The new revenue recognition standard issued by the FASB in 2014 fundamentally changes how hospitals recognize revenue from contracts with customers. Hospitals must now recognize revenue when promised goods or services are provided to patients in an amount equal to the transaction price, which is the amount of consideration the hospital expects to receive after accounting for both explicit and implicit price concessions. Determining the transaction price involves a five-step process that includes identifying contracts, determining the transaction price by estimating variable consideration such as discounts and price concessions, and allocating the transaction price to distinct performance obligations. Hospitals must implement the new standard for annual reporting periods beginning after December 15, 2017 for public entities and after December 15, 2018 for nonpublic entities.
Reaching Out, Inviting In: How Medical Call Centers Can Give Hospitals an Edg...TinaMinnick
Certainly the advent of value‐based purchasing attaches a persuasive incentive for improved core measures and HCAHPS performance, but as any hospital that has experienced a negative letter to the editor or defaming remark on a website will attest, the hard and soft costs of patient satisfaction can impact more than just the bottom line. Forward‐thinking organizations not only seek to understand the relationship between patient communications and satisfaction,they are forging it.
2 examples of transactional vs high-trust people practicesHayat Hamici
It's often not about what you do, but about how you do it. These 2 examples show you that it doesn't take much to transform transactional interactions with your employees into moments that foster trust and strong relationships.
Nick Garner - LAC 2017 - The great 'brand phrase' goldmineiGB Affiliate
It's been talked about before; ranking on brand phrases, but today this strategy makes more sense than ever. Operators are winning more rankings on generic phrases, squeezing out affiliates and forcing you to rethink you rankings game plan.
Why are operators getting stronger and stronger rankings? It's because links are losing their power and the vacuum is being filled with engagement signals. If the new battleground is engagement, how can affiliates be really engaging and earn more money?
Nick Garner, Founder & CEO Oshi Online Casino will demonstrate how affiliates can rank and convert on brand phrases and why for Oshi Online Casino, to do so is win-win for both the operator and affiliate.
Thinking 'engagement first'
Targeting operators who are easy to rank on
How and why ranking on brand is a fair deal for everyone
Judith lewis - LAC 2017 - Walking hand in hand: Combining PR and SEOiGB Affiliate
A joint PR and SEO strategy can help your website strike gold. Having a strong online brand reputation will only ever grow your link acquisition without introducing any black-hat tactics. However, many affiliates can ignore PR as a “nice to have” rather than a “need to have” which instantly rules out some effective wins for your SEO goals and the opportunity to grow your business from a website to a brand.
Andy Bar, Head Yeti at leading PR and SEO agency 10 Yetis, will demonstrate the fundamental tools and real results that can be achieved by a united PR and SEO front.
What kind of campaigns work (ideas and themes)
How you can fast track the volume of links
How you can compete with bigger brands
Take away of 10 practical tips
Reaching Out, Inviting In: How Medical Call Centers Can Give Hospitals an Edg...TinaMinnick
Certainly the advent of value‐based purchasing attaches a persuasive incentive for improved core measures and HCAHPS performance, but as any hospital that has experienced a negative letter to the editor or defaming remark on a website will attest, the hard and soft costs of patient satisfaction can impact more than just the bottom line. Forward‐thinking organizations not only seek to understand the relationship between patient communications and satisfaction,they are forging it.
2 examples of transactional vs high-trust people practicesHayat Hamici
It's often not about what you do, but about how you do it. These 2 examples show you that it doesn't take much to transform transactional interactions with your employees into moments that foster trust and strong relationships.
Nick Garner - LAC 2017 - The great 'brand phrase' goldmineiGB Affiliate
It's been talked about before; ranking on brand phrases, but today this strategy makes more sense than ever. Operators are winning more rankings on generic phrases, squeezing out affiliates and forcing you to rethink you rankings game plan.
Why are operators getting stronger and stronger rankings? It's because links are losing their power and the vacuum is being filled with engagement signals. If the new battleground is engagement, how can affiliates be really engaging and earn more money?
Nick Garner, Founder & CEO Oshi Online Casino will demonstrate how affiliates can rank and convert on brand phrases and why for Oshi Online Casino, to do so is win-win for both the operator and affiliate.
Thinking 'engagement first'
Targeting operators who are easy to rank on
How and why ranking on brand is a fair deal for everyone
Judith lewis - LAC 2017 - Walking hand in hand: Combining PR and SEOiGB Affiliate
A joint PR and SEO strategy can help your website strike gold. Having a strong online brand reputation will only ever grow your link acquisition without introducing any black-hat tactics. However, many affiliates can ignore PR as a “nice to have” rather than a “need to have” which instantly rules out some effective wins for your SEO goals and the opportunity to grow your business from a website to a brand.
Andy Bar, Head Yeti at leading PR and SEO agency 10 Yetis, will demonstrate the fundamental tools and real results that can be achieved by a united PR and SEO front.
What kind of campaigns work (ideas and themes)
How you can fast track the volume of links
How you can compete with bigger brands
Take away of 10 practical tips
INDIBA FISIOTERAPIA - FISIOESTÉTICA
Fisioestética facial y corporal con Indiba Activ 902 (radiofrecuencia)
Radiofrecuencia Facial:
Los tratamientos faciales con Indiba Activ es un tratamiento no invasivo dirigido a personas con arrugas, bolsas de ojos, falta de brillo, flacidez y falta de colágeno en la piel.
La finalidad de la aplicación de la tecnología del Indiba Activ sobre la piel es la de elevar la temperatura del tejido hasta 4 grados centígrados, provocando una aceleración del metabolismo en las células de un 13% por cada grado de temperatura. Teniendo en cuenta esto podemos acelerar el crecimiento celular y la producción de colágeno y elastina, mejorar la oxigenación celular, aumentar la porosidad de la membrana celular aumentando el flujo de toxinas del interior al exterior, llevar a la superficie de la piel sangre llena de nutrientes que va a dar un aspecto luminoso a la piel y mejorar, en definitiva, la flaccidez, la falta de vitalidad de la piel y prevenir posibles arrugas.
