This chapter establishes the context for topics covered in the text by highlighting key issues affecting healthcare organizations. It is organized into three sections that address: (1) changing methods of healthcare financing and delivery; (2) addressing the high cost of care; and (3) establishing value-based payment mechanisms. The document discusses the Affordable Care Act and its provisions for expanding insurance coverage and Medicaid. It also covers trends like the rise of accountable care organizations and value-based purchasing systems.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
Accountable Care Organizations: 4 Physician BenefitsGreenway Health
Why would physicians join an Accountable Care Oragnization (ACO)? This informative slide presentation gives a brief overview of ACOs, their benefits, and four reasons physicians may have for joining one.
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
Impact on Health Reform on Device Development and FundingUBMCanon
The document discusses the impact of US healthcare reform on medical device development and funding. It summarizes that healthcare reform through the Affordable Care Act and other policies is driving major changes in health insurance purchasing and moving payments from fee-for-service to bundled payments and accountable care organizations. This shift to alternative payment models will require device manufacturers to understand how provider reimbursement is changing to ensure their devices provide value within the new systems.
The document discusses health care reform under the Affordable Care Act and new models of care, specifically Accountable Care Organizations (ACOs). It provides an overview of the key elements of ACOs, noting they accept responsibility for quality and cost of care for a defined patient population. The document contrasts old models like PHOs with the new ACO model, which emphasizes coordinated, patient-centric care paid for based on quality rather than volume of services.
Direct to Employer - Dealing With Narrow Networks in the 'New Exchange World'McKonly & Asbury, LLP
This webinar was hosted by Tyler Wenger and Suzanne Sentman from McKonly & Asbury with special guest host Ernie Tsoules from Rhoads & Sinon.This presentation addressed the fact that self-insured employers are increasingly seeking to reduce employee health care costs. A new model of achieving this goal is taking hold in the market by employers contracting directly with new types of health care provider networks, commonly referred to as “narrow networks." This session explored the evolution of these new arrangements and its impact on employers, health care providers and employees. The session also addressed the key business and legal issues that are important to consider in developing these new relationships.
Check out our Upcoming Events page for news and updates on our future seminars and webinars at http://www.macpas.com/events/
1) Dispersion of accountable care organizations varies significantly by region, with some markets having multiple ACOs and others having none. Hospitals and hospital systems are the primary sponsors of ACOs.
2) The success of different accountable care models is still unclear as implementation is ongoing and independent of government programs.
3) Significant investment in accountable care exists with over 100 ACOs identified prior to full implementation of Medicare programs. However, definitions and requirements for ACOs remain vague.
Growth and Dispersion of Accountable Care OrganizationsLeavitt Partners
Leavitt Partners’ Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, released a white paper today entitled Growth and Dispersion of Accountable Care Organizations. This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution of ACOs following federal health reform and the recent announcement of the Medicare Shared Savings Program. Data and analysis on the growth and national dispersion trends of more than 160 ACO or ACO-like organizations are highlighted.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
Accountable Care Organizations: 4 Physician BenefitsGreenway Health
Why would physicians join an Accountable Care Oragnization (ACO)? This informative slide presentation gives a brief overview of ACOs, their benefits, and four reasons physicians may have for joining one.
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
Impact on Health Reform on Device Development and FundingUBMCanon
The document discusses the impact of US healthcare reform on medical device development and funding. It summarizes that healthcare reform through the Affordable Care Act and other policies is driving major changes in health insurance purchasing and moving payments from fee-for-service to bundled payments and accountable care organizations. This shift to alternative payment models will require device manufacturers to understand how provider reimbursement is changing to ensure their devices provide value within the new systems.
The document discusses health care reform under the Affordable Care Act and new models of care, specifically Accountable Care Organizations (ACOs). It provides an overview of the key elements of ACOs, noting they accept responsibility for quality and cost of care for a defined patient population. The document contrasts old models like PHOs with the new ACO model, which emphasizes coordinated, patient-centric care paid for based on quality rather than volume of services.
Direct to Employer - Dealing With Narrow Networks in the 'New Exchange World'McKonly & Asbury, LLP
This webinar was hosted by Tyler Wenger and Suzanne Sentman from McKonly & Asbury with special guest host Ernie Tsoules from Rhoads & Sinon.This presentation addressed the fact that self-insured employers are increasingly seeking to reduce employee health care costs. A new model of achieving this goal is taking hold in the market by employers contracting directly with new types of health care provider networks, commonly referred to as “narrow networks." This session explored the evolution of these new arrangements and its impact on employers, health care providers and employees. The session also addressed the key business and legal issues that are important to consider in developing these new relationships.
Check out our Upcoming Events page for news and updates on our future seminars and webinars at http://www.macpas.com/events/
1) Dispersion of accountable care organizations varies significantly by region, with some markets having multiple ACOs and others having none. Hospitals and hospital systems are the primary sponsors of ACOs.
2) The success of different accountable care models is still unclear as implementation is ongoing and independent of government programs.
3) Significant investment in accountable care exists with over 100 ACOs identified prior to full implementation of Medicare programs. However, definitions and requirements for ACOs remain vague.
Growth and Dispersion of Accountable Care OrganizationsLeavitt Partners
Leavitt Partners’ Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, released a white paper today entitled Growth and Dispersion of Accountable Care Organizations. This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution of ACOs following federal health reform and the recent announcement of the Medicare Shared Savings Program. Data and analysis on the growth and national dispersion trends of more than 160 ACO or ACO-like organizations are highlighted.
Growth and Dispersion of Accountable Care OrganizationsLeavitt Partners
The Leavitt Partners Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, published a white paper entitled "Growth and Dispersion of Accountable Care Organizations." This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution of ACOs following federal health reform and the recent announcement of the Medicare Shared Savings Program. Data and analysis on the growth and national dispersion trends of more than 160 ACO or ACO-like organizations are highlighted.
The document provides an overview of health insurance in India. It defines health insurance and describes what a typical health insurance policy covers, including room and boarding expenses, nursing costs, surgeon fees, and medical treatment costs. It notes that over 80% of Indians lack health insurance coverage. The major types of health insurance policies in India include hospitalization plans, pre-existing disease plans, senior citizen plans, maternity plans, daily cash plans, and critical illness plans. The document also outlines several government-run health insurance schemes in India like RSBY, Ayushman Bharat, and state-specific programs. It concludes with a discussion of public and private agencies involved in providing health insurance in India.
This document defines various key terms related to health insurance:
1. It describes an actuary as an insurance professional responsible for determining premiums based on claims paid versus premiums collected to ensure profits.
2. It provides brief definitions for terms like admitting privilege, affordable care act, agent, beneficiary, benefit, brand name drug, broker, carrier, case management, certificate of insurance, claim, and COBRA.
3. It explains concepts such as coinsurance, copayment, credit for prior coverage, deductible, denial of claim, dependent, effective date, exclusion, explanation of benefits, fee for service, generic drug, group health insurance, and guaranteed issue.
Resetting Payer-Provider Arrangements for COVID-19 and the Evolving Improveme...Health Catalyst
As the healthcare industry recovers from COVID-19, providers are re-evaluating the financial arrangements that motivate them to improve their processes while benefiting payers and patients.
With the pandemic driving lower provider volumes and straining hospital resources, the industry has a renewed urgency for policies that drive better outcomes while lowering cost and improving revenue. Moving forward, healthcare must reset its payer-provider performance standards to the post COVID-19 environment.
Renewed approaches to the following models will consider the impact of remote care, how to reimburse telehealth services, and the need for consistent payments to providers:
1. Pay for performance.
2. Bundled payments.
3. ACOs.
As the Affordable Care Act takes effect, health insurance companies will have to design and implement new healthcare models to keep up with the new consumer population.
The Proposed Health Care Reform’S Impact On MarketingStone Ward
The document summarizes key aspects of the proposed US health care reform plan, including:
1) It would require all Americans to have health insurance and businesses to provide it or pay a penalty. Subsidies would help lower-income families purchase insurance.
2) Health insurance exchanges would be created to allow consumers to compare plans starting in 2013.
3) While hospitals, doctors, and private Medicare plans oppose aspects of the plan, supporters argue it will reduce costs and improve care by covering more of the uninsured.
The document provides questions and answers about the proposed Medicare Shared Savings Program and Accountable Care Organizations (ACOs). It addresses concerns about limiting beneficiary care, risk-bearing requirements for ACOs, data sharing with ACOs, and ensuring various types of providers can participate, including small physician practices and rural providers. Key points addressed include that beneficiary participation in ACOs is voluntary, strong protections and monitoring are in place to prevent limiting care, risk is intensified to better meet program goals, and options aim to facilitate diverse ACO models tailored to local needs.
high value care to reduce waste in health caremukeshkakkar
This document discusses health care costs and payment models. It defines different types of health care costs including charges, reimbursements, and out-of-pocket costs. It describes how traditional payment models like fee-for-service can promote cost variation and lack transparency. It also discusses recent value-based reforms like accountable care organizations (ACOs) and pay for performance models that aim to improve quality and reduce costs. The document provides examples of estimating out-of-pocket costs and explores how insurance status impacts clinical recommendations and adherence.
Chapter 1: Context of Health Care Financial ManagementNada G.Youssef
This document discusses key topics in health care financial management including lowering costs, goals of the health care system, and changing methods of financing and delivery. It outlines reforms under the Affordable Care Act to expand access through insurance marketplaces and Medicaid expansion while controlling costs through value-based purchasing. It also covers trends like the rise of the uninsured and accountable care organizations, as well as factors affecting the cost of care and impacts to provider reimbursement models.
The Healthcare Quality Coalition wrote to CMS Administrator Berwick to provide feedback on the proposed Medicare Shared Savings Program and ACO regulations. The coalition supports the goals of improved care coordination and reduced costs through alternative payment models like ACOs. However, the letter outlines several concerns with the proposed rule, including that it requires reporting on too many quality measures in year one, does not adequately account for patient acuity, and may not provide sufficient incentives for high-quality organizations to participate. The coalition urges CMS to address these issues in the final rule.
The document discusses bundled payments for care improvement (BPCI) initiatives created under the Patient Protection and Affordable Care Act (PPACA). It explains that PPACA aimed to move away from fee-for-service reimbursement and encourage coordinated, high-quality, lower-cost care. The Center for Medicare and Medicaid Innovation was established to test new payment models like BPCI, which link payments for multiple services during an episode of care. BPCI creates incentives to improve transitional care and reduce costs through gain-sharing arrangements between providers.
The document discusses Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. It explains that ACOs are groups of doctors, hospitals, and other health care providers that come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of ACOs is to ensure patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. The document provides details on ACO legal structures, governance, operations, payment models, and audits to ensure compliance with program rules.
ACSG DIRECT TO EMPLOYER WHITE PAPER MARCH 15jackell
This document describes a population health management system that medical providers can access to manage healthcare for self-insured employers. It allows providers to take control of healthcare delivery and costs in their community. The system has been in place for over 12 years and has successfully reduced healthcare trends and costs for over 1 million members. It provides tools for providers to identify high-risk patients, implement treatment regimens, monitor compliance, and share in savings through gainsharing arrangements with employers. Medical providers who implement this turn-key system can diversify their payer mix and increase revenues.
