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Profitability: comparing hospital results with other industries.

Changes in healthcare economics now permit more meaningful financial comparisons between hospitals and other industries. A study focusing on return on equity and other financial ratios highlighted critical changes needed to improve the fiscal health of hospitals. These suggestions include increasing net prices on existing product lines, entering new markets, using short-term debt to relieve long-term debt burdens, and expanding uses of operating leases.

Financial Audit↗

Examine revenue cycle to smooth patient accounting.

Because it is a hospital's prime generator of cash flow, accounts receivable must be closely and creatively managed. Patient accounts troubleshooting, however, involves looking at more than the goings-on in the billing department. An effective approach includes an examination of all departments' effects on the revenue cycle.

Accounts Payable and Receivable↗

Pressure growing in the fight to stay tax exempt.

With legislative and regulatory scrutiny trained on not-for-profit hospitals, administrators should brace themselves for potential challenges to their tax-exempt status. Industry leaders recommend reviewing documents that outline a hospital's charitable purpose, setting a clear policy on providing care to persons unable to pay for it, placing a value on community services, and taking other steps. Whether changes in laws governing tax exemption come from national, state, or local efforts, hospitals should be ready to show proof of their charitable activities.

Charities↗

Charge reviews can beef up bottom lines.

Traditionally, healthcare organizations have been reluctant to pursue charge reviews until pressed to do so by third-party challenges to their charges. But a hospital pursuing either a concurrent or retrospective review may realize significant revenue enhancement--and not only from correcting undercharges on charge-based accounts. Charge reviews can lead to smoothed patient documentation, better cost accounting, more appropriate Medicare payment, and, ultimately, an improved bottom line.

Concurrent Review↗

The case for comparability in financial reporting.

Government-owned organizations are accountable to citizens and their elected representatives. These organizations must provide financial information that will help in determining whether they are effectively pursuing their primary goal, which is to promote the general welfare. Regardless of the kind of service provided by a government-owned organization, the information needs of citizens and their elected representatives must be considered when developing accounting rules. If these needs are ignored or compromised in favor of the needs of other users, such as investors or creditors (the primary users of business financial reports), then financial reporting by government-owned organizations will not meet its objectives.

Accounting↗

IRS memorandum limits joint ventures.

Based on a new memorandum, the Internal Revenue Service (IRS) will be looking at joint hospital/physician activities with greater attention to the nuances of public versus private benefit. As a result, hospitals face greater risk of losing their tax-exempt status in the maze of joint ventures, physician recruitment, and practice acquisition. To be successful, ventures will have to be backed by sound reasoning and thorough documentation.

Community-Institutional Relations↗

Business continuity planning: the hospital's insurance policy.

A comprehensive business continuity plan can prepare an organization for unforeseen circumstances that would otherwise totally disrupt the delivery of healthcare services. Properly planning for such an event can build confidence in the organization and safeguard the assets of the institution. In this article, the authors present a step-by-step plan for creating a business continuity plan.

Disaster Planning↗

Healthcare Financial Management Association, Principles and Practices Board. Statement No. 16. Classifying, valuing, and analyzing accounts receivable related to patient services.

This Principles and Practices Board project was undertaken in response to the frequent requests from HFMA members for a standard calculation of "days of revenue in receivables." The board's work on this project indicated that every element of the calculation required standards, which is what this statement provides. Since there have been few standards for accounts receivable related to patient services, the industry follows a variety of practices, which often differ from each other. This statement is intended to provide a framework for enhanced external comparison of accounts receivable related to patient services, and thereby improve management information related to this very important asset. Thus, the standards described in this statement represent long-term goals for gradual transition of recordkeeping practices and not a sudden or revolutionary change. The standards described in this statement will provide the necessary framework for the most meaningful external comparisons. Furthermore, management's understanding of deviations from these standards will immediately assist in analysis of differences in data between providers.

Accounts Payable and Receivable↗

Practice acquisition: buy or build?

While the advantage to a hospital of having a stake in a physician's practice is clear, the manner by which it should gain that stake is not. Should a hospital acquire an existing practice through outright purchase or assist a physician in building a new one? This article discusses the financial components that influence this decision and presents a pro forma analysis model.

Cost-Benefit Analysis↗

Estimating the value of group medical practices: a primer.

Estimating the value of a group medical practice can be a difficult task for a healthcare financial manager. There are three generally accepted approaches to estimating value, however, that a financial manager can take: the income approach, the cost approach, and the market approach. Whichever approach or combination of approaches is chosen, a financial manager must thoroughly understand the subjective nature of value and how it relates to the objective task of performing such an estimation.

Accounting↗

Methods for optimizing revenue in rural hospitals.

Rural hospitals have been failing over the last two decades, and one of the biggest reasons has been lack of attention paid to detail and accuracy in the coding and pricing of services rendered. Most research that has explored the problems of coding accuracy and its impact on reimbursement has focused on coding by medical record professionals, but many coding procedures are performed by "front line" lower-level employees working in a hospital's laboratory, radiology department, pharmacy, or other ancillary service departments. This article explains how rural hospitals can optimize their reimbursement and adhere to Medicare/Medicaid and other third-party payer regulations by training coders properly and by reviewing their pricing policies to make sure that prices charged accurately reflect the true cost of services.

Data Collection↗

Determining optimal risk retention in the healthcare industry.

Several methodologies may be used for determining the level of risk that a healthcare organization should retain as part of its overall insurance and risk management program. Approaches used in the past, however, may not be appropriate to use in the 1990s. This article proposes a more comprehensive methodology of risk determination.

Accounting↗