¿Cuando podemos aplicar este tratamiento? Se puede realizar un tratamiento de “choque” de 6 sesiones repartidas en un corto espacio de tiempo y ampliar después a un tratamiento cada 3 semanas, un mes o mes y medio. O por el contrario si tenemos un evento cercano en el que queremos que nuestra piel luzca una apariencia perfecta, podemos hacer entre dos y tres sesiones en un corto periodo de tiempo siempre cerca de la fecha señalada.
Radiofrecuencia corporal:
El método Indiba Activ aplica una tecnología desarrollada y patentada por Indiba, que logra la elevación local de la temperatura del tejido humano (hipertermia profunda) mediante la circulación de corrientes de alta frecuencia a través del mismo, obteniendo una gran eficacia en los tratamientos de estética. Mejora la microcirculación, disminuye el edema, reduce los depósitos grasos y la flacidez cutánea.
Trabajamos a nivel local una zona del cuerpo: glúteos, abdomen cartucheras... mediante la aplicación de Indiba Activ y un masaje indoloro produciendo efecto mecánico y movilizando los depósitos de grasa, mejorando la circulación y favoreciendo la producción de fibroblastos y con ello mejorando la flaccidez gracias a la producción de colágeno.
Podemos trabajar problemas como:
– Celulítis: edematosa / fibrosa / adiposa
– Postcirujía: drenaje de edemas, cicatrización, reabsorción de hematomas y lifting.
– Remodelación y reafirmación corporal
La pasión por lo que hacemos, nos lleva a contar con un equipo comprometido, altamente formado y capacitado que trata de dar lo mejor de si en todo momento. La formación continua y nuestro afán por aprender y mejorar cada día, nos hacen estar siempre a la vanguardia ofreciendo los tratamientos más innovadores y efectivos del mercado.
Quédate con nosotros, déjate mimar!
Harry hugo -LAC 2017 - "Social media doesn’t acquire users”: Why you’re wrong iGB Affiliate
Today’s consumer is increasingly concerned by what happens in their social sphere when it comes to brand recognition, trust and their buying decisions. Affiliates are in an opportune position to be involved with engaged social audiences and as a direct result, increase their customer acquisition and website traffic.
Harry Hugo, Director of the trend-setting social media experts at The Goat Agency, will demonstrate proven examples of how influencer marketing can transform your social media marketing and see genuine results.
Building a social media following that are engaged and vocal
How influencer marketing on social channels creates direct acquisition
Who are your influencers and how to create social influence – industry evidence in action
Lukasz Zelezny - LAC 2017 - Optimising site structure for indexingiGB Affiliate
You can tick all the SEO boxes possible but if the Googlebots can’t crawl and index your site quickly and effectively, it could all be for nothing. Thankfully, there are some essential must-dos that will ensure that you’re helping the bots find your website and index the most useful information for your rankings. From creating a sitemap to optimising your content and even using social media, Lukasz Zelezny will lead you through the best strategies to achieve a well-indexed website.
What does Google look for and what does Google rate highly?
Utilising tools such as Google search console
Internal linking structure
Mobile vs desktop indexing
GLOBAL PERSPECTIVE CAMBRIDGE IGCSE: WATER, FOOD AND AGRICULTUREGeorge Dumitrache
GLOBAL PERSPECTIVE CAMBRIDGE IGCSE: WATER, FOOD AND AGRICULTURE. Definitions, questions for the research project, global/international perspectives, local/national perspectives, family/personal perspectives, useful websites.
Research several types of reimbursement methods for healthcare for.docxronak56
Research several types of reimbursement methods for healthcare for physicians in Saudi Arabia. Draft a paper comparing the different methods.
Be sure to include:
Reimbursement of Claims
1. Introduction
2. Elements of Reimbursement
3. Reimbursement in Saudi Arabia
4. Evaluating Types of Reimbursement
5. Compare and contrast Types of Reimbursement
6. Impact of reimbursement on healthcare facilities
7. Trends in Healthcare Reimbursement
8. Conclusion
The following information can be used
1- Introduction (minimum 100 words) Definition of reimbursement
Reimbursement is another term for payment. A provider or facility submits a claim. Then the health insurance company or third-party administrator pays the provider or facility for their claim based on their contract. It sounds simple, but the payment arrangements in healthcare can be complex. As providers do not generally receive full payment for services upon a patient’s receipt of services under a health insurance scheme, reimbursement becomes essential to a provider’s livelihood.
2- Elements of Reimbursement (minimum 100 words)
· Coverage refers to a set of rules that explain when a payer will or will not pay for a product or service. Coverage can vary by payer and depends on what each payer considers to be medically necessary. In general, payers want to see regulatory approval, strong clinical evidence demonstrating the treatment is at least as beneficial as the established alternative, and a demonstration of the treatment’s cost-effectiveness. Payers expect well-designed clinical trials with results published in peer-reviewed journals. Support from the physician community and professional societies are also increasingly important to adoption and coverage of new technology.
· Coding refers to the sets of alphanumeric codes that are the language of billing. Providers use codes to tell a payer what products or services were provided and why. There are three main sets of codes: CPT, HCPCS, and ICD-10-CM. Choosing the right code to accurately describe a product or service while maximizing payment requires a detailed understanding of the coding structures. If no code exists, it is important to understand the approval process for acquiring a new one – whether it be a CPT code used by physicians to describe what is done to a patient, or an HCPCS code which describe products not described by CPT codes. Finally, it is important to understand that choosing the wrong code creates not only financial implications but also legal culpability.
· Payment is driven by the coding systems and is probably the most complicated element of reimbursement. Although coding drives payment, reimbursement is not quite as simple as just submitting an active code. Payment is driven by complex payment methodologies that differ depending on the site of care where delivery is provided. For example, payment for the same procedure in an Ambulatory Surgery Center (ASC) is often less than payment for the same procedure perfo ...
Professional Services Agreement: An Alternative Strategy to Hospital EmploymentCBIZ, Inc.
Any compensation arrangement between a hospital and physician must meet a litany of regulatory constraints, mainly those implicating the Stark Laws, the Anti-Kickback Statute, and the IRS regulations of not-for-profit entities.