ACSG DIRECT TO EMPLOYER WHITE PAPER MARCH 15jackell
This document describes a population health management system that medical providers can access to manage healthcare for self-insured employers. It allows providers to take on insurance-like roles without assuming insurance risk. The system utilizes over a decade of data on over 1 million members to analyze healthcare costs and outcomes. Medical providers are incentivized through gain-sharing agreements where they receive a portion of savings if healthcare budgets are kept lower than projected. The system aims to reduce costs through coordinated care, recruiting high quality/low cost providers, and promoting wellness. It has achieved healthcare cost reductions of up to 32% for some employers that have used the system.
US Health Care System Week 5 For this assignment, you wishandicollingwood
US Health Care System:
Week 5
For this assignment, you will generate, designate, Organize, investigate and, present a Manage Care Control Cost Plan: Under traditional indemnity insurance, the money follows the patient. Patients select health care providers and visit them as they choose. Providers then bill the private insurer or public payer and are reimbursed on a fee-for-service or per case basis
Manage Care Control Cost Plan: Chapters 9 & 10
Objective
:
Managed health care as it has developed in the USA, and the current backlash against it, must be viewed in the context of the traditional US health care system.
This system of employer-based, indemnity insurance and fee-for-service health care conditioned both providers ‘and patients ‘expectations of unlimited resources and unrestrained choice.
Not surprisingly, the constraints and controls imposed by managed care have resulted in outrage by doctors and their patients (and by doctors through their patients).
ASSIGNMENT GUIDELINES (10%):
For this assignment, you will generate, designate, Organize, investigate and, present a Manage Care Control Cost Plan: Under traditional indemnity insurance, the money follows the patient. Patients select health care providers and visit them as they choose. Providers then bill the private insurer or public payer and are reimbursed on a fee-for-service or per case basis.
Most indemnity plans attempt to limit demand through financial barriers to the patient, such as deductibles and co-insurance, rather than constraints on the provider. Many also require the patient to pay the provider directly and seek reimbursement from the insurer, often with payments less than charges.
Due to growing popular discontent with managed care organizations, many critics believe that the system will not continue in its current state. No one, however, expects managed care to disappear completely and indemnity plans to rise to their former prominence. Changes are expected to occur as managed care programs begin competing among themselves. Cost and efficiency will no longer be the main selling point; quality of services will take precedence. One researcher has suggested that along with new systems of managed care and continuing systems of indemnity plans, health care providers may even organize and offer services directly to employers, thus eliminating the middlemen. This development would be beneficial to all involved: employers would pay less; providers would be better compensated; and clients would receive better care
The paper will be 4-5 pages long. More information and due date will provide in the Fifth Week assignments link.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1.
Introduction (30%)
Provide a short-lived outline of the meaning (not a description) of Chapter 9 and 10 and articles you read, in your own words. Types and classifications of managed care models.
2.
Manage Care Control Cost Plan:
(50%)
a.
Cost savings
‘‘Structural changes centere ...
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
The document discusses key issues related to health reform implementation for safety net health systems. It provides an overview of the National Association of Public Hospitals and Health Systems (NAPH), which advocates for safety net hospitals. The document outlines provisions of the Affordable Care Act related to coverage expansion, exchanges, provider payments, and innovation opportunities. It identifies challenges and questions for safety net health systems to consider regarding health reform implementation.
Kentucky health cooperative an overviewjacktillman
The document provides an overview of Consumer Operated and Oriented Plans (CO-OPs), which were established under the Affordable Care Act to foster the creation of nonprofit health insurers. It discusses the role of CO-OPs and health insurance exchanges, and federal regulations for CO-OPs. It then introduces the Kentucky Health Cooperative as an example CO-OP that was awarded funding to operate in Kentucky.
Jill Pizzola's Tenure as Senior Talent Acquisition Partner at THOMSON REUTERS...dsnow9802
Jill Pizzola's tenure as Senior Talent Acquisition Partner at THOMSON REUTERS in Marlton, New Jersey, from 2018 to 2023, was marked by innovation and excellence.
Growth and Dispersion of Accountable Care OrganizationsLeavitt Partners
The Leavitt Partners Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, published a white paper entitled "Growth and Dispersion of Accountable Care Organizations." This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution of ACOs following federal health reform and the recent announcement of the Medicare Shared Savings Program. Data and analysis on the growth and national dispersion trends of more than 160 ACO or ACO-like organizations are highlighted.
The document provides an overview of health insurance in India. It defines health insurance and describes what a typical health insurance policy covers, including room and boarding expenses, nursing costs, surgeon fees, and medical treatment costs. It notes that over 80% of Indians lack health insurance coverage. The major types of health insurance policies in India include hospitalization plans, pre-existing disease plans, senior citizen plans, maternity plans, daily cash plans, and critical illness plans. The document also outlines several government-run health insurance schemes in India like RSBY, Ayushman Bharat, and state-specific programs. It concludes with a discussion of public and private agencies involved in providing health insurance in India.
This document defines various key terms related to health insurance:
1. It describes an actuary as an insurance professional responsible for determining premiums based on claims paid versus premiums collected to ensure profits.
2. It provides brief definitions for terms like admitting privilege, affordable care act, agent, beneficiary, benefit, brand name drug, broker, carrier, case management, certificate of insurance, claim, and COBRA.
3. It explains concepts such as coinsurance, copayment, credit for prior coverage, deductible, denial of claim, dependent, effective date, exclusion, explanation of benefits, fee for service, generic drug, group health insurance, and guaranteed issue.
Resetting Payer-Provider Arrangements for COVID-19 and the Evolving Improveme...Health Catalyst
As the healthcare industry recovers from COVID-19, providers are re-evaluating the financial arrangements that motivate them to improve their processes while benefiting payers and patients.
With the pandemic driving lower provider volumes and straining hospital resources, the industry has a renewed urgency for policies that drive better outcomes while lowering cost and improving revenue. Moving forward, healthcare must reset its payer-provider performance standards to the post COVID-19 environment.
Renewed approaches to the following models will consider the impact of remote care, how to reimburse telehealth services, and the need for consistent payments to providers:
1. Pay for performance.
2. Bundled payments.
3. ACOs.
As the Affordable Care Act takes effect, health insurance companies will have to design and implement new healthcare models to keep up with the new consumer population.
The Proposed Health Care Reform’S Impact On MarketingStone Ward
The document summarizes key aspects of the proposed US health care reform plan, including:
1) It would require all Americans to have health insurance and businesses to provide it or pay a penalty. Subsidies would help lower-income families purchase insurance.
2) Health insurance exchanges would be created to allow consumers to compare plans starting in 2013.
3) While hospitals, doctors, and private Medicare plans oppose aspects of the plan, supporters argue it will reduce costs and improve care by covering more of the uninsured.
The document provides questions and answers about the proposed Medicare Shared Savings Program and Accountable Care Organizations (ACOs). It addresses concerns about limiting beneficiary care, risk-bearing requirements for ACOs, data sharing with ACOs, and ensuring various types of providers can participate, including small physician practices and rural providers. Key points addressed include that beneficiary participation in ACOs is voluntary, strong protections and monitoring are in place to prevent limiting care, risk is intensified to better meet program goals, and options aim to facilitate diverse ACO models tailored to local needs.
high value care to reduce waste in health caremukeshkakkar
This document discusses health care costs and payment models. It defines different types of health care costs including charges, reimbursements, and out-of-pocket costs. It describes how traditional payment models like fee-for-service can promote cost variation and lack transparency. It also discusses recent value-based reforms like accountable care organizations (ACOs) and pay for performance models that aim to improve quality and reduce costs. The document provides examples of estimating out-of-pocket costs and explores how insurance status impacts clinical recommendations and adherence.
Chapter 1: Context of Health Care Financial ManagementNada G.Youssef
This document discusses key topics in health care financial management including lowering costs, goals of the health care system, and changing methods of financing and delivery. It outlines reforms under the Affordable Care Act to expand access through insurance marketplaces and Medicaid expansion while controlling costs through value-based purchasing. It also covers trends like the rise of the uninsured and accountable care organizations, as well as factors affecting the cost of care and impacts to provider reimbursement models.
The Healthcare Quality Coalition wrote to CMS Administrator Berwick to provide feedback on the proposed Medicare Shared Savings Program and ACO regulations. The coalition supports the goals of improved care coordination and reduced costs through alternative payment models like ACOs. However, the letter outlines several concerns with the proposed rule, including that it requires reporting on too many quality measures in year one, does not adequately account for patient acuity, and may not provide sufficient incentives for high-quality organizations to participate. The coalition urges CMS to address these issues in the final rule.
The document discusses bundled payments for care improvement (BPCI) initiatives created under the Patient Protection and Affordable Care Act (PPACA). It explains that PPACA aimed to move away from fee-for-service reimbursement and encourage coordinated, high-quality, lower-cost care. The Center for Medicare and Medicaid Innovation was established to test new payment models like BPCI, which link payments for multiple services during an episode of care. BPCI creates incentives to improve transitional care and reduce costs through gain-sharing arrangements between providers.
The document discusses Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. It explains that ACOs are groups of doctors, hospitals, and other health care providers that come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of ACOs is to ensure patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. The document provides details on ACO legal structures, governance, operations, payment models, and audits to ensure compliance with program rules.
ACSG DIRECT TO EMPLOYER WHITE PAPER MARCH 15jackell
This document describes a population health management system that medical providers can access to manage healthcare for self-insured employers. It allows providers to take control of healthcare delivery and costs in their community. The system has been in place for over 12 years and has successfully reduced healthcare trends and costs for over 1 million members. It provides tools for providers to identify high-risk patients, implement treatment regimens, monitor compliance, and share in savings through gainsharing arrangements with employers. Medical providers who implement this turn-key system can diversify their payer mix and increase revenues.
ACSG DIRECT TO EMPLOYER WHITE PAPER MARCH 15jackell
This document describes a population health management system that medical providers can access to manage healthcare for self-insured employers. It allows providers to take on insurance-like roles without assuming insurance risk. The system utilizes over a decade of data on over 1 million members to analyze healthcare costs and outcomes. Medical providers are incentivized through gain-sharing agreements where they receive a portion of savings if healthcare budgets are kept lower than projected. The system aims to reduce costs through coordinated care, recruiting high quality/low cost providers, and promoting wellness. It has achieved healthcare cost reductions of up to 32% for some employers that have used the system.
US Health Care System Week 5 For this assignment, you wishandicollingwood
US Health Care System:
Week 5
For this assignment, you will generate, designate, Organize, investigate and, present a Manage Care Control Cost Plan: Under traditional indemnity insurance, the money follows the patient. Patients select health care providers and visit them as they choose. Providers then bill the private insurer or public payer and are reimbursed on a fee-for-service or per case basis
Manage Care Control Cost Plan: Chapters 9 & 10
Objective
:
Managed health care as it has developed in the USA, and the current backlash against it, must be viewed in the context of the traditional US health care system.
This system of employer-based, indemnity insurance and fee-for-service health care conditioned both providers ‘and patients ‘expectations of unlimited resources and unrestrained choice.
Not surprisingly, the constraints and controls imposed by managed care have resulted in outrage by doctors and their patients (and by doctors through their patients).
ASSIGNMENT GUIDELINES (10%):
For this assignment, you will generate, designate, Organize, investigate and, present a Manage Care Control Cost Plan: Under traditional indemnity insurance, the money follows the patient. Patients select health care providers and visit them as they choose. Providers then bill the private insurer or public payer and are reimbursed on a fee-for-service or per case basis.
