involves allocating funds and resources to key processes. Accounting, analysis, and reporting are involved in the later stages of financial management after funds have been released.
References
Robinson, T. R., Henry, E., Pirie, W. L., & Broihahn, M. A. (2015). International financial statement analysis . John Wiley & Sons.
Skurka, M. A. (Ed.). (2017). Health information management: principles and organization for health information services . John Wiley & Sons.
Staman, J. A. (2014, September). Health care fraud and abuse laws affecting Medicare and Medicaid: an overview. Library of Congress, Congressional Research Service.
Theriou, N. G. (2015). Strategic Management Process and the Importance of Structured Formality, Financial and Non-Financial Information. European Research Studies , 18 (2), 3.