Hospital-based contracts are often essential to secure coverage for physician services like anesthesiology, pathology, critical care, and more. These contract terms can be complex, and address elements like call coverage, medical direction, quality initiatives, and conditions of exclusivity. Hospital-based services are among the fastest-growing segments in hospital expenses.
What is an Accountable Care Organizations (ACO) How does an ACOs .pdfwasemanivytreenrco51
What is an Accountable Care Organizations (ACO)? How does an ACO\'s economics work to
manage costs and quality?
Solution
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care
providers, who come together voluntarily to give coordinated high quality care to their Medicare
patients.
An accountable care organization (ACO) is a healthcare organization characterized by a payment
and care delivery model that seeks to tie provider reimbursements to quality metrics and
reductions in the total cost of care for an assigned population of patients. A group of coordinated
health care providers forms an ACO, which then provides care to a group of patients. The ACO
may use a range of payment models (capitation, fee-for-service with asymmetric or symmetric
shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the
quality, appropriateness and efficiency of the health care provided. According to the Centers for
Medicare and Medicaid Services (CMS), an ACO is \"an organization of health care providers
that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who
are enrolled in the traditional fee-for-service program who are assigned to it.
Design and Structure
There is no single organizational model for developing an ACO. ACOs may be formed and
organized by health systems using employed and contracted physicians, by integrated delivery
systems, by physician groups (either primary care or multispecialty) or through joint ventures or
contractual relationships among providers. Regardless of the organizational structure, an ACO
must be physician-led and physician-driven. Physician leadership is critical because an ACO is
primarily a vehicle for clinical integration, not financial or risk integration. Only physicians are
able to develop, monitor and adjust clinical care protocols that can more efficiently use resources
based on documented effectiveness.
Qualifying ACOs will be assigned a pool of patients whose care the ACO will be responsible for
managing in a cost-effective and clinically appropriate manner. The ACO will need to develop
internal mechanisms for monitoring and managing costs and quality that cut across traditional
reporting lines and result in a higher degree of clinical interdependence than is typical in a less-
integrated medical community.
The PPACA states that any of the following groups of providers of services and suppliers that
have established a mechanism for shared governance are eligible to participate, in accordance
with regulations to be developed by the Secretary of Health and Human Services (HHS):
ACOs Under Health Reform
Section 3022 of PPACA requires HHS to establish a shared savings program under which
qualifying ACOs may be eligible for incentive payments. The criteria in the statute, which will
need to be further defined by regulation, include:
ACOs will be required to measure and report their progress to HHS, includ.
12M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y EttaBenton28
12M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y S P R I N G 2 0 0 5 , V O L . 6 , N O . 3
T
his year the healthcare industry is expected
to account for 15.6% of GDP, and expendi-
tures for physician services are expected to
be $347.9 billion. A large part of that goes to
physician practices, and, because they are
such a large part of the economy, they represent an
opportunity for management accountants to assist
physicians in evaluating contracts with third-party pay-
ers and providing financial information for strategic
decisions. To do so, management accountants need to
understand the unique revenue, cost, and contractual
intricacies of physician practices.
While most businesses’ sources of revenue are sales
and fees, physician practices depend on the organiza-
tional structure of the healthcare revenue reimburse-
ment relationships among provider, patient, and
third-party insurer. Revenue reimbursements can come
from indemnity, preferred provider organizations
(PPOs), and/or healthcare maintenance organizations
(HMOs). In particular, to advise a physician or evaluate
profits, a management accountant must understand the
relationships between a practice’s revenues and its costs.
Because these revenue reimbursements are contractual-
ly determined, controlling costs is critical to the survival
of a physician’s practice. A management accountant can
help a physician calculate costs, select the appropriate
cost structure to manage costs, and help make tough
strategic decisions about the financial future of the prac-
tice. Once a management accountant understands the
source of revenues and the cost constraints, he or she
can then help a physician evaluate a revenue reimburse-
ment contract. For example, if the contract is from an
indemnity plan or a PPO, evaluation is relatively
straightforward if the management accountant under-
stands a practice’s organizational structures and cost con-
trol. But if the revenue comes from an HMO capitation
contract—that is, a fixed rate of payment to cover a
specified set of health services and procedures—
evaluating the contract requires additional analysis
because revenues are based on anticipated services.
P H YS I C I A N G R O U P R E V E N U E S
In order to consult with a physician group, a manage-
ment accountant must have a good understanding of
How Management
Accountants Make
Physicians’ Practices
More Profitable
Spring
2005
VOL.6 NO.3
Spring
2005
THE KEY TO PROFITABILITY IS TO USE COST ANALYSIS BY DETERMINING A PRACTICE’S
COST STRUCTURE AND USING THOSE COSTS TO EVALUATE CONTRACTS, ALLOCATE
BONUSES EQUITABLY, AND MAKE STRATEGIC DECISIONS ABOUT THE FINANCIAL FUTURE
OF THE PRACTICE GROUP.
B Y M A R S H A S C H E I D T , D B A , C M A , A N D G R E G T H I B A D O U X , P H . D .
13M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y S P R I N G 2 0 0 5 , V O L . 6 , N O . 3
the sources of practice revenues. As noted ...
12M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y ChantellPantoja184
12M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y S P R I N G 2 0 0 5 , V O L . 6 , N O . 3
T
his year the healthcare industry is expected
to account for 15.6% of GDP, and expendi-
tures for physician services are expected to
be $347.9 billion. A large part of that goes to
physician practices, and, because they are
such a large part of the economy, they represent an
opportunity for management accountants to assist
physicians in evaluating contracts with third-party pay-
ers and providing financial information for strategic
decisions. To do so, management accountants need to
understand the unique revenue, cost, and contractual
intricacies of physician practices.
While most businesses’ sources of revenue are sales
and fees, physician practices depend on the organiza-
tional structure of the healthcare revenue reimburse-
ment relationships among provider, patient, and
third-party insurer. Revenue reimbursements can come
from indemnity, preferred provider organizations
(PPOs), and/or healthcare maintenance organizations
(HMOs). In particular, to advise a physician or evaluate
profits, a management accountant must understand the
relationships between a practice’s revenues and its costs.