Most indemnity plans attempt to limit demand through financial barriers to the patient, such as deductibles and co-insurance, rather than constraints on the provider. Many also require the patient to pay the provider directly and seek reimbursement from the insurer, often with payments less than charges.
Due to growing popular discontent with managed care organizations, many critics believe that the system will not continue in its current state. No one, however, expects managed care to disappear completely and indemnity plans to rise to their former prominence. Changes are expected to occur as managed care programs begin competing among themselves. Cost and efficiency will no longer be the main selling point; quality of services will take precedence. One researcher has suggested that along with new systems of managed care and continuing systems of indemnity plans, health care providers may even organize and offer services directly to employers, thus eliminating the middlemen. This development would be beneficial to all involved: employers would pay less; providers would be better compensated; and clients would receive better care
The paper will be 4-5 pages long. More information and due date will provide in the Fifth Week assignments link.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1.
Introduction (30%)
Provide a short-lived outline of the meaning (not a description) of Chapter 9 and 10 and articles you read, in your own words. Types and classifications of managed care models.
2.
Manage Care Control Cost Plan:
(50%)
a.
Cost savings
‘‘Structural changes centere ...
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
The document discusses key issues related to health reform implementation for safety net health systems. It provides an overview of the National Association of Public Hospitals and Health Systems (NAPH), which advocates for safety net hospitals. The document outlines provisions of the Affordable Care Act related to coverage expansion, exchanges, provider payments, and innovation opportunities. It identifies challenges and questions for safety net health systems to consider regarding health reform implementation.
Kentucky health cooperative an overviewjacktillman
The document provides an overview of Consumer Operated and Oriented Plans (CO-OPs), which were established under the Affordable Care Act to foster the creation of nonprofit health insurers. It discusses the role of CO-OPs and health insurance exchanges, and federal regulations for CO-OPs. It then introduces the Kentucky Health Cooperative as an example CO-OP that was awarded funding to operate in Kentucky.
Jill Pizzola's Tenure as Senior Talent Acquisition Partner at THOMSON REUTERS...dsnow9802
Jill Pizzola's tenure as Senior Talent Acquisition Partner at THOMSON REUTERS in Marlton, New Jersey, from 2018 to 2023, was marked by innovation and excellence.
Job Finding Apps Everything You Need to Know in 2024SnapJob
SnapJob is revolutionizing the way people connect with work opportunities and find talented professionals for their projects. Find your dream job with ease using the best job finding apps. Discover top-rated apps that connect you with employers, provide personalized job recommendations, and streamline the application process. Explore features, ratings, and reviews to find the app that suits your needs and helps you land your next opportunity.
5 Common Mistakes to Avoid During the Job Application Process.pdfAlliance Jobs
The journey toward landing your dream job can be both exhilarating and nerve-wracking. As you navigate through the intricate web of job applications, interviews, and follow-ups, it’s crucial to steer clear of common pitfalls that could hinder your chances. Let’s delve into some of the most frequent mistakes applicants make during the job application process and explore how you can sidestep them. Plus, we’ll highlight how Alliance Job Search can enhance your local job hunt.
How to Prepare for Fortinet FCP_FAC_AD-6.5 Certification?NWEXAM
Begin Your Preparation Here: https://bit.ly/3VfYStG — Access comprehensive details on the FCP_FAC_AD-6.5 exam guide and excel in the Fortinet Certified Professional - Network Security certification. Gather all essential information including tutorials, practice tests, books, study materials, exam questions, and the syllabus. Solidify your knowledge of Fortinet FCP_FAC_AD-6.5 certification. Discover everything about the FCP_FAC_AD-6.5 exam, including the number of questions, passing percentage, and the time allotted to complete the test.
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Are you interested to know what actions help in a job search? This webinar is the summary of several individuals who discussed their job search journey for others to follow. You will learn there are common actions that helped them succeed in their quest for gainful employment.
Joyce M Sullivan, Founder & CEO of SocMediaFin, Inc. shares her "Five Questions - The Story of You", "Reflections - What Matters to You?" and "The Three Circle Exercise" to guide those evaluating what their next move may be in their careers.
Resumes, Cover Letters, and Applying OnlineBruce Bennett
This webinar showcases resume styles and the elements that go into building your resume. Every job application requires unique skills, and this session will show you how to improve your resume to match the jobs to which you are applying. Additionally, we will discuss cover letters and learn about ideas to include. Every job application requires unique skills so learn ways to give you the best chance of success when applying for a new position. Learn how to take advantage of all the features when uploading a job application to a company’s applicant tracking system.
A Guide to a Winning Interview June 2024Bruce Bennett
This webinar is an in-depth review of the interview process. Preparation is a key element to acing an interview. Learn the best approaches from the initial phone screen to the face-to-face meeting with the hiring manager. You will hear great answers to several standard questions, including the dreaded “Tell Me About Yourself”.
Leadership Ambassador club Adventist modulekakomaeric00
Aims to equip people who aspire to become leaders with good qualities,and with Christian values and morals as per Biblical teachings.The you who aspire to be leaders should first read and understand what the ambassador module for leadership says about leadership and marry that to what the bible says.Christians sh
2. LearningObjectives
• Identify keyelementsthat are driving changes in health care
delivery
• Identify keyapproachesto controlling health care costs and
resulting ethicalissues
• Identify keychanges in reimbursementmechanismsto
providers
3. • CAPITATIONAsystem that pays providers a specific amount in advance to
care for the health care needs of a population over a specific time period.
Providers are usually paid on per memberper month (PMPM) basis. The
provider then assumes the risk that the cost of caring for the population
mayexceed the aggregate PMPM amount received.
• CARE MAPPING A process that specifies in advance the preferred
treatment regimen for patients with particular diagnoses. This is also
referred to as a clinical pathway, clinical protocol, or practice guideline.
• SHARED SAVINGSA payment strategythat encouragesprovidersto reduce
health care spending for a defined patient population by offeringthem a
percentageof the net savings realizedas a resultof their efforts.
•
CAPITATION
الصحية الرعاية احتياجات لرعاية اًممقد ًادمحد اًغمبل الخدمة لمقدمي يدفع نظام هو
للسكان
محددة زمنية فترة خالل
.
الشهر في عضو كل أساس على للمقدمين الدفع يتم ما عادة
(
PMPM
.)
يفترض ثم
مبلغ إجمالي تتجاوز قد السكان رعاية تكلفة أن خطر الخدمة مقدم
PMPM
المستلم
.
•
خريطة رسم
تشخيص من يعانون الذين للمرضى المفضل العالج نظام اًقمسب تحدد عملية الرعاية
معينة ات
.
الممارسة إرشادات أو السريري البروتوكول أو السريري المسار باسم اًضأي هذا إلى شارُي
.
•
المشترك التوفير
الص الرعاية على اإلنفاق تقليل على الخدمة مقدمي تشجع دفع استراتيجية
لمجموعة حية
لجهودهم نتيجة المحققة المدخرات صافي من مئوية نسبة منحهم خالل من المرضى من محددة
.
4. • MALPRACTICEREFORM
The ACA addresses medicalliability in twoways:
(1) extensionof federal malpractice protectionsto
nonmedical personnel working infreeclinics.
(2) authorization of $50 million over the next five yearsfor
HHS to award demonstration project grants. These
grants would be provided to states to develop,
implement, institute,and evaluatealternativesto the
present system used in the United States to resolve
charges against physicians and other health care
providers of wrongdoing topatients. الخاطئ اإلصالح
تتناول
ACA
مرحلتين على الطبية المسؤولية
:
.1
العاملي الطبيين غير للموظفين الممارسة سوء ضد الفيدرالية الحماية تمديد
العيادات في ن
المجانية
.
.2
بمبلغ تفويض
50
لـ القادمة الخمس السنوات مدى على دوالر مليون
HHS
منح لمنح
اإليضاحية المشاريع
.
وتأس وتنفيذ لتطوير الدول إلى المنح هذه تقديم سيتم
بدائل وتقييم يس
األطب إلى الموجهة التهم لتسوية المتحدة الواليات في المستخدم الحالي للنظام
ومقدمي اء
المرضى معاملة إساءة بشأن اآلخرين الصحية الرعاية
.
5. LoweringCosts
• Patient Protection and Affordable CareAct(ACA)
• CMS trying to control risingcosts
Center for Medicare and Medicaid Services(CMS)
• Value Based Purchasing(VBP)
7. Toestablish a contextfor the topics covered in this text,
this chapter highlights key issues affecting health care
organizations.It is organizedintothree sections:
(1)changing methods of health carefinancingand
delivery,
(2) addressing the high cost ofcare,and
(3) establishing value-based paymentmechanisms.
القض على الضوء الفصل هذا يسلط ، النص هذا يغطيها التي للموضوعات سياق إلنشاء
ايا
الصحية الرعاية مؤسسات على تؤثر التي الرئيسية
.
أقسام ثالثة إلى منظمة وهي
:
.1
، وتقديمها الصحية الرعاية تمويل طرق تغيير
.2
و ، الرعاية تكلفة ارتفاع معالجة
.3
القيمة أساس على الدفع آليات إنشاء
.
8. ChangingMethodsOfHealthCare
FinancingandDelivery
• Requirementthat almost all individualshave insurance coverage
• Requirementthat statescreateinsurance exchanges
• Provisionsfor expansionof Medicaid (is a social health care program
for familiesand individualswith low income and resources)
• Provisions for medicalloss ratioand premium rate reviews
• Bundled paymentsandVBP
• Accountable CareOrganizations
This individual mandate lies at the heart ofthelegislation.
whereindividualsand smallbusinesses can obtaincoverage.TheACA containsrequirements
foran essential benefitspackageand providesforchangesto the taxlaw that include
penaltiesfor individualswhochoose not to haveinsurance.
under agesixty-five.
value-basedpurchasingsystem
to share in costsavingsthat they achieveforthe Medicare program.
•
اًبتقري األفراد لجميع تأمينية تغطية وجود اشتراط
.
•
التأمين تبادالت إنشاء على ينص الذي الشرط
.
•
برنامج لتوسيع أحكام
Medicaid
(
المنخفض الدخل ذوي واألفراد للعائالت اجتماعية صحية رعاية برنامج هو
والموارد
.)
•
األقساط أسعار ومراجعات الطبية الخسارة نسبة مخصصات
.
•
و المجمعة المدفوعات
VBP
.
•
المسؤولة الرعاية منظمات
.
9.
10. Trends(HealthInsuranceExchanges)
• *Rise of uninsured from 36 million to 50million2001-2010
• ACA authorizes competitive insurance marke place
• Rise of uncompensatedcare for the uninsured2001-2011
• Accountable Care Organizations*(ACO)
• Patient Centered MedicalHome(PCMH)
• New technology
• value-based purchasingsystem(VBP)
at the state leveland providesfortwo types of exchanges,an individualexchange and a small businessexchange
The individual exchange provides a mechanism for implementing the individual mandate for
those who either do not have access to health insurance through an employer plan or who are
uninsured for otherreasons.
The small of health insurance for their employees by pooling their buying power and provide
business exchange provides access for small businesses, enabling them to improve the quality ding
multiplehealth insurance options.
الص التأمين إلى الوصول إمكانية لديهم ليس الذين ألولئك الفردي التفويض لتنفيذ آلية الفردي التبادل يوفر
خطة خالل من حي
أخرى ألسباب عليهم المؤمن غير أو العمل صاحب
.
