SUBDOMAIN 732.2 – Financial Resource Management and Healthcare Reimbursement

Competencies:
732.2.9: Healthcare Finance – The graduate develops a broad knowledge of financial information and organization classification as well as financial decision-making processes in the operations of healthcare organizations.
732.2.10: Operating Revenue and the Revenue Cycle – The graduate describes and compares sources of operating revenue and facility-wide structures of revenue cycles in healthcare organizations, and calculates rates of federal programs applicable to healthcare organizations.
732.2.12: Revenue Determination – The graduate describes the general factors that influence healthcare pricing and the components of negotiating a managed care contract, and calculates returns on investment for healthcare organizations.
732.2.13: General Accounting Principles and Financial Statements – The graduate describes the functions of financial and managerial accounting, and analyzes financial statements for healthcare organizations.
732.2.14: Strategic Financial Planning – The graduate explains the strategic financial process, the components of cost concepts, and decision-making and capital formations, and evaluates financial plans for healthcare organizations.
732.2.15: Management Control Process – The graduate explains the management control process and analyzes variances for management use in healthcare organizations.

Introduction:

There are many factors to be considered when examining organizational finances and making decisions that have long-term effects on a medical practice. In healthcare organizations, there are multiple payers that influence reimbursement. There are external agencies such as the federal or state government, which may set rate limits that impact revenues. Also, there are outside forces such as marketing structure and competition that influence pricing of healthcare services. Managers who oversee budgets and help to make financial decisions need an overall understanding of the forces shaping this environment.

Requirements:

Create an essay discussing the factors that management would need to consider in guiding a healthcare practice in a financially prudent manner.

A. Describe the types of financial documentation a healthcare practice should use to determine its current financial status.
1. Discuss what influences price setting for services in a healthcare practice.
2. Discuss what factors influence revenue collection in a healthcare practice.
3. Discuss what types of decisions can be made and/or actions taken from analyzing this information.

B. Explain the importance of developing a financial plan for a healthcare practice.
1. Discuss the steps involved in developing the plan from part B.

C. Discuss how to create a budget for a healthcare practice.

D. Discuss the use of a management control process for a healthcare practice.
1. Describe the phases of the management control process.

E. When you use sources, include all in-text citations and references in APA format.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section.