Because these revenue reimbursements are contractual-
ly determined, controlling costs is critical to the survival
of a physician’s practice. A management accountant can
help a physician calculate costs, select the appropriate
cost structure to manage costs, and help make tough
strategic decisions about the financial future of the prac-
tice. Once a management accountant understands the
source of revenues and the cost constraints, he or she
can then help a physician evaluate a revenue reimburse-
ment contract. For example, if the contract is from an
indemnity plan or a PPO, evaluation is relatively
straightforward if the management accountant under-
stands a practice’s organizational structures and cost con-
trol. But if the revenue comes from an HMO capitation
contract—that is, a fixed rate of payment to cover a
specified set of health services and procedures—
evaluating the contract requires additional analysis
because revenues are based on anticipated services.
P H YS I C I A N G R O U P R E V E N U E S
In order to consult with a physician group, a manage-
ment accountant must have a good understanding of
How Management
Accountants Make
Physicians’ Practices
More Profitable
Spring
2005
VOL.6 NO.3
Spring
2005
THE KEY TO PROFITABILITY IS TO USE COST ANALYSIS BY DETERMINING A PRACTICE’S
COST STRUCTURE AND USING THOSE COSTS TO EVALUATE CONTRACTS, ALLOCATE
BONUSES EQUITABLY, AND MAKE STRATEGIC DECISIONS ABOUT THE FINANCIAL FUTURE
OF THE PRACTICE GROUP.
B Y M A R S H A S C H E I D T , D B A , C M A , A N D G R E G T H I B A D O U X , P H . D .
13M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y S P R I N G 2 0 0 5 , V O L . 6 , N O . 3
the sources of practice revenues. As noted ...
INDIBA FISIOTERAPIA - FISIOESTÉTICA
Fisioestética facial y corporal con Indiba Activ 902 (radiofrecuencia)
Radiofrecuencia Facial:
Los tratamientos faciales con Indiba Activ es un tratamiento no invasivo dirigido a personas con arrugas, bolsas de ojos, falta de brillo, flacidez y falta de colágeno en la piel.
La finalidad de la aplicación de la tecnología del Indiba Activ sobre la piel es la de elevar la temperatura del tejido hasta 4 grados centígrados, provocando una aceleración del metabolismo en las células de un 13% por cada grado de temperatura. Teniendo en cuenta esto podemos acelerar el crecimiento celular y la producción de colágeno y elastina, mejorar la oxigenación celular, aumentar la porosidad de la membrana celular aumentando el flujo de toxinas del interior al exterior, llevar a la superficie de la piel sangre llena de nutrientes que va a dar un aspecto luminoso a la piel y mejorar, en definitiva, la flaccidez, la falta de vitalidad de la piel y prevenir posibles arrugas.
¿Cuando podemos aplicar este tratamiento? Se puede realizar un tratamiento de “choque” de 6 sesiones repartidas en un corto espacio de tiempo y ampliar después a un tratamiento cada 3 semanas, un mes o mes y medio. O por el contrario si tenemos un evento cercano en el que queremos que nuestra piel luzca una apariencia perfecta, podemos hacer entre dos y tres sesiones en un corto periodo de tiempo siempre cerca de la fecha señalada.
Radiofrecuencia corporal:
El método Indiba Activ aplica una tecnología desarrollada y patentada por Indiba, que logra la elevación local de la temperatura del tejido humano (hipertermia profunda) mediante la circulación de corrientes de alta frecuencia a través del mismo, obteniendo una gran eficacia en los tratamientos de estética. Mejora la microcirculación, disminuye el edema, reduce los depósitos grasos y la flacidez cutánea.
Trabajamos a nivel local una zona del cuerpo: glúteos, abdomen cartucheras... mediante la aplicación de Indiba Activ y un masaje indoloro produciendo efecto mecánico y movilizando los depósitos de grasa, mejorando la circulación y favoreciendo la producción de fibroblastos y con ello mejorando la flaccidez gracias a la producción de colágeno.
Podemos trabajar problemas como:
– Celulítis: edematosa / fibrosa / adiposa
– Postcirujía: drenaje de edemas, cicatrización, reabsorción de hematomas y lifting.
– Remodelación y reafirmación corporal
La pasión por lo que hacemos, nos lleva a contar con un equipo comprometido, altamente formado y capacitado que trata de dar lo mejor de si en todo momento. La formación continua y nuestro afán por aprender y mejorar cada día, nos hacen estar siempre a la vanguardia ofreciendo los tratamientos más innovadores y efectivos del mercado.
Quédate con nosotros, déjate mimar!
Harry hugo -LAC 2017 - "Social media doesn’t acquire users”: Why you’re wrong iGB Affiliate
Today’s consumer is increasingly concerned by what happens in their social sphere when it comes to brand recognition, trust and their buying decisions. Affiliates are in an opportune position to be involved with engaged social audiences and as a direct result, increase their customer acquisition and website traffic.
Harry Hugo, Director of the trend-setting social media experts at The Goat Agency, will demonstrate proven examples of how influencer marketing can transform your social media marketing and see genuine results.
Building a social media following that are engaged and vocal
How influencer marketing on social channels creates direct acquisition
Who are your influencers and how to create social influence – industry evidence in action
Lukasz Zelezny - LAC 2017 - Optimising site structure for indexingiGB Affiliate
You can tick all the SEO boxes possible but if the Googlebots can’t crawl and index your site quickly and effectively, it could all be for nothing. Thankfully, there are some essential must-dos that will ensure that you’re helping the bots find your website and index the most useful information for your rankings. From creating a sitemap to optimising your content and even using social media, Lukasz Zelezny will lead you through the best strategies to achieve a well-indexed website.
What does Google look for and what does Google rate highly?
Utilising tools such as Google search console
Internal linking structure
Mobile vs desktop indexing
GLOBAL PERSPECTIVE CAMBRIDGE IGCSE: WATER, FOOD AND AGRICULTUREGeorge Dumitrache
GLOBAL PERSPECTIVE CAMBRIDGE IGCSE: WATER, FOOD AND AGRICULTURE. Definitions, questions for the research project, global/international perspectives, local/national perspectives, family/personal perspectives, useful websites.