التجاري التبادل وتوفير الشرائية قوتهم تجميع خالل من لموظفيهم الصغير الصحي التأمين يوفر
للشركات الوصول
المتعددة الصحي التأمين خيارات جودة تحسين من يمكنهم مما ، الصغيرة
.
11. • This rise (from 36 million to 50 million) is dueto several factors,
including:
(1)health insurance and out-of-pocketcostsbecoming too costlyfor many individuals,
even when theyareworking;
(2)individuals being screened out by insuranceunderwritersbecause of
preexistingconditions;
(3)employerseitherscalingback employees'benefitsoreliminating them altogether by
hiring part-timeworkers;
(4) stategovernmentstighteningMedicaideligibilitycriteria;
(5)individuals voluntarily deciding not to purchase insurance for a variety of financial and
nonfinancial reasons, including the assumption that they will not need care or that they
will be taken care of by the "system"anyway.
The ACA provides for a minimum benefits package; however,participants will be able to shop for
health insurance from among an array of commercialhealth insurance products with varying levels
of deductibles, coinsurance, and additional benefits over and above the minimum. The benefit
packages are referred to as bronze, silver,gold, and platinum, depending on how much participants
choose to pay.
االرتفاع هذا ويرجع
(
من
36
إلى مليون
50
مليون
)
منها عوامل عدة إلى
:
.1
؛ العمل عند حتى ، األفراد من للعديد بالنسبة التكلفة باهظة الشخصية والتكاليف الصحي التأمين أصبح
.2
؛ اًقمسب الموجودة الظروف بسبب التأمين وكالء قبل من فحصهم يتم الذين األفراد
.3
؛ جزئي بدوام عمال تعيين طريق عن اًمتما عليها القضاء أو الموظفين مزايا تقليص إما العمل أرباب
.4
؛ الطبية األهلية لمعايير الحكومات تشديد
.5
افترا ذلك في بما ، المالية وغير المالية األسباب من متنوعة لمجموعة التأمين شراء عدم اًعطو قرروا الذين األفراد
لن أنهم ض
أن أو رعاية إلى يحتاجوا
"
النظام
"
حال أي على بهم سيهتم
.
12. • *Accountable CareOrganizations
An ACO is a voluntary group of health care providers who come
together to provide coordinated care to a patient population in order
to improve quality andreduce costs by keeping patients healthy and
by reducing unnecessary service duplication
• *Patient-Centered MedicalHome
The patient-centered medical home (PCMH) is a partnership
between primary care providers (PCPs), patients, and their families
to deliver a coordinated and comprehensive rangeof services inthe
mostappropriate settings.
*
المسؤولة الرعاية منظمات
ACO
لمجمو منسقة رعاية لتقديم يجتمعون الذين الصحية الرعاية مقدمي من تطوعية مجموعة هي
من عة
وتقل المرضى صحة على الحفاظ طريق عن التكاليف وخفض الجودة تحسين أجل من المرضى
يل
الخدمة في الضرورية غير االزدواجية
*
المريض على يركز طبي منزل
المريض على يركز الذي الطبي المنزل
(
PCMH
)
األولية الرعاية مقدمي بين شراكة هو
(
PCPs
)
اإلعدادات أنسب في الخدمات من وشاملة منسقة مجموعة لتقديم وعائالتهم والمرضى
.
14. AnotherFactorsThatCouldContributetoanDecreasein Costs
• Pharmaceuticals are going off patent, creating opportunities forcost
savings with genericdrugs.
• Certain behaviors have begun to change, spurred in large part by
employerswho can no longer affordto pay for employeehealth care
the way they have in thepast.
Lean thinking breaks processes down into identifiable steps to ensure that each
componentis a value-added activity.Amain tenetof lean thinking and Six Sigma is to
reduce the variationinhow activitiesare conducted, an importantstep towardquality
improvement.
Six Sigma, including the related concept of lean thinking, which offersasystematic
approachto analysisand performance improvement.The five major componentsof
the Six Sigma approach are defined, measure, analyze, improve, and control
(nicknamed DMAIC)
•
باستخد التكاليف في وفورات لتحقيق اًصفر يخلق مما ، االختراع براءات عن األدوية تخرج
األدوية ام
العامة
.
•
ب يعد لم الذين العمل أرباب قبل من كبير حد إلى مدفوعة ، التغير في السلوكيات بعض بدأت
تحمل إمكانهم
الماضي في عليها كانوا التي بالطريقة للموظفين الصحية الرعاية تكاليف
.
16. ImpactstoReimbursement
Cost AccountingSystems
The process of estimating and classifying costs incurred by an organization.These costs
can be analyzed at the organizational and departmental levels. separating cost
accounting systems from financial accounting systems and moving away from
traditionalcost-accountingsystemsbased on assignment to activity-basedcostsystems.
This is an expensive endeavor, but lower reimbursements force hospitals to invest in
more sophisticatedcostaccountingsystems.
MergersandAcquisitions
a mergerrequiresthat neither of the parties coming togetherhas control.The two (or
more) entitiesmerge to startan entirely new entity with no step-upin basis of the
assets. the new entity comesinto being on the dateof the merger.
an acquisition,there is a controllingparty,and the assets and liabilitiesare markedto
fairvalue.Acquisitionsare more common than mergersin the health care industry.
New DRGSystem
The new system, based on Medicareseverity-adjusted diagnosis-related groups (MS-
DRGs), has 25 major disease categories, 745 diagnosis-related groups, and 3 subclasses
of complications and comorbidities. It is intended to more closely align reimbursement
to patientseverity of illness, It is intendedto reduce overallcoststhrough improvedcare,
thus combining quality with costcontrol and improved equity.(pay for peiformance,or
P4P)
17. ImpactstoReimbursement
GROUP PURCHASINGORGANIZATION(GPO)A networkof health careorganizationsand
a third-party vendor who are able to acquire large volumes of supplies from
manufacturersat negotiateddiscountedratesowing toeconomies of scale.
RetailHealth CareWalk-inmedical services for basic preventivehealth care provided in a
retailoutlet, such as a pharmacy,bya licensed care provider.
Compliance The process of abiding by governmental regulations, whether in the
provisionof care, billing,privacy,accountingstandards,security,or anyother regulated
area.
RecoveryAuditContractor(RAC) A programcreated under the MedicareModernization
Act of 2003 to identify and recover improper Medicare payments to health care
providers.
Value-Based Purchasing (VBP) A payment methodology designed to provide incentives
to providersfor delivering qualityhealth careat a lower cost. The financial rewardscome
from funds being withheldby the payor;these funds are then redistributedon providers'
achievement of an improvement on specific performance measures, including patient
satisfaction.
ICD-1 0 The WorldHealth Organization'sInternational StatisticalClassificationofDiseases
and Related Health Problems (lCD) is a coding system for diseases that is used in the
United Statesfor health insurance claim reimbursement.
18. • Recovery Audit Contractors(RAC)
-There are two types of reviews:automated and complex. The
automated review requires nomedical records.
The complexreviewensues when the automated reviewprovidesevidence of a high
likelihood that the service received improper payment or that there is no Medicare
policy, Medicare article, or Medicare-sanctioned coding guideline for the service
provided.
- The Medicare Audit Improvement Act of2012 was designed to promote transparency
and fairness in RAC reviews, and if passed, itwould establish a penalty for a RAC's failure
to follow the program requirements. It would also, among other things:
1) Establish a consolidatedlimit formedical record requests.
2)Requiremedical necessity audits to focus on widespread payment errors.
3)Allow denied inpatient claims to be billed as outpatient claimswhen appropriate.
4) Requirephysician reviewforMedicare denials.
•
المراجعات من نوعان هناك
:
ومعقد آلي
.
طبية سجالت أي تتطلب ال اآللية المراجعة
.
•
ال أنه أو صحيحة غير مدفوعات تلقت الخدمة بأن كبير احتمال وجود على ً
دليال اآللية المراجعة تقدم عندما المعقدة المراجعة تتم
سيا توجد
سة
Medicare
مقالة أو
Medicare
ترميز إرشادات أو
Medicare
المقدمة للخدمة
.
-
لعام الطبية الرعاية تدقيق تحسين قانون تصميم تم
2012
مراجعات في واإلنصاف الشفافية لتعزيز
RAC
، إقراره تم وإذا ،
فشل على عقوبة فرض فسيتم
RAC
البرنامج متطلبات اتباع في
.
أخرى أمور بين من ، اًضأي سيكون
:
.1
الطبية السجالت لطلبات موحد حد وضع
.
.2
طلب
تدقيقات
المنتشرة الدفع أخطاء على للتركيز الطبية الضرورة
.
.3
االقتضاء عند الخارجيين المرضى مطالبات أنها على المرفوضة الداخليين المرضى مطالبات بدفع السماح
.
.4
برنامج رفض لحاالت الطبيب مراجعة طلب
Medicare
.
19. • MedicalTourism
Travelto a foreign country to obtain normally expensive medical
services at a steep discount. Even with a family member escorting
the patient (and getting the added benefitof foreigntravel),the total
cost is typicallylessthan it would be athome.
• Electronic Health Record(EHR)
Also called an electronic medical record (EMR), this online version of
patients' medical records can include patient demographics,
insurance information, dictations and notes, medication and
immunization histories, ancillary testresults,and the like.Under strict
security permissions, the information can be accessed either in-
house or in private officesettings.
طبية سياحة
حاد بخصم عادة الثمن باهظة طبية خدمات على للحصول أجنبي بلد إلى السفر
.
المريض بمرافقة األسرة أفراد أحد قيام مع حتى
(
والحصول
الخارج إلى للسفر إضافية ميزة على
)
المنزل في عليه ستكون مما أقل تكون ما عادة اإلجمالية التكلفة فإن ،
.
اإللكتروني الصحي السجل
(
EHR
)
اإللكتروني الطبي السجل باسم اًضأي ُعرفي
(
EMR
)
التركي للمرضى الطبية السجالت من اإلنترنت عبر النسخة هذه تتضمن أن ويمكن ،
بة
و ، اإلضافية االختبارات ونتائج ، والتحصين األدوية وتاريخ ، والمالحظات واإلمالءات ، التأمين ومعلومات ، للمرضى السكانية
شابه ما
.
الخاصة المكتب إعدادات في أو المنزل في إما المعلومات إلى الوصول يمكن ، صارمة أمنية تصاريح بموجب
.
20. • Prospective PaymentSystem(PPS)
The payment system used by Medicare to reimburse providers a predetermined
amount. Several payment methods fall under the PPS umbrella, including
methods based on DRGs (for inpatient admissions), APCs (for outpatient visits), a
resource-based relative value scale (RBRVS) (for professional services), and
resource utilizationgroups (RUGs) (forskilled nursing home care). Use of DRGs
was the first method that fell under this type of predetermined payment
arrangement.
Health care systemsareconsolidatingto be largerplayersin the market in
order to:
1)Spread fixed technologyand administrative costs over a largerrevenue base.
2) Strengthen marketpenetration.
3) Gain better accesstocapital.
4) Add new servicelines.
5) Obtain bettercontractsfromcommercialpayors.
المحتمل الدفع نظام
(
PPS
)
قبل من المستخدم الدفع نظام
Medicare
اًقمسب ًادمحد اًغمبل الخدمة مقدمي لتعويض
.
الدف طرق من العديد تندرج
تحت ع
مظلة
PPS
إلى المستندة الطرق ذلك في بما ،
DRGs
(
الداخليين المرضى لدخول
)
و ،
APCs
(
المرضى لزيارات
الخارجيين
)
الموارد على القائم النسبية القيمة ومقياس ،
(
RBRVS
( )
المهنية للخدمات
)
الموارد استخدام ومجموعات ،
(
RUGs
( )
المهرة المنزلية للرعاية
.)
