Cleverley (2011) describes a model of how the financial information
is collected and analyzed in a health care organization for the purpose
of decision making :
a. Evaluating the financial condition
b. Evaluating stewardship of asset resources
c. Assessing organizational efficiency of patient care workflow
d. Assessing the effectiveness of organizational service outcomes
e. Determining compliance of operations with Board directives
As a member of a consulting team you have been asked by the
Board of Trustees to create an assessment tool to evaluate the
Patient billing and coding process in a 250 bed community hospital
located in an affluent suburb.
First, describe the key elements of an efficient hospital patient
financial billing ,coding and revenue collections operation. Suggest
qualitative and quantitative benchmarks that can be used to
measure positive financial outcomes.
Second, provide suggestions on how the board can improve their
fiscal stewardship by maximizing revenue collections.
2. List and describe the characteristics of private and government based
health care insurance payers that impact revenue generation in
health care organizations. How does an increase in Medicare and
Medicaid patients in the payer mix for a HCO affect senior management
strategies to maximize patient care revenues ?
3. How does the chief regulatory compliance officer change organizational
culture to promote accurate documentation of clinical procedures ?
What type of support is expected from the Board in this process ?
4. Chapter 6 suggests that the solvency and viability of a health care organization
is determined in part by the ability of the organizations senior leadership
to effectively control revenue generation. Taking into consideration the
prevalent payment methods of cost based ,fee for service, percentage
of billed charges or bundled payments ,list and describe in detail the ways
financial managers enhance revenue sustainability.
5. Discuss the specific methods that health care financial managers justify the
reasonableness of procedural charges that are often marked up several
hundred per cent over actual costs.
6. Describe how the Community Value Index measures the viability and solvency of
a non-profit health care organization. Discuss in detail the specific measurement
components that make up the Index.