Research several types of reimbursement methods for healthcare for.docxronak56
Research several types of reimbursement methods for healthcare for physicians in Saudi Arabia. Draft a paper comparing the different methods.
Be sure to include:
Reimbursement of Claims
1. Introduction
2. Elements of Reimbursement
3. Reimbursement in Saudi Arabia
4. Evaluating Types of Reimbursement
5. Compare and contrast Types of Reimbursement
6. Impact of reimbursement on healthcare facilities
7. Trends in Healthcare Reimbursement
8. Conclusion
The following information can be used
1- Introduction (minimum 100 words) Definition of reimbursement
Reimbursement is another term for payment. A provider or facility submits a claim. Then the health insurance company or third-party administrator pays the provider or facility for their claim based on their contract. It sounds simple, but the payment arrangements in healthcare can be complex. As providers do not generally receive full payment for services upon a patient’s receipt of services under a health insurance scheme, reimbursement becomes essential to a provider’s livelihood.
2- Elements of Reimbursement (minimum 100 words)
· Coverage refers to a set of rules that explain when a payer will or will not pay for a product or service. Coverage can vary by payer and depends on what each payer considers to be medically necessary. In general, payers want to see regulatory approval, strong clinical evidence demonstrating the treatment is at least as beneficial as the established alternative, and a demonstration of the treatment’s cost-effectiveness. Payers expect well-designed clinical trials with results published in peer-reviewed journals. Support from the physician community and professional societies are also increasingly important to adoption and coverage of new technology.
· Coding refers to the sets of alphanumeric codes that are the language of billing. Providers use codes to tell a payer what products or services were provided and why. There are three main sets of codes: CPT, HCPCS, and ICD-10-CM. Choosing the right code to accurately describe a product or service while maximizing payment requires a detailed understanding of the coding structures. If no code exists, it is important to understand the approval process for acquiring a new one – whether it be a CPT code used by physicians to describe what is done to a patient, or an HCPCS code which describe products not described by CPT codes. Finally, it is important to understand that choosing the wrong code creates not only financial implications but also legal culpability.
· Payment is driven by the coding systems and is probably the most complicated element of reimbursement. Although coding drives payment, reimbursement is not quite as simple as just submitting an active code. Payment is driven by complex payment methodologies that differ depending on the site of care where delivery is provided. For example, payment for the same procedure in an Ambulatory Surgery Center (ASC) is often less than payment for the same procedure perfo ...
Professional Services Agreement: An Alternative Strategy to Hospital EmploymentCBIZ, Inc.
Any compensation arrangement between a hospital and physician must meet a litany of regulatory constraints, mainly those implicating the Stark Laws, the Anti-Kickback Statute, and the IRS regulations of not-for-profit entities.
Hospital-based contracts are often essential to secure coverage for physician services like anesthesiology, pathology, critical care, and more. These contract terms can be complex, and address elements like call coverage, medical direction, quality initiatives, and conditions of exclusivity. Hospital-based services are among the fastest-growing segments in hospital expenses.
What is an Accountable Care Organizations (ACO) How does an ACOs .pdfwasemanivytreenrco51
What is an Accountable Care Organizations (ACO)? How does an ACO\'s economics work to
manage costs and quality?
Solution
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care
providers, who come together voluntarily to give coordinated high quality care to their Medicare
patients.
An accountable care organization (ACO) is a healthcare organization characterized by a payment
and care delivery model that seeks to tie provider reimbursements to quality metrics and
reductions in the total cost of care for an assigned population of patients. A group of coordinated
health care providers forms an ACO, which then provides care to a group of patients. The ACO
may use a range of payment models (capitation, fee-for-service with asymmetric or symmetric
shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the
quality, appropriateness and efficiency of the health care provided. According to the Centers for
Medicare and Medicaid Services (CMS), an ACO is \"an organization of health care providers
that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who
are enrolled in the traditional fee-for-service program who are assigned to it.
Design and Structure
There is no single organizational model for developing an ACO. ACOs may be formed and
organized by health systems using employed and contracted physicians, by integrated delivery
systems, by physician groups (either primary care or multispecialty) or through joint ventures or
contractual relationships among providers. Regardless of the organizational structure, an ACO
must be physician-led and physician-driven. Physician leadership is critical because an ACO is
primarily a vehicle for clinical integration, not financial or risk integration. Only physicians are
able to develop, monitor and adjust clinical care protocols that can more efficiently use resources
based on documented effectiveness.
Qualifying ACOs will be assigned a pool of patients whose care the ACO will be responsible for
managing in a cost-effective and clinically appropriate manner. The ACO will need to develop
internal mechanisms for monitoring and managing costs and quality that cut across traditional
reporting lines and result in a higher degree of clinical interdependence than is typical in a less-
integrated medical community.
The PPACA states that any of the following groups of providers of services and suppliers that
have established a mechanism for shared governance are eligible to participate, in accordance
with regulations to be developed by the Secretary of Health and Human Services (HHS):
ACOs Under Health Reform
Section 3022 of PPACA requires HHS to establish a shared savings program under which
qualifying ACOs may be eligible for incentive payments. The criteria in the statute, which will
need to be further defined by regulation, include:
ACOs will be required to measure and report their progress to HHS, includ.
12M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y EttaBenton28
12M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y S P R I N G 2 0 0 5 , V O L . 6 , N O . 3
T
his year the healthcare industry is expected
to account for 15.6% of GDP, and expendi-
tures for physician services are expected to
be $347.9 billion. A large part of that goes to
physician practices, and, because they are
such a large part of the economy, they represent an
opportunity for management accountants to assist
physicians in evaluating contracts with third-party pay-
ers and providing financial information for strategic
decisions. To do so, management accountants need to
understand the unique revenue, cost, and contractual
intricacies of physician practices.
While most businesses’ sources of revenue are sales
and fees, physician practices depend on the organiza-
tional structure of the healthcare revenue reimburse-
ment relationships among provider, patient, and
third-party insurer. Revenue reimbursements can come
from indemnity, preferred provider organizations
(PPOs), and/or healthcare maintenance organizations
(HMOs). In particular, to advise a physician or evaluate
profits, a management accountant must understand the
relationships between a practice’s revenues and its costs.