استخدام كان
DRGs
ترتيبات من النوع هذا تحت تندرج التي األولى الطريقة هو
اًقمسب المحددة الدفع
.
السوق في أكبر اًبالع لتكون الصحية الرعاية أنظمة توحيد يتم
أجل من
:
.1
إي قاعدة على اإلدارية والتكاليف الثابتة التكنولوجيا نشر
أكبر رادات
.
.2
السوق اختراق تعزيز
.
.3
المال رأس إلى أفضل بشكل الوصول
.
.4
جديدة خدمة خطوط إضافة
.
.5
التجاريين الممولين من أفضل عقود على الحصول
.
21. Summary
• Health care administratorfacesnumerous complexissues when making strategic
and financialdecisions.
• High ethical standardsmust be demonstrated
Health InsurancePortabilityand AccountabilityAct (HIPAA)
A set of federal compliance regulations enacted in 1996 to ensure
standardization of billing, privacy, and reporting practices as
institutionsconvert toelectronicsystems
The HITECHAct (2009) was enacted with thegoalof:
a. Creating and expanding the currenthealth care IT infrastructure
b. Promoting electronic dataexchange
c. SubstantiallyandrapidlyincreasingEHR adoption
Hospitals can keep funds longer and reduce inventory costs by incorporating just-in-time
ordering techniques, and opportunity exists for cost savings by joining group purchasing
organizations (GPOs) that cannegotiatecost discountsthrough largevolumes
المعق القضايا من العديد الصحية الرعاية مسؤول يواجه
دة
والمالية االستراتيجية القرارات اتخاذ عند
.
العالية األخالقية المعايير إثبات يجب
النق وقابلية الصحي التأمين قانون
ل
والمساءلة
(
HIPAA
)
من مجموعة
ت التي الفيدرالية االمتثال لوائح
في سنها م
عام
1996
ممارسات توحيد لضمان
التقار وإعداد والخصوصية الفوترة
ير
األنظمة إلى تحول كمؤسسات
اإللكترونية
هايتك قانون سن تم
(
2009
)
بهدف
:
الح التحتية البنية وتوسيع إنشاء
الية
الص للرعاية المعلومات لتكنولوجيا
حية
.
للبيا اإللكتروني التبادل تعزيز
نات
.
اعتماد في وسريعة كبيرة زيادة
EHR
.
28. Balance SheetComponents
• Heading-Name of the organizationanddate
• Body includes:
• Assets= Liabilities+ NetAssets
• Liabilitieshave 2 categories-current andnoncurrent
• Net Assets=Communities interest in the assets of the notfor
profit
• Footnotes=additional key information
In investor-ownedentities, the equationbecomes
Assets= Liabilities+ Stockholders'Equity
In not-for-profithealth care entity,theequation
Basic AccountingEquation:
Assets = Liabilities+ Net Assets (or stockholders'equity).
فئتان لها الخصوم
-
المتداولة
المتداولة وغير
األصول صافي
=
مصلحة
غير األصول في المجتمعات
للربح الهادفة
الهوامش
=
أساسية معلومات
إضافية
العنوان
-
والتاريخ المنظمة اسم
يشمل الجسم
:
29. Assets
• Probable future economic benefits obtained or controlledby a
particularentity as a resultof past transactionsor events.
• Represent resourcesowned
• Are recorded at their cost unless donated
• If donated recordedat fair value at date of donation
Liquidity refers to how quickly an asset can be turned into cash,and current assetsare
generallylisted in liquidityorder.
المتداولة الأصول إدراج ويتم ، نقد إلى الأصل تحويل سرعة مدى إلى السيولة تشير
اًعموم
السيولة ترتيب في
.
•
عل الحصول تم التي المحتملة المستقبلية الاقتصادية المنافع
أو يها
سابقة أحداث أو لمعاملات نتيجة معين كيان قبل من عليها السيطرة
.
•
المملوكة الموارد تمثيل
•
بها التبرع يتم لم ما نفقتها على مسجلة
•
التبرع تاريخ في العادلة بالقيمة التبرع تم إذا
30. More onAssets
• Current assets are those used or consumed within a year
• Limited or restricted to use in noncurrentportion identified for
how they can be used
• Noncurrent assets are resources to be used or consumedover a
period of time > one year (or veryold)
• Cash and cash equivalents are the most liquid asseton the balance
sheet
• Noncurrent and long term are used interchangeably
•
عام غضون في المستهلكة أو المستخدمة تلك هي المتداولة األصول
•
استخدامها لكيفية المحدد الحالي غير الجزء في لالستخدام مقيد أو محدود
•
زمني فترة مدى على استهالكها أو استخدامها سيتم التي الموارد هي المتداولة غير األصول
ة
>
سنة
واحدة
(
ًادج قديمة أو
)
•
العمومية الميزانية في سيولة األصول أكثر المعادل والنقد النقد يعتبر
•
بالتبادل الحالي وغير الطويل المدى استخدام يتم
31. Current & NoncurrentAssets
• Current may include : cash, investments, limitedor restricted
as to use current position, patient accounts receivable,
estimated receivables from 3rd party payers, inventories,
assets held for sale, prepaidexpenses
• Noncurrentmay include: self insurance, benefitplans, capital
equipment, held by the board under bond indenture
agreements, property and equipment, goodwill, net of
accumulatedamortization
Suppliesare sometimes called inventory.
المخزون ا
ً
أحيان المستلزمات تسىم
.
تشمل قد الحالية
:
و ، الحالي الوضع الستخدام مقيدة أو محدودة ، واالستثمارات ، النقدية
حسابات
واألص ، والمخزونات ، الثالث الطرف دافعي من المقدرة المدينة والذمم ، المدينة المرضى
ول
مسبقا المدفوعة والمصروفات ، للبيع بها المحتفظ
المتداول غير يشمل قد
:
يحت التي الرأسمالية والمعدات ، المزايا وخطط ، الذاتي التأمين
بها فظ
وصافي ، والشهرة ، والمعدات والممتلكات ، السندات عقد اتفاقيات بموجب اإلدارة مجلس
المتراكم االستهالك
32. Cash and Cash Equivalents: are the most liquid current assets. This account is composed
of actual money on hand as well as savings and checking accounts. Cash equivalents are
short-term investmentswith an original maturityof three months or less.
PatientAccountsReceivable,Netof Allowancefor Doubtful Accounts
Gross patient accounts receivable is the amount owed the health care entity at full
charges. However, many payors , such as Medicaid, insurance companies, large employers,
and managed care entities, are given discounts, are givendiscounts,called contractual
allowances. After subtracting contractual allowances and charity care discountsfrom gross
patient accounts receivable,whatremains is the patient accounts receivablethatthe
providerhas a legalright tocollect.
A reserve or allowance is deducted from patient accounts receivable on thebalance
sheet. It representsan estimateof how much of the entity's patientaccountsreceivable are not likely to
be collectable. This estimateis called the allowancefor doubtful accounts.
Examples of current assets
سيولة األكثر المتداولة األصول من يعادله وما النقد
.
المتوفرة الفعلية األموال من الحساب هذا يتكون
إلى باإلضافة
الجارية والحسابات التوفير حسابات
.
است تاريخ ذات األجل قصيرة استثمارات هي المعادلة النقدية
يبلغ أصلي حقاق
أقل أو أشهر ثالثة
.
تحصيلها في المشكوك الحسابات مخصصات صافي ، المدينة المرضى حسابات
الكاملة بالرسوم الصحية الرعاية لكيان المستحق المبلغ هو القبض المستحقة المرضى حسابات إجمالي
.
ف ، ذلك ومع
من العديد إن
مثل ، الدائنين
Medicaid
م ويتم ، خصومات منحهم يتم ، دارةُمال الرعاية وكيانات الكبار العمل وأصحاب التأمين وشركات
نحهم
التعاقدية العالوات تسمى ، خصومات
.
ال حساب إجمالي من الخيرية الرعاية وخصومات التعاقدية المخصصات طرح بعد
مريض
ًايقانون تحصيلها للمزود يحق التي المدينة المرضى حسابات هو تبقى ما يبقى ، لالستالم القابل
.
العمومية الميزانية في المدينة المرضى حسابات من المخصص أو االحتياطي خصم يتم
.
الذ لمقدار اًتقدير يمثل إنه
المدينة مم
تحصيلها المحتمل غير من التي للمرضى
.
تحصيلها في المشكوك الحسابات مخصص التقدير هذا يسمى
.
33. Suppliesrefersto small-dollaritemsthat will be used up or fully consumedwithin one
year or less, such as pharmaceuticalsand officesupplies.
Equipmentrefersto moreexpensiveitems thatwill be used over a longerperiod, such as
buildings andradiologyequipment.
Prepaidexpensesinclude items the health care entityhas paid forin advance, such as
rent andinsurance.
Investments:
The classification of investments depends on how long management intends to hold them and
whether or not restrictions or other requirements are absent. Short-term investments often
include certificates of deposit, commercial paper, and treasury bills (those with an original
maturity of three months or less are included in cash and cash equivalents)andalso
marketablesecurities designated as tradingsecurities. Short-term investments allow a health care
facility to earn interest on idle cash and, at the same time, providealmostimmediateaccess to cash
for unexpectedsituations.
Examples of currentassets
غضو في بالكامل استهالكها أو استخدامها سيتم التي بالدوالر الصغيرة العناصر إلى اإلمدادات تشير
أو واحد عام ن
المكتبية واللوازم الصيدالنية المستحضرات مثل ، أقل
.
ومعدات المباني مثل ، أطول لفترة استخدامها سيتم والتي تكلفة األكثر العناصر إلى المعدات تشير
األشعة
.
و اإليجار مثل ، اًقمسب الصحية الرعاية هيئة دفعتها التي البنود اًممقد المدفوعة المصروفات تشمل
التأمين
.
األخر المتطلبات أو القيود كانت إذا وما بها االحتفاظ اإلدارة تنوي التي المدة على االستثمارات تصنيف يعتمد
موجودة غير ى
ال أم
.
الخزانة وأذون التجارية واألوراق اإليداع شهادات على األجل قصيرة االستثمارات تشتمل ما ًابغال
(
الت تلك
تاريخ لها ي
المعادل والنقد النقد في مدرجة أقل أو أشهر ثالثة لمدة أصلي استحقاق
)
للتسوي القابلة المالية األوراق اًضوأي
كأوراق المصنفة ق
للتداول مالية
.
وفي ، الخامل النقد على فائدة بكسب الصحية الرعاية لمنشأة األجل قصيرة االستثمارات تسمح
، الوقت نفس
المتوقعة غير المواقف في النقود إلى الفوري الوصول من قدر أقصى توفير
.
34. Examples of noncurrent assets
capital equipment: (includes long-lasting goods acquired and owned by a company or
organization that are not consumed in the normal course of business—goods such as
machinery,trucks,largecomputers,and officefurniture),
Properties and Equipment,Net
This categoryof assets represents the major capital investments in the facility. Three
types of assets are included in this category: land, plant,and equipment. Plant refers to
buildings (fixed, immovable objects), land refers to property, and equipment includes a
wide varietyof durableitems from beds to CATscanners
Goodwill:
Goodwillis the term used forwhat an entity is buying in an acquisition when it payscash
and assumes liabilitiesin excess of the fair valueof the assets acquired.
