1. Explain the inpatient and outpatient reimbursement methodology for Medicare as a payer
Reimbursement is calculated in outpatient regarding the case date, the contract rate, the fee charged for the services received as well as the percentage of the bill incurred. In patients, however, get a difference at the rate whereby it is calculated as a percent of the incurred cost per diem.
2. Explain the inpatient and outpatient reimbursement methodology for commercial payer
For commercial payers the for outpatient, the services are reimbursed using either of the methods; percentage of the accrued charges, the fee for the service, fee schedule as well as case rate. Meanwhile, for inpatients all the charges are made for the duration the patient stays in the hospital using the per diem costs, the percent of the bill, fee for services provided, the case as well as the contract rate
3. Assume the following for your facility
Fixed Cost = $20,000
Selling Price = $200
Variable Cost = $40
What is the contribution margin in percent?
Contribution Margin per Unit (Revenue per unit – Variable cost per Car)
CM Ratio = CM per Unit / Sales per Unit
= Revenue per Unit – Variable Cost per Unit = 200 – 40 = 160
= 160/ 200
= 0.8 x 100 = 80%
4. What is the definition of Planning? Of strategic planning? Of operational planning?
Planning is the process that is set by the management team for the hospital to ensure that goals are well defined. The resources that are meant for the success of the program have to be set up as well as a following of the values of the organization so as to achieve the plan.
5. Explain the role of Chief Operating Officer
Roles of Chief Operating Officer have changed in the recent years due to the demand for quality healthcare has led to the need for employment of the Bureau who manage the care not only in the hospital but the community that it serves. The officer has to be conversant with the operations of the facility as well as coordinating with the health care personnel to ensure that short and long-term care is provided to the patients.
6. Distinguish between the purpose of healthcare management and healthcare financial management
The goal of healthcare management is to ensure that the organization achieves the objectives that have been set appropriately. The managers make decisions which affect the performance of the employees. They have the role of recruiting staff members as well as the technology required for the units to function. The help in making financial decisions that are necessary for the patients to be attended to sufficiently. On the other hand, healthcare financial management deals mainly with commercial negotiations for the company to help in ensuring availability of finances for emergencies, payment of the employees as well as making decisions at management meetings that make it possible for the business to make strategic investment plans.
The chief financial officer is charged with the responsibility of setting goals and objectives that are related to finances of the hospital. The offer also guides the facility on investment ideas that are aimed at earning more profits. The other role is to ensure that the financial records are up to date and well filled for future reference (Shinkman, para 3).
8. Explain the role of a Chief Compliance Officer
A chief compliance officer of any organization is tasked with the role of monitoring and promoting the standards that have been set to achieve the quality of care desired. Their responsibility has to be supported mainly by the technical team that can discern what needs to be done. The officer makes sure that the employees understand the compliance program that has been set in place by the hospital to provide quality health care.
9. Discuss the difference between second party payment and third party payment
The second party is described as the organization that is paid to provide service to a particular person while third party payment occurs when a person who is not a beneficiary pay for services received in a hospital, for example, an employer
10. What is the definition of accounts receivable? What are the steps in managing accounts receivable?
Accounts receivable is a claim or debt that the organization has against the patient that has been treated at the facility and the steps used in managing accounts receivable include the evaluation of the history of the organization both financial and credit. Then ensure a payment term that is well understood. The organization then has to do electronic invoices to ensure there is enough evidence. Payment methods that the company provides as well have to be varied to cater for different needs. Finally, the hospital can outsource people to manage the accounts to ensure auditing of the process.
4. What is the definition of Planning? Of strategic planning? Of operational planning?
Planning is the process that is set by the management team for the hospital to ensure that goals are well defined. The resources that are meant for the success of the program have to be set up as well as a following of the values of the organization so as to achieve the plan.
5. Explain the role of Chief Operating Officer
Roles of Chief Operating Officer have changed in the recent years due to the demand for quality healthcare has led to the need for employment of the Bureau who manage the care not only in the hospital but the community that it serves. The officer has to be conversant with the operations of the facility as well as coordinating with the health care personnel to ensure that short and long-term care is provided to the patients.
6. Distinguish between the purpose of healthcare management and healthcare financial management
The goal of healthcare management is to ensure that the organization achieves the objectives that have been set appropriately. The managers make decisions which affect the performance of the employees. They have the role of recruiting staff members as well as the technology required for the units to function. The help in making financial decisions that are necessary for the patients to be attended to sufficiently. On the other hand, healthcare financial management deals mainly with commercial negotiations for the company to help in ensuring availability of finances for emergencies, payment of the employees as well as making decisions at management meetings that make it possible for the business to make strategic investment plans.
The chief financial officer is charged with the responsibility of setting goals and objectives that are related to finances of the hospital. The offer also guides the facility on investment ideas that are aimed at earning more profits. The other role is to ensure that the financial records are up to date and well filled for future reference (Shinkman, para 3).