Because these revenue reimbursements are contractual-
ly determined, controlling costs is critical to the survival
of a physician’s practice. A management accountant can
help a physician calculate costs, select the appropriate
cost structure to manage costs, and help make tough
strategic decisions about the financial future of the prac-
tice. Once a management accountant understands the
source of revenues and the cost constraints, he or she
can then help a physician evaluate a revenue reimburse-
ment contract. For example, if the contract is from an
indemnity plan or a PPO, evaluation is relatively
straightforward if the management accountant under-
stands a practice’s organizational structures and cost con-
trol. But if the revenue comes from an HMO capitation
contract—that is, a fixed rate of payment to cover a
specified set of health services and procedures—
evaluating the contract requires additional analysis
because revenues are based on anticipated services.
P H YS I C I A N G R O U P R E V E N U E S
In order to consult with a physician group, a manage-
ment accountant must have a good understanding of
How Management
Accountants Make
Physicians’ Practices
More Profitable
Spring
2005
VOL.6 NO.3
Spring
2005
THE KEY TO PROFITABILITY IS TO USE COST ANALYSIS BY DETERMINING A PRACTICE’S
COST STRUCTURE AND USING THOSE COSTS TO EVALUATE CONTRACTS, ALLOCATE
BONUSES EQUITABLY, AND MAKE STRATEGIC DECISIONS ABOUT THE FINANCIAL FUTURE
OF THE PRACTICE GROUP.
B Y M A R S H A S C H E I D T , D B A , C M A , A N D G R E G T H I B A D O U X , P H . D .
13M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y S P R I N G 2 0 0 5 , V O L . 6 , N O . 3
the sources of practice revenues. As noted ...
12M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y ChantellPantoja184
12M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y S P R I N G 2 0 0 5 , V O L . 6 , N O . 3
T
his year the healthcare industry is expected
to account for 15.6% of GDP, and expendi-
tures for physician services are expected to
be $347.9 billion. A large part of that goes to
physician practices, and, because they are
such a large part of the economy, they represent an
opportunity for management accountants to assist
physicians in evaluating contracts with third-party pay-
ers and providing financial information for strategic
decisions. To do so, management accountants need to
understand the unique revenue, cost, and contractual
intricacies of physician practices.
While most businesses’ sources of revenue are sales
and fees, physician practices depend on the organiza-
tional structure of the healthcare revenue reimburse-
ment relationships among provider, patient, and
third-party insurer. Revenue reimbursements can come
from indemnity, preferred provider organizations
(PPOs), and/or healthcare maintenance organizations
(HMOs). In particular, to advise a physician or evaluate
profits, a management accountant must understand the
relationships between a practice’s revenues and its costs.
Because these revenue reimbursements are contractual-
ly determined, controlling costs is critical to the survival
of a physician’s practice. A management accountant can
help a physician calculate costs, select the appropriate
cost structure to manage costs, and help make tough
strategic decisions about the financial future of the prac-
tice. Once a management accountant understands the
source of revenues and the cost constraints, he or she
can then help a physician evaluate a revenue reimburse-
ment contract. For example, if the contract is from an
indemnity plan or a PPO, evaluation is relatively
straightforward if the management accountant under-
stands a practice’s organizational structures and cost con-
trol. But if the revenue comes from an HMO capitation
contract—that is, a fixed rate of payment to cover a
specified set of health services and procedures—
evaluating the contract requires additional analysis
because revenues are based on anticipated services.
P H YS I C I A N G R O U P R E V E N U E S
In order to consult with a physician group, a manage-
ment accountant must have a good understanding of
How Management
Accountants Make
Physicians’ Practices
More Profitable
Spring
2005
VOL.6 NO.3
Spring
2005
THE KEY TO PROFITABILITY IS TO USE COST ANALYSIS BY DETERMINING A PRACTICE’S
COST STRUCTURE AND USING THOSE COSTS TO EVALUATE CONTRACTS, ALLOCATE
BONUSES EQUITABLY, AND MAKE STRATEGIC DECISIONS ABOUT THE FINANCIAL FUTURE
OF THE PRACTICE GROUP.
B Y M A R S H A S C H E I D T , D B A , C M A , A N D G R E G T H I B A D O U X , P H . D .
13M A N A G E M E N T A C C O U N T I N G Q U A R T E R L Y S P R I N G 2 0 0 5 , V O L . 6 , N O . 3
the sources of practice revenues. As noted ...
Critical issues in hospital and health system m&a fall 2014Rex James Burgdorfer
Since the enactment of the Affordable Care Act, the pace of hospital and health system consolidation has accelerated to a level not seen since the late 1990s, when hospitals were reacting to the formation of HMOs. The year 2013 saw a total of 87 consolidation transactions, following 105 in 2012. This volume represents a significant increase over 58, the median number of transactions completed each year between 2001 and 2011. Unlike the last wave of consolidation, which was driven primarily by financial and reimbursement considerations, today’s hospital mergers are just as likely to be between financially strong partners as they are to be in response to challenged operations or economics. Hospital companies increasingly are turning to mergers and acquisitions as a tool to improve quality, manage risk, access capital and contend with the changing regulatory environment. The articles in this collection explore the drivers of the current wave of consolidation, address the causes of transaction failures and review the range of structural alternatives available in the marketplace.
Hospital Workers’ Compensation Claims: Strategies for Successitduediligence
Workers’ compensation claims typically account for only 3-5% of a hospital’s revenue, but require an inordinate amount of effort to bill and collect in a compliant manner. On the surface, workers’ compensation claims may appear to be similar to claims from any other payer. The patient is registered, insurance coverage is identified, the patient is treated, and bills are submitted. Any denials are addressed and ultimately cash is posted after confirming proper reimbursement. Hospitals have processes in place to deal with these functions every day. As demonstrated in this white paper, however, each step in the revenue cycle related to a workers’ compensation claim involves unique challenges.
Clinical Co-Management Arrangements: Trends, Issues and FMV ConsiderationsCBIZ, Inc.