Goodwillrepresentsthe future earningspower of the acquiredentity.
الرأسمالية المعدات
( :
ي وال مؤسسة أو شركة وتملكها عليها الحصول تم التي األمد طويلة السلع تشمل
استهالكها تم
العادية األعمال سياق في
-
المكاتب وأثاث الكبيرة الكمبيوتر وأجهزة والشاحنات اآلالت مثل سلع
)
،
صافي ، ومعدات خصائص
المنشأة في الرئيسية الرأسمالية االستثمارات األصول من الفئة هذه تمثل
.
ف األصول من أنواع ثالثة تضمين يتم
الفئة هذه ي
:
األرض
والمعدات واآلالت
.
المباني إلى النبات يشير
(
المنقولة وغير الثابتة األشياء
)
وت ، الممتلكات إلى األرض وتشير ،
المعدات شمل
الضوئية الماسحات إلى األسرة من المعمرة العناصر من متنوعة مجموعة
CAT
حسنة نية
:
تز التزامات وتفترض ًادنق تدفع عندما استحواذ عملية في المنشأة تشتريه لما المستخدم المصطلح هي الشهرة
العادلة القيمة عن يد
المكتسبة لألصول
.
عليه المستحوذ للكيان المستقبلية األرباح قوة الشهرة تمثل
.
35. Liabilities
• Obligations of the entity to pay itscreditors
• Can be debts or otherobligations
• 2 types
1) Current Liabilities- Financial obligations due within one year
2)Noncurrent liabilities- Resources used or consumed over periods
longer than oneyear
Liabilities: The probable future sacrifices of economic benefits arising from present
obligations of a particularentity to transferassets or provideservices to other entities
in the future as a result of past transactionsor events. Liabilities can be debts or other
obligations: for example, deferred revenue, which is an obligation to provide or deliver
goodsor services when paymenthas been receivedin advance.
لدائنيها بالدفع المنشأة التزامات
أخرى التزامات أو اًنديو تكون أن يمكن
2
أنواع
(1
المتداولة المطلوبات
-
واحدة سنة خالل المستحقة المالية االلتزامات
2
)
المتداولة غير الخصوم
-
وا سنة من أطول فترات مدى على المستهلكة أو المستخدمة الموارد
حدة
المطلوبات
:
ل الحالية االلتزامات عن الناشئة االقتصادية للمنافع المحتملة المستقبلية التضحيات
لتحويل معين كيان
سابقة أحداث أو لمعامالت نتيجة المستقبل في أخرى لمنشآت خدمات تقديم أو األصول
.
ا تكون أن يمكن
لخصوم
أخرى التزامات أو اًنديو
:
البض تسليم أو بتوفير التزام وهي ، المؤجلة اإليرادات ، المثال سبيل على
الخدمات أو ائع
اًممقد الدفعة استالم عند
.
36. Current& NoncurrentLiabilities
• Current could include: accounts payable, accrued expenses,
salaries & wages, estimated payables to third parties, short
term borrowings, commercial paper and current portion of
long-term debt.
• Noncurrent could include: long term debt (mortgages and
bonds payable, and estimates for malpractice or self-insured
risks such as a self-funded health benefit or worker's
compensation arrangement),self-insurance reserves,accrued
pension and retireehealthcosts
الجاري التداول يشمل أن يمكن
:
واألجور والرواتب ، المستحقة والمصروفات ، الدائنة الحسابات
،
الحالي والجزء التجارية واألوراق ، األجل قصيرة والقروض ، أخرى ألطراف المقدرة الدائنة والذمم
من
األجل طويلة الديون
.
المتداول غير يشمل أن يمكن
:
األجل طويلة الديون
(
الدفع المستحقة والسندات العقارية الرهون
،
ترتي أو اًيذات الممولة الصحية المزايا مثل الذاتي التأمين مخاطر أو الممارسة سوء وتقديرات
تعويض ب
العمال
)
للمتقاعد الصحية والتكاليف ، المستحقة والمعاشات ، الذاتي التأمين واحتياطيات ،
ين
37. Current Portionof Long-TermDebt
This accountcontains the amount of the entity's long-term debt that is expected to be paid
off within one year. This information is sometimes reported in the account notes payable,
which reports the amount of short-term (less than one year) obligations for which a formal
note has beensigned.
Deferred revenue: consists of fees that have been collected in advance. It represents cash that
is received before the service is rendered by the entity. Accordingly, it is an obligation that will,
upon performance, become revenue. “CurrentLiabilities”
األجل طويلة الديون من المتداول الجزء
واحد عام خالل سداده المتوقع للكيان األجل طويل الدين مبلغ على الحساب هذا يحتوي
.
عن اإلبالغ يتم
هذه
االلتزام مبلغ إلى تشير والتي ، الدفع المستحقة الحساب سندات في األحيان بعض في المعلومات
األجل قصيرة ات
(
واحدة سنة من أقل
)
بشأنها رسمية مذكرة على التوقيع تم التي
.
المؤجلة اإليرادات
:
اًممقد تحصيلها تم التي الرسوم من تتكون
.
ال تقديم قبل المستلم النقد يمثل
الكيان قبل من خدمة
.
إيرادات ، األداء عند ، سيصبح التزام فهو ، ذلك على ًءوبنا
" .
المتداولة المطلوبات
"
38. NetAssets
• Remaining assets after deducting itsliabilities
• 3 classes
1) Permanently restricted (the presence or absence ofdonor-
imposed restrictions)
2) Temporarilyrestricted
3) Unrestricted
• May also include- non controllingownership interestin
subsidiaries
Net Assets (or Equity): The assets of an entity that remain after deducting its liabilities(also
called residual interest). In a business enterprise, equity is the ownership interest. In a not -
for -profit entity,which has noownershipinterest.
Net assets= Assets-Liabilities
Stockholders'Equity
Investor-ownedhealth careentities use a differentformof presentationin the stockholders'
equity section of the balancesheet.
Stockholders' equity in investor-ownedentitiesconsistsof the stockand retainedearnings.
التزاماتها خصم بعد المتبقية األصول
3
فصول
1
)
دائم بشكل مقيدة
(
المانح يفرضها قيود وجود عدم أو وجود
ون
)
2
)
مؤقتا مقيدة
3
)
مقيد غير
اًضأي تتضمن قد
-
الشركات في مسيطرة غير ملكية حصة
التابعة
األصول صافي
(
الملكية حقوق أو
:)
التزاماتها خصم بعد تبقى التي الكيان أصول
(
المتبق الفائدة اًضأي وتسمى
ية
.)
تجارية مؤسسة في
الملكية حصة هي الملكية حقوق ،
.
الملكية في مصلحة له وليس ، للربح هادف غير كيان في
.
المساهمين حقوق
الميزان في المساهمين حقوق قسم في العرض من اًفمختل ًالشك للمستثمرين المملوكة الصحية الرعاية كيانات تستخدم
العمومية ية
.
المحتجزة واألرباح األسهم من للمستثمرين المملوكة الكيانات في المساهمين حقوق تتكون
.
39. Statement ofOperations
• Summary of the entity’s revenues and
expenses over aperiod of time. (As opposed
to the balancesheet)
• Period is usually the time between statements
• Uses the accrual basis foraccounting
• It does not use the cash basis foraccounting
• Represents how much the entity earned, its
gainsand other sources of revenue and the
resources used during the accounting period
•
الكيان إليرادات ملخص
زمنية فترة خالل ومصاريفه
.
(
العمومي الميزانية عكس على
ة
)
•
الوقت عادة هي الزمنية الفترة
العبارات بين
•
االستحقاق أساس يستخدم
للمحاسبة
•
النقدي األساس يستخدم ال
للمحاسبة
•
المنش كسبته ما مقدار يمثل
أة
اإليرادات ومصادر وأرباحها
المستخدمة والموارد األخرى
المحاسبية الفترة خالل
40. Statement ofOperation
Components
• Title-name of entity,statement andperiod for information
• Unrestricted revenue, gains and other support
• Net patient services revenue
• Premium revenue
• Other revenue
• Provision for baddebt
• Net assets released from restriction
•
العنوان
-
المعلومات وفترة والبيان الكيان اسم
•
الدعم أشكال من وغيرها المقيدة غير والمكاسب اإليرادات
•
المرضى خدمات إيرادات صافي
•
ممتازة عائدات
•
اخرى ايرادات
•
المعدومة الديون مخصص
•
القيود من عنها المفرج األصول صافي
41. Statement ofOperations
continued
• Expenses
• Depreciation and amortization (non cashexpenses)
• Other
• Operating Income
• Non operating items
• Excess of revenue overexpenses
• Excessof revenue over expenses, net of noncontrolling
interest
Interest is the costto borrowmoney
المال اض ر
اقي تكلفة ي
ه الفائدة
•
نفقات
•
واإلطفاء االستهالك
(
نقدية غير مصاريف
)
•
آخر
•
التشغيل دخل
•
العاملة غير العناصر
•
المصاريف على اإليرادات فائض
•
الملك حقوق خصم بعد ، المصروفات على اإليرادات فائض
ية
42. UnrestrictedRevenue
The term revenues refers to the amounts either earned by the entity or donated to it.
Gains can come from transactions such as selling assets for more than theircarryingvalue
(such as selling a building or other investment). Other support includes such items as
appropriationsfrom governmentalentitiesand unrestricteddonations.Netpatientservice
revenuegenerallymakes up the largestportion of unrestrictedrevenue,gains.
revenues representamounts earned bythe entity,notthe amount of cash it received
during the period.
Net Patient ServiceRevenue
Gross patient service revenue is the amount the health care entitywould haveearned if all
the payorspaidfull charges.
the provision for bad debts, also called bad debt expense or uncollectiblesexpense
المقيدة غير اإليرادات
له بها التبرع تم أو الكيان عليها حصل التي المبالغ إلى اإليرادات مصطلح يشير
.
تأتي أن يمكن
من المكاسب
الدفترية قيمتها من بأكثر األصول بيع مثل معامالت
(
آخر استثمار أو مبنى بيع مثل
.)
الدع يشمل
ًادبنو اآلخر م
المقيدة غير والتبرعات الحكومية الكيانات من االعتمادات مثل
.
ع المرضى خدمة إيرادات صافي يشكل
اًممو
المقيدة غير األرباح من األكبر الجزء
.
الفتر خالل تلقته الذي النقدي المبلغ وليس ، الكيان قبل من المكتسبة المبالغ اإليرادات تمثل
ة
.
المريض خدمة إيرادات صافي
الرس دافع كل دفع إذا الصحية الرعاية كيان ستكسبه كانت الذي المبلغ هو المريض خدمة إيرادات إجمالي
كاملة وم
.
ل القابلة غير المصاريف أو المعدومة الديون مصروفات اًضأي وتسمى ، المعدومة الديون مخصص
لتحصيل
43. Premium revenue is revenueearned from capitatedcontracts,orit couldbe health plan revenueif the
entity has a healthplan.
Net assets released from restriction are funds reclassified tounrestricted accounts from
temporarilyrestrictednet assets.
Depreciationandamortizationreflectthe amount of a noncurrentasset used up during
the accountingperiod.
Depreciation:A measureof the extent to which a tangible asset(such as plantor equipment) has
been used up (during the accountingperiod) orconsumed.