8. Explain the role of a Chief Compliance Officer
A chief compliance officer of any organization is tasked with the role of monitoring and promoting the standards that have been set to achieve the quality of care desired. Their responsibility has to be supported mainly by the technical team that can discern what needs to be done. The officer makes sure that the employees understand the compliance program that has been set in place by the hospital to provide quality health care.
9. Discuss the difference between second party payment and third party payment
The second party is described as the organization that is paid to provide service to a particular person while third party payment occurs when a person who is not a beneficiary pay for services received in a hospital, for example, an employer
10. What is the definition of accounts receivable? What are the steps in managing accounts receivable?
Accounts receivable is a claim or debt that the organization has against the patient that has been treated at the facility and the steps used in managing accounts receivable include the evaluation of the history of the organization both financial and credit. Then ensure a payment term that is well understood. The organization then has to do electronic invoices to ensure there is enough evidence. Payment methods that the company provides as well have to be varied to cater for different needs. Finally, the hospital can outsource people to manage the accounts to ensure auditing of the process.
11) Explain the rationale for granting organizations tax-exempt status.
Some companies usually enjoy consideration as federal tax exempt because of the provision in the Tax Code of the United States under 501 (c) 3. One of the reasons for this grant could be that the organization lies in the category of the Charitable Tax Exemption, which allows revenues such as income and federal corporate to be exempted from the taxation practices. Some of the certain reasons for the tax-exempt status could be that the firm is under a group exemption and falls under assessment by a parent company. Another reason could be that because it is a church or because the organization receives less than five thousand dollars regarding gross receipt. The other rationale could be that it is a fiscal conduit.
12) Explain the inpatient and outpatient reimbursement methodology for a Self-Pay patient.
For the self-pay patient, the repayment depends on the date in which the service was rendered however in the inpatient case; it usually depends on the public aid. As for the outpatient, the methodology applied demands that the apportionment for reimbursement should be in relation to the service cost.
13) Explain the inpatient and outpatient reimbursement methodology for a Managed Care Payer.
In the case of inpatient treatment, the third party is the one involved in the reimbursement process regarding comprehension. As for the outpatient, which seems to incur much more costs for the companies involved, the firms provide the initial costs. Documentation is paramount, and there must be a timeframe for the reimbursement.
14) Explain the role of a Chief Information Officer.
This officer’s work in a company tends to be influenced by the corporate strategy and the technology adopted. The responsibilities include formulating technological strategies and any budgetary formulations needed for the business. Furthermore, the worker introduces the ICT vision through strategic planning. He or she oversees the other workers; process on matters relating to technology to ensure the set outcome is achieved. If the CIO does the work as expected, then the company should be more competent digitally.
15) Explain the inpatient and outpatient reimbursement methodology for Medicaid as a payer.
When Medicaid is the payer, then the payment occurs in relation to the costs involved and the duration of the stay of the patient in the case of inpatient. Some of the reimbursements have occurred regarding the diagnosis-related groups, which are referred to as the DRGs. In the case of outpatient, it also considers the patient classification. For the outpatient, the methodologies include ambulatory patient classification, which can either be simple or of a full nature.
16) Assume the following for your facility:
Fixed Cost = $20,000
Selling Price = $200
Variable Cost = $40
What is the breakeven point in units?
Break Even Point (BEP) = Fixed Costs / CM per Unit (Revenue per unit – Variable cost per Unit)
BEP = 20000 / (200 – 40)
= 20000/160
= 125 Units
17) Assume the following for your facility:
Fixed Cost = $20,000
Selling Price = $200
Variable Cost = $40
What is the breakeven point in dollars?
BEP in dollars = Fixed Expenses / 1 – Variable Cost/ Sales
= 20000/ 1-40/200
= 20000/ 1-0.2
= 20000/0.8
= $25,000/=
18) Explain the role of a Chief Executive Officer.
Also known as the CEO, this worker is usually the highest ranked executive in the firm. With this status comes great responsibilities that determine the general success of the enterprise. Some of the roles of the CEO include the provision of the necessary resources to the subordinates and ensure the allocation facilitates optimum production and output. The other function is providing a vision for the whole organization. The vision has to be strategic, clear and well communicated to the rest of the firm to ensure responsibilities are done well and the overall goal achieved. Building culture is among the most important roles of the CEO. By setting the values, the executive needs to ensure application of a certain culture to ensure the goals of the organization as achieved and customer experience enhanced. Overseeing the performance of the enterprise is also a task that is expected of the CEO (Trammel 7). The individual must be keenly involved in the motivation of the workers to perform better through being keen and making good decisions, which is also a key responsibility.
Works Cited
Trammel Joel. “Lead from the Top: 5 Core Responsibilities of a CEO. Entrepreneur. 1 May 2014. Web. 16 March 2016. (http://www.entrepreneur.com/article/233354)
Ron, Shinkman. The changing roles of the Hospital CFO. Fierce Health Finance. Web 16 March 2016. (http://www.fiercehealthfinance.com/story/changing-role-hospital-cfo/2012-12-17)