Healthcare providers are under scrutiny and feel pressure from patients, employers, insurance and the federal and state governments to provide higher quality care at lower costs and higher efficiency.
Myanmar Strategic Purchasing 2: Calculating a Capitation PaymentHFG Project
This is the second in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar. This pilot will start developing the important functions of, and provide valuable lessons around, contracting of health providers and purchasing that will contribute to the broader health financing agenda. More specifically, it is introducing a blended payment system that mixes capitation payments and performance-based incentives to reduce households’ out-of-pocket spending and to incentivize providers to deliver an essential package of primary care services
Medicare Advantage 3 Day Rule and Funds Flow White Paper
New Revenue Recognition Standards for Hospitals
1. NEW REVENUE RECOGNITION STANDARD FOR HOSPITALS
by Joelle Pulver, Partner, and Katherine Jackson, Senior Manager, Health Care Practice
A new standard requires hospitals to rethink how their accounting
functions handle revenue recognition, specifically self-pay revenue.
Issued in May 2014, Financial Accounting Standards Board (FASB)
Accounting Standards Codification® (ASC) Topic 606, Revenue from
Contracts with Customers, fundamentally changes the way companies
across most industries are required to recognize revenue under US
generally accepted accounting principles (GAAP), specifically with
customer contracts. Leases, financial instruments, insurance contracts,
guarantees, and nonmonetary exchanges aren’t impacted by the new
guidance in ASC Topic 606.
At the highest level, the new standard requires hospitals to recognize revenue:
• When promised goods or services are provided to patients
• In the amount of consideration the hospital expects to receive
FIVE-STEP PROCESS
There’s a five-step process outlined by the FASB that hospitals will follow under the new standard.
Adopting the new standard is a significant undertaking that requires hospitals to start preparing now. Effective dates
for the new standard are as follows:
• Public entities, including conduit debt obligors. These entities will need to adopt the new standard for
annual reporting periods beginning after December 15, 2017.
Page 1 of 6
2. • Nonpublic entities. These entities will need to adopt the new standard for annual reporting periods
beginning after December 15, 2018.
Any entity may choose to adopt the new standard early but not earlier than annual reporting periods beginning after
December 15, 2016.
Since hospitals will want to spend the most time understanding how these steps affect self-pay revenue recognition,
let’s take a closer look at steps one and three.
STEP ONE: IDENTIFY THE CONTRACT
To be considered a contract within the scope of ASC Topic 606, a contract must meet these criteria:
• The parties have approved the contract either in writing (patient responsibility or consent form); orally
(perhaps a scheduled appointment); or implicitly, based on the hospital’s customary business practices
(emergency room visits, for example).
• Each party’s rights and the contract’s payment terms are identified.
• The contract has commercial substance.
• Collection is probable.
Before applying the standard’s model to a contract, it must be probable the hospital will collect substantially all of
the consideration to which it’s entitled. A hospital may make this determination based on past experience with either
a specific patient or a class of similar patients—the latter of which is known as the portfolio approach. If the
collectibility threshold isn’t met, a patient contract doesn't exist within the scope of the standard.
Example
A patient is admitted to the emergency room and is unresponsive. The hospital determines the patient is
uninsured, and attempts to assist the patient in qualifying for Medicaid. If the hospital has historical information
on the ultimate payer class for this individual—for example, Medicaid or self-pay—the contract is within the
scope of the standard.
If the hospital doesn’t have historic information on the ultimate payer class, the contract only falls within the
scope of the standard once the payer class is confirmed. However, if the ultimate payer class is determined to be
charity care, the collectibility threshold isn’t met, and the contract doesn’t fall within the scope of the standard.
Evaluating collectibility involves determination of the transaction price, defined as the amount of consideration the
hospital expects to be entitled to in exchange for providing promised goods or services to a patient. It includes the
effects of variable consideration— such as discounts and price concessions—and may be less than the stated contract
price.
STEP THREE: DETERMINE THE TRANSACTION PRICE
To determine transaction price, a hospital should consider all historical, current, and forecasted information that’s
reasonably available, including historical cash collections from the identified payer class. The hospital should also
review all reasonably available information to estimate variable consideration, whether applied on a contract-by-
contract basis or by using a portfolio approach. The ultimate transaction price should reflect both explicit and
implicit price concessions.
Explicit Price Concession Example
Page 2 of 6
3. In the example above, the patient was determined to be self-paying, and qualifies for the hospital’s uninsured
discount policy with a 50 percent discount. This discount is an explicit price concession and reduces the
transaction price from the gross charges of $50,000 to $25,000, which is billed to the patient.
Implicit Price Concessions
In determining implicit price concessions, a hospital should consider the following:
• If its customary business practice is to provide services prior to performing a credit assessment. For example,
the hospital has an obligation to provide medically necessary or emergency services regardless of patient’s
intent or ability to pay, which makes conducting a credit check before providing services unnecessary.
• If it continues to provide care to patients and patient classes, despite historical experience indicating the
hospital won’t collect substantially all of the charges determined after applying explicit price concessions.
If either of these factors is present, the hospital has provided an implicit price concession, even if the hospital will
continue to attempt to collect the full amount of discounted charges.
Implicit Price Concession Example
Continuing with the explicit price concession example above, the gross charges for the services are $50,000, and
the amount billed to the patient is $25,000. The hospital intends to pursue collection of the $25,000, but based
on historic experience expects to collect only $5,000. The hospital’s calculation of the implicit price concession
is based on its commitment to providing services to uninsured self-pay patients and the knowledge that actual
cash collections will be substantially less than the amount billed after explicit price concessions are accounted
for. Based on these conditions, the hospital would conclude it would probably collect $5,000, and the
collectibility criteria in step one is met. The hospital would record patient revenue and accounts receivable of
$5,000.
Once a hospital determines it‘s provided an implicit price concession, subsequent changes to the estimate of variable
consideration should generally be accounted for as changes in the implicit price concession and a direct adjustment
to patient revenue.