Amortization:ameasureof how much of an intangibleasset (such as debtissuance cost and goodwill) has
been used up (during the accountingperiod) or consumed.
Other expenses is a catchall categoryformiscellaneous operatingexpenses that are not considered
significantenough to be listedseparately.
Operatingand NonoperatingItems
an excessof revenueover expenses, revenuesand gainsover expenses and losses, earned income, or
performance earnings.
On the statementof operations,expensesare a measure of the amount of resourcesused or consumed in
providinga service, not cashoutflows.
صحية خطة لديه الكيان كان إذا صحية خطة إيرادات تكون قد أو ، االستسالم عقود من المكتسبة اإليرادات هي الممتازة اإليرادات
.
اًتمؤق المقيدة األصول صافي من مقيدة غير حسابات إلى تصنيفها المعاد األموال هو القيود من المحررة األصول صافي
.
المحاسبية الفترة خالل المستخدم المتداول غير األصل مبلغ واإلطفاء االستهالك يعكس
.
االستهالك
:
الملموس األصل استخدام لمدى مقياس
(
المعدات أو المصنع مثل
( )
المحاسبية الفترة خالل
)
استهالكه أو
.
االستهالك
:
الملموسة غير األصول لمقدار مقياس
(
والشهرة الدين إصدار تكلفة مثل
)
استخدامها تم التي
(
المحاسبية الفترة خالل
)
استهال أو
كها
.
منفصل بشكل إدراجها ليتم يكفي بما كبيرة تعتبر ال التي المتنوعة التشغيل لمصروفات شاملة فئة هي األخرى المصاريف
.
العاملة وغير العاملة العناصر
األداء أرباح أو المكتسب الدخل أو والخسائر المصروفات على والمكاسب واإليرادات النفقات على اإليرادات زيادة
.
ا النقدية التدفقات وليس ، خدمة تقديم في المستهلكة أو المستخدمة الموارد لمقدار اًسمقيا المصروفات تعد ، العمليات بيان في
لخارجة
.
44. StatementofChangesinNetAssets
• Repeats some of the information on the statement of
operations to explain changes in unrestrictednet assets but also
adds informationabout changes in restricted netassets
• Areas covered are unrestricted net assets, temporarily restricted
net assets, permanently restricted net assets, increase in net
assets and net assets at the beginning andend of the year.
Its purpose is toexplain whythere was a change from one year to the nextin the entire
net asset section of the balance sheet. two majorreasons:
- increases (decreases) in unrestricted netassets.
- changes in temporarily and permanently restricted netassets.
•
يضيف ولكنه المقيدة غير األصول صافي في التغييرات لشرح العمليات بيان في المعلومات بعض يكرر
معلومات اًضأي
المقيدة األصول صافي في التغييرات حول
•
بش المقيدة األصول وصافي اًتمؤق المقيدة األصول وصافي المقيدة غير األصول صافي هي المشمولة المجاالت
دائم كل
العام ونهاية بداية في األصول وصافي األصول صافي في والزيادة
.
•
العم الميزانية في بالكامل األصول صافي قسم في أخرى إلى سنة من تغيير حدوث سبب شرح هو منه والغرض
ومية
.
سببان
رئيسيان
:
-
الزيادات
(
النقصان
)
المقيدة غير األصول صافي في
.
-
ودائم مؤقت بشكل المقيدة األصول صافي في التغييرات
.
45. Statement of CashFlows
• Takes the accrual basis financial statements that reportactivity
as it was earned and expended or committed for expenditure
and converts it to the actual flow ofcash
• Covers the same time period as the statement ofoperations
• Discloses key noncash investing andfinancingtransactions
•
أ وإنفاقها اكتسابها تم كما التقارير تلك االستحقاق أساس على المالية البيانات تأخذ
بها االلتزام و
للنقد الفعلي التدفق إلى وتحويلها للنفقات
•
العمليات بيان مثل الزمنية الفترة نفس يغطي
•
النقدية غير الرئيسية والتمويل االستثمار معامالت عن تفصح
47. Cash Flows from OperatingActivities
The first section identifies the cash inflows and outflows resulting from the normal operations of
an entity. Because most entities do not have this information readily available, they derive it by
starting with the increase (decrease) in net assets from the statementof changes in net assets and
then making adjustmentsto convertthis accrual- based information intocashflows.
Cash FlowsfromInvestingActivities
The second section of the statementof cash flows is cash flows from investingactivities. This
showscash inflowsand outflowsfrom such accountsas:
Purchaseof plant,property,andequipment
Purchase of long-terminvestments
Proceedsfrom sale of plant,property,andequipment
Proceeds from sale of long-terminvestments
Investingby an entity includes investingin itself (such as when an entitybuysnew
equipment).
التشغيلية األنشطة من النقدية التدفقات
للكيان العادية العمليات عن الناتجة والخارجة الداخلة النقدية التدفقات األول القسم يحدد
.
لديه تتوفر ال الكيانات معظم ألن اًنظر
بسهولة المعلومات هذه ا
بالزيادة بالبدء تشتقها فإنها ،
(
النقصان
)
لتحويل تعديالت إجراء ثم األصول صافي في التغيرات بيان من األصول صافي في
القائمة المعلومات هذه
نقدية تدفقات إلى االستحقاق على
.
االستثمارية األنشطة من النقدية التدفقات
االستثمارية األنشطة من النقدية التدفقات هو النقدية التدفقات بيان من الثاني القسم
.
والخا الداخلة النقدية التدفقات هذا يوضح
مثل حسابات من رجة
:
والمعدات والممتلكات المنشآت شراء
األجل طويلة استثمارات شراء
األجل طويلة استثمارات بيع من متحصالت والمعدات والممتلكات اآلالت بيع من متحصالت
نفسه في االستثمار كيان قبل من االستثمار يشمل
(
جديدة معدات الكيان يشتري عندما مثل
.)
48. Cashand Cash Equivalentsatthe Endof the Year
This is the "bottomline" of the statementof cash flows and is the same as the cash and
cash equivalentsamountthat appearson the balance sheet.
CashFlows fromFinancingActivities
In this section of the statementof cash flows, we identify the changes in cash flows
resulting from financing activities.These include
Transferstoparent
Proceeds from selectedcontributions
Proceeds from issuance of long-termdebt
Repayment oflong-termdebt
Interestfromrestricted investmentsif interestincomeis also restricted
Repaymentand issuanceoflong-term debt are identifiedin cash flow from financing
activitiesin the statementof cashflows.
التمويل أنشطة من النقدية التدفقات
أنشطة عن الناتجة النقدية التدفقات في التغيرات نحدد ، النقدية التدفقات بيان من القسم هذا في
التمويل
.
هذه وتشمل
الوالدين إلى التحويالت
مختارة مساهمات من عائدات
األجل طويل دين سداد األجل طويل دين إصدار حصيلة
اًضأي الفوائد دخل تقييد تم إذا المقيدة االستثمارات من الفوائد
بيان في التمويلية األنشطة من النقدية التدفقات في األجل طويلة الديون وإصدار سداد تحديد يتم
النقدية التدفقات
.
العام نهاية حكمه في وما النقد
هو هذا
"
النهائية المحصلة
"
ال في يظهر الذي المعادل والنقد النقد مبلغ نفس وهو النقدية التدفقات لبيان
العمومية ميزانية
.
50. Performance Indicator: The FASB requires not -for profit health care entities to include a
performance indicator in their statement of operations. The FASB defines it as an
intermediatelevelthat reports he results of operations.Note that operationsincludesboth
operatingand nonoperatingitems. It is analogousto income from continuingoperationsor
net income in an investor-ownedentity.
Charity CareDiscounts:Discountsfrom gross patientaccountsreceivablegiven to patients
who cannotpaytheir bills and who meet the entity'scharity carepolicy.
Amortization:
(1) The allocationofthe acquisition costof debt to the period that it benefits.
(2)The gradual process of payingoff debt through a series of equal periodic payments.
Each payment covers a portion of the principal plus current interest. The periodic
payments are equal over the lifetime of the loan, but the proportion going towardthe
principal graduallyincreases. The amount of a paymentcan be determined by using the
formulato calculatethe presentvalue of an annuity
األداء مؤشر
:
عملي بيان في أداء مؤشر تضمين للربح الهادفة غير الصحية الرعاية كيانات من المالية المحاسبة معايير مجلس يطلب
اتها
.
مجلس يعرفه
العمليات نتائج عن تقارير يقدم الذي المتوسط المستوى بأنه المالية المحاسبة معايير
.
التشغيل عناصر تشمل العمليات أن الحظ
العاملة وغير
.
إنه
للمستثمرين مملوك كيان في الدخل صافي أو المستمرة العمليات من للدخل مشابه
.
الخيرية الرعاية خصومات
:
ي والذين فواتيرهم دفع يستطيعون ال الذين للمرضى الممنوحة للمرضى المدينة الذمم إجمالي من خصومات
سياسة ستوفون
للجهة الخيرية الرعاية
.
اإلطفاء
:
منها تستفيد التي للفترة الديون اقتناء تكلفة تخصيص
.
المتساوية الدورية المدفوعات من سلسلة خالل من الديون لسداد التدريجية العملية
.
إلى باإلضافة المال رأس من اًءجز دفعة كل تغطي
الحالية الفائدة
.
ًاتدريجي تزداد المال رأس نحو تذهب التي النسبة لكن ، القرض عمر مدى على متساوية الدورية المدفوعات
.
الدف مبلغ تحديد يمكن
الصيغة باستخدام ع
سنوي لمعاش الحالية القيمة لحساب
51. AccumulatedDepreciation:The totalamountof depreciationtakenon an asset since it was put
intouse.
Third-PartyPayors:Commonlyreferred to as thirdparties, these are entitiesthat pay on behalf of
patients.
NoncontrollingInterest:The amount of a partially owned subsidiary entity that the parent
does notown.
Operating Income: is a classification within excess of revenues over expenses, which
separatesrevenues earned through health care-relatedactivities(operatingincome) and
those earned from other than health care-related activities (nonoperating items). Note
that nonoperatingitems aremost often a mixture of revenues,gains,and losses.
Investmentincome (loss) is reportedasnonoperating.
Net Income: Equivalentto excessof revenue over expenses fora not -for-profitentity.
المتراكم االستهالك
:
التنفيذ حيز في وضعه منذ األصول أحد على تم الذي لإلهالك اإلجمالي المبلغ
.
الخارجية الدفع جهات
:
المرضى عن نيابة تدفع كيانات وهي ، ثالثة كأطراف ًةعاد إليها شارُي
.
المسيطرة غير الفائدة
:
األم الشركة تملكه ال والذي اًيجزئ المملوك الفرعي الكيان مبلغ
.
التشغيلي الدخل
:
من المكتسبة اإليرادات بين يفصل والذي ، المصروفات عن الزائدة اإليرادات ضمن تصنيف
األنشطة خالل
الصحية بالرعاية المتعلقة
(
التشغيلي الدخل
)
الص بالرعاية المتعلقة غير األخرى األنشطة من المكتسبة وتلك
حية
(
غير البنود
التشغيلية
.)
والخسائر والمكاسب اإليرادات من اًجمزي تكون ما ًابغال العاملة غير العناصر أن الحظ
.
دخل عن اإلبالغ تم
(
خسارة
)
عامل غير أنه على االستثمار
.
الدخل صافي
:
للربح هادف غير لكيان المصروفات على اإليرادات فائض يعادل
.