If, in the process of estimating the transaction price, the hospital determines it hasn’t provided an implicit price
concession, but has elected to accept the risk of default by the patient, that uncollectible amount represents an
impairment loss and is recorded as a bad debt expense. Additional impairment losses may be taken and recorded as
bad debt if there are facts and circumstances—like bankruptcy or job loss—that indicate the patient’s credit
worthiness has deteriorated.
This overview of implicit price concessions is subject to additional due diligence, currently underway with FASB’s
Transition Resource Group and the American Institute of Certified Public Accountants (AICPA).
Applying Revenue Guidance to Portfolios
As a practical expedient, a hospital may apply the revenue guidance to a portfolio of contracts with similar
characteristics. However, this is allowable only if the hospital reasonably expects the financial statement effects of
applying the standard to the portfolio, rather than to individual contracts, wouldn’t be materially different.
A sample of the characteristics a hospital should consider when grouping contracts for inclusion in a portfolio
includes:
• Type of service—inpatient, outpatient, skilled nursing, or home health
• Type of payers—insurance contract, governmental program, or uninsured self-pay
Page 3 of 6
4. • Dates when contracts are entered into are the same or close to each other
A hospital may include a combination of the above considerations and others in its determination of a portfolio.
However, it isn’t required to apply the portfolio practical expedient when considering evidence from similar contracts
to develop an estimate of variable consideration.
Contract Portfolio Example
A hospital provides services to patients covered by an insurance carrier and doesn’t perform credit assessments
prior to providing services. Each patient has a patient responsibility in the form of a co-payment. The hospital
identifies these patients as a portfolio of contracts and applies a portfolio approach based on qualitative and
quantitative factors.
Standard charges amount to $500,000 for these patients, consisting of insurance and co-payment amounts. The
hospital has a contractual agreement with the insurance carrier that results in a 50 percent contractual
allowance, representing an explicit price concession. The adjusted charges comprise $225,000 due from the
insurance carrier and $25,000 due from patient co-payments. The hospital expects to collect 100 percent of the
insurance carrier amount and 40 percent of the co-payment amount based on historical experience.
Based on the above pattern, the contractual adjustment of $250,000 is an explicit price concession, reducing the
transaction price. The $15,000 in patient co-payments the hospital doesn’t expect to collect represents an
implicit price concession and also reduces the transaction price.
These concessions result in a total transaction price of $235,000 ($225,000 from the insurance carrier and
$10,000 from co-payment amounts). The hospital would only use this estimate of variable consideration as the
transaction price after consideration of the implicit and explicit price concessions. The hospital would then
recognize patient revenue and accounts receivable of $235,000 in applying the revenue recognition model.
Under current guidance, the net patient service revenue booked—$235,000—would be the same as under new
guidance. The $15,000 implicit price concession recorded as a bad debt expense under current guidance
wouldn’t be recorded as such under new guidance, but would instead be recorded as a revenue reduction.
Self-Pay Example
Under current revenue recognition guidance and using the implicit price concession example, the hospital would
record patient revenue of $25,000 (gross charges of $50,000 less the 50 percent uninsured policy discount) and
$20,000 of bad debt expense, due to the expected actual collection of $5,000. This bad debt expense would be
an offset to net patient service revenue, resulting in net patient service revenue of $5,000.
Under the new guidance, the total net patient service revenue recorded would still be $5,000, but there would be
no bad debt expense. However, any future impairments of the $5,000 receivable would be recorded as bad debt
expense, which will now be a component of operating expenses rather than an offset to net patient service
revenue.
TRANSITIONING AND DISCLOSURES
Before the standard goes into effect, hospitals will need to decide if a full or a modified retrospective transition
makes the most sense for their particular circumstances. When deciding which transition approach to use, hospitals
should consider the various optional practical expedients included in the standard.
With the full retrospective, all reporting periods presented are reported under the new standard, and a hospital is
required to disclose any adjustment to prior-period information. Under the modified retrospective approach, the
Page 4 of 6
5. initial period of adoption is reported under the new revenue model, while previous periods are presented under
existing GAAP.
Hospitals that choose the modified retrospective approach are required to make a cumulative effect adjustment to
the opening balance of retained earnings (or other appropriate components of equity or net assets) and disclose the
effects of adopting the new standard on each financial statement line item.
Other required disclosures for public entities, regardless of whether a hospital chooses the full or modified
retrospective approach, include but are not limited to:
• Disaggregated revenue information (for example, by customer type, geographic region, and product lines)
• Contract asset and liability information, including any significant changes from the prior year
• Judgments, and changes in judgments, that significantly affect the determination of the revenue amount and
timing
The new standard provides nonpublic entities with relief from certain disclosure requirements, including optional
elections to exclude some of the more onerous quantitative disclosures.
UNRESOLVED IMPLEMENTATION ISSUES
The AICPA Revenue Recognition Task Forces have identified six unresolved implementation issues specific to health
care entities. These issues are listed in a summary document released by the AICPA on February 1, 2017, as:
• Disclosure requirements of FASB Accounting Standards Update (ASU) 2014-09
• Accounting for contract costs
• Consideration of ASC Topic 606, Revenue from Contracts with Customers, for third-party settlement
estimates
• Continuing care retirement community (CCRC): Identifying and satisfying the performance obligations and
recognizing the monthly and periodic fees and nonrefundable entrance fees under Type A or life-care
contracts for continuing care retirement communities
• CCRC: Identifying performance obligations and recognizing the performance obligations to provide future
services and use of facilities
• Significant financing component: CCRC contracts and patient and third-party payer amounts in arrears
NEXT STEPS
The new revenue recognition standard represents a fundamental change in how hospitals recognize revenue from
customer contracts. Recognizing revenue earlier or later than you would have under existing GAAP could impact your
financial performance metrics, financing and tax planning, and debt covenant compliance, so you’ll want to get ahead
of the changes. To do so, hospitals should begin work now to understand how ASC Topic 606 will affect their
financial statements and to determine what the possible tax implications are.
WE'RE HERE TO HELP
For more information on the new revenue recognition standards and how they apply to your company’s financial
statements, contracts, or operations, contact your Moss Adams professional.
Joelle Pulver has been in public accounting since 2002. She is well versed in providing audit
services to health plans, integrated health systems, hospitals, senior living facilities, and other
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