52. Summary
• Examined have been the 4 basic financial statements which
comprise a picture of the financial health of a non profit,business
oriented health careentity.
• The four basic financial statementsare:
• Balance Sheet
• Statement of Operations
• Statement of Changes in NetAssets
• Statement of Cash Flows
•
لكيان المالي للوضع صورة تشكل التي األربعة األساسية المالية البيانات فحص تم
صحية رعاية
لألعمال موجه ربحي غير
.
•
هي األربعة األساسية المالية البيانات
:
•
التوازن ورقة
•
العمليات بيان
•
األصول صافي في التغيرات بيان
•
النقدية التدفقات بيان
54. LearningObjectives
•
Recordfinancialtransactions
•
Understand the basics of accrualaccounting
•
Summarizetransactionsinfofinancial statements
One of the major roles of accounting is to record these transactionsand
report the results in a standardizedformat tointerested parties.
ي
ف النتائج عن واإلبالغ المعامالت هذه تسجيل للمحاسبة الرئيسيةاألدوار ومن
موحد شكل
المهتمة افراألط إىل
.
55. The“Book”
• As transactions occur (such as the purchase of supplies), they are recorded
chronologically in a “Book” called a journal. This book is more likely to be a
computer than a paper journal requiring manual entries.
• Periodically (simultaneously when using most computer programs), the
transactionsare summarizedby account(i.e., cash, equipment, revenues, etc.) into
another book called aledger
• The journaland ledger make up the chronological listing of
transactions and the current balance in eachaccount
• Totals foreach accountin the ledger are used to preparethe four financial
statements
•
المعامالت حدوث عند
(
اإلمدادات اء ر
ش مثل
)
ي
ف اًزمني تسجيلها يتم ،
"
كتاب
"
د يسىم
اليومية ر
في
.
إدخاالت يتطلب ي
ر
ورف يومية ر
دفي من ر
أكي اً
كمبيوترالكتاب هذا يكون أن المرجح من
يدوية
.
•
دوريا
(
الكمبيوتر امجرب معظم استخدام عند واحد وقت ي
ف
)
ع المعامالت تلخيص يتم ،
طريق ن
حساب
(
الخ ، اداترواإلي والمعدات النقدية أي
)
األستاذ ر
دفي يسىم آخر ر
دفي ي
ف
•
حس كل ي
ف ي
الحاىل والرصيد للمعامالت الزمنية القائمة األستاذ ر
ودفي المجلة تشكل
اب
•
األربع المالية القوائم إلعداد وتستخدم األستاذ ر
دفي ي
ف حساب لكل المجاميع حساب
ة
56. The Book
The Journal
The journal is informal, also known as “book of original entry”. Its consists of recorded in the
accounting entries, the recorded accounting at a record of business transactions, will be in
sequential order,accordingto the datethe transactionsoccur, or in chronological order.
Recordinga transactionin the generaljournal is called journalizing.It is known as a subsidiary
book.
Once you haverecorded a transactionin a general journal, the amountsare posted to the
appropriate accounts, such as equipment,accountsreceivable,and cash transactions.
صحيفة
"
المجلة
"
باسم أيضا تعرف ،رسمية ر
غي
"
ي
األصل اإلدخال كتاب
."
القيو ي
ف المسجلة من يتألف
، المحاسبية د
للتاري وفقا ، ي
تسلسل ترتيب ي
ف تكون وسوف ، التجارية المعامالت سجل ي
ف المسجلة والمحاسبة
، التكون المعامالت خ
ي
الزمن تيب ر
الي ي
ف أو
.
اليومية ر
بدفي العام اليومية ر
دفي ي
ف التسجيل معاملة تسىم
.
المعروف ومن
تابع كتابباسم
.
2types
The Ledger
The ledger is more formalized, also known as “the book of second entry”. It is used to track assets,
liabilities,owner capital,revenues,and expenses.It is a book or file used to record all relevantaccounts.
The act of recordinga transaction in the ledger is called posting. The general ledger is known as a
principlebook.
ر
ودفي
األستاذ
ر
أكي
،رسمية
والمعروف
أيضا
باسم
"
ر
دفي
الدخول
ي
الثان
"
.
يتم
استخدامه
لتتبع
األصول
والخصو
م
أسرو
المال
المالك
اداترواإلي
والمرصوفات
.
وهو
كتاب
أو
ملف
يستخدم
لتسجيل
جميع
الحسابات
ذات
الصلة
.
ويسىم
اءرإج
تسجيل
الح
كة
ر
ي
ف
ر
دفي
األستاذ
حيل ر
الي
.
عرفُي
ر
دفي
األستاذ
العام
ر
كدفي
أساس
.
و المعدات مثل ،المناسبة الحسابات إلى المبالغ ترحيل يتم ،عام يومية دفتر في حركة تسجيل بمجرد
التي الحسابات
النقدية والحركات استردادها يمكن
.
59. Methods ofAccounting
• Cash basis of accounting- tracks cash when received and when cash
is expended regardless of when services were provided or resources
wereused
• Accrual basis of accounting- records revenues when earnedand
resources used regardlessof the flow ofcash in or out of theentity
• Health care organizationsuseaccrualbasis ofaccounting
Accrual Basis ofAccounting
An accounting method that aligns the flow of resources and the revenues those
resources helped to generate.It recordsrevenueswhen earned and resources when
used, regardlessof the flow of cash in or out of the organization.Thisis the standard
method in use today.
•
للمحاسبة النقدي األساس
-
بغض النقدية إنفاق يتم وعندما استالمها عند النقدية يتتبع
وقت عن النظر
استعمالها تم التي الموارد أو الخدمات تقديم
•
للمحاسبة االستحقاق أساس
-
ت عن النظر بغض المستخدمة والموارد مكتسبات عند السجالت
دفق
الكيان خارج أو داخل النقدية
•
المحاسبة في االستحقاق أساس د ِ
رَسُت الصحية الرعاية منظمات
توليدها على الموارد تلك ساعدت التي واإليرادات الموارد تدفق بمواءمة يقوم محاسبي أسلوب
.
ا يسجل
إليرادات
المؤسسة خارج أو داخل النقد تدفق عن النظر بغض ،استخدامها عند والموارد كسبها عند
.
ا األسلوب هو هذا
لقياسي
اليوم االستخدام في
.
60. cash basis of accounting focuses on the flows of cash in and out of the
organization, whereas the accrual basis of accountingfocuseson the flows of
resources and the revenues those resources help togenerate
االستح أساس أن حين في ،وخارجها المنظمة داخل النقد تدفقات على للمحاسبة النقدي األساس يركز
في قاق
توليدها على الموارد تلك تساعد التي واإليرادات الموارد تدفقات على الحسابات حسابات
61.
62.
63.
64. RecordingTransactions
• 2 rules under accrualaccounting
1- At least two accounts must be used to record a
transaction:
a) Increase (decrease) an asset account
whenever assetsare acquired (used).
b) Increase (decrease) a liability account whenever
obligations are incurred (paidfor).
c) Increase a revenues, gains, or other support
account when it occurs.
d) Increase an expenseaccountwhen an asset is used.
Net assets increase when unrestrictedrevenues, gains,and other support
increase, and net assets decrease whenexpenses occur.
أساس على المحاسبة إطار في قاعدتان
االستحقاق
1
-
لتسج األقل على حسابين استخدام يجب
يل
المعاملة
:
أ
-
زيادة
(
نقصان
)
تم كلما األصول حساب
األصول على الحصول
(
المستخدمة
.)
ب
-
زيادة
(
نقصان
)
تك تم كلما التزام حساب
بد
التزامات
(
ثمنها مدفوع
.)
ت
-
حساب أو المكاسب أو اإليرادات زيادة
ذلك حدوث عند الدعم
.
ث
-
أح استخدام عند المصروفات حساب زيادة
د
األصول
.
صافي وينخفض ،الدعم زيادة من وغيرها والمكاسب اإليرادات تزداد عندما األصول صافي وتزداد
النفقات حدوث عند األصول
.
65. 2nd RuleRecording
Transactions
2- After each transaction, the fundamentalaccountingequation
must be in balance:
Assets=Liabilities +NetAssets
Contraasset
An asset that, when increased, decreases the value of a related asset on the books. Two
primary examples are accumulated depreciation, which is the contra-asset to properties
and equipment,and the allowancefor uncollectibles,which is the contra-assetto
accounts receivable.
The terms allowance for doubtful accounts, allowance for uncollectible accounts, and
allowance for bad debt are used interchangeablyin practice. Similarly,the terms provision
for bad debt and bad debt expenseare used interchangeablyin practice.
NetAssets=totalAssets– total Liabilities
2
-
األساسية المحاسبية المعادلة ،معاملة كل بعد
:
•
الدفاتر في صلة ذي أصل قيمة من يقلل ،زيادته عند ،أصل
.
األص وهو ،المتراكم االستهالك هما رئيسيان مثاالن وهناك
غير ول
ا المستحقة للحسابات المقابل األصل وهو ،المحصلة غير المبالغ وبدل ،والمعدات الممتلكات في لالستخدام القابلة
لقبض
.
•
للتحص القابلة غير الحسابات وبدل ،تحصيلها في المشكوك الحسابات بدل شروط العملية الممارسة في وتستخدم
الديون وبدل ،يل
المعدومة
.
الع الممارسة في تستخدم المعدومة الديون ومصاريف المعدومة بالديون المتعلقة الحكم شروط فإن ،وبالمثل
ملية
.
66.
67.
68. Developing the Financial
Statements
• Once the transactionshave been analyzedand recorded,
the organization can develop the four financial
statements:
• Balance Sheet
• Statement of Operations
• Statementof Changes in NetAssets
• Statement of Cash Flows
تط للمنظمة يمكن ،وتسجيلها المعامالت تحليل بمجرد
وير
األربعة المالية البيانات
:
69. The Statement of Operations includes:
1Unrestricted Revenues, Gains, and Other Support
2Operating Expenses
3Operating Income and Excess of Revenues over Expenses.
4Increase in Unrestricted NetAssets
The Balance Sheetincludes:
1Assets
2Liabilities
3NetAssets
The Statement of Changesin NetAssets includes:
1Unrestricted net assets
2Temporarily restricted netassets
3Permanentlyrestrictednetassets
4Increase in netassets
5Net assets at the beginning and end of the year.
The Statement of Cash Flowsincludes:
1Cash flows from operating activities
2Cash flows from investing activities
3Cash flows from financingactivities.
70. Summary
• One of the major roles of accounting is torecord the transactions in a standardized
format and report the results.
• These transactionsare the basis for the financialstatements
• Accrual accounting is used by health careorganizations
• Financial statements are a foundationfor decision making in health care organizations
Operating Expenses are costs that are incurredin the day-to-dayoperation
of the business.
Operating income is the difference between unrestricted revenues,gains,
and other support andexpenses
•
النتائج عن واإلبالغ موحد شكل في المعامالت تسجيل هو للمحاسبة الرئيسية األدوار أحد
.
•
المالية البيانات أساس هي المعامالت هذه
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الصحية الرعاية مؤسسات قبل من االستحقاق أساس على المحاسبة استخدام يتم
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الصحية الرعاية مؤسسات في القرار اتخاذ أساس هي المالية البيانات
التجارية لألعمال اليومية العمليات في تكبدها يتم التي التكاليف هي التشغيل نفقات
.
األخرى والنفقات والدعم المقيدة غير والمكاسب اإليرادات بين الفرق هو التشغيلي الدخل