Sutter Case Analysis

Accelerating cash collections at the point of service has never been more critical than it is today. Sophisticated accounting tools that enable providers to analyze patient utilization and outcomes help practice managers monitor payer performance and evaluate external contracts effectively. Growing financial pressure to strive toward more efficient claims flow through the revenue cycle means every provider must search for innovative tools to overcome the challenges.

Ever evolving technology, scientific breakthroughs, extended life expectancy, and unemployment often involves leads to a high level of uncollectible accounts within the healthcare industry When a patient receive services provided by a healthcare facility or physician’s office patient financial services gather patient demographics, insurance information, and income information. The information provided by the patient is reviewed to determine their financial status thereby determining their ability to pay for healthcare services. When the patient is deemed, they cannot afford to pay for medical services they determine if the services would be categorized as free services, or a sliding scale/discounted services. If services are provided free of charge or on a discounted rate, then the services are exempt from tax and is categorized as a charitable item thereby the service is recordable under uncollectible items as charity services versus an uncollectible debt.

A lot of money gets lost in unpaid revenue from insured persons with an estimated $41 billion; the ideal way going forward on this issue is simply offering individuals who are uninsured sufficient payment plans that they can comfortably pay back. Labor and supplies are the engine of hospitals, focusing on monitoring as well as controlling these will save a great deal of money. A good way to benefit from monitoring the supplies patterns is standardizing the rates of good with vendors. Economic feasibility and financial viability have proven to be serious challenges that lead

Trends indicate the administrative complexity in the U.S. health care system requires that American hospitals employ far larger staffs to handle billing requirements (Anderson & Squires, p. 1-2). Furthermore, despite enormous innovation and investments in technology, the U.S. is failing to achieve improvements in life expectancy. The return on investment has been low; therefore, examination into other methods to increase quality of care, and decrease costs has become compelling. The U.S. has known for quite some time that health care costs, and therefore spending have gotten out of control. There have been several Presidents who have unsuccessfully attempted to help alleviate the nation of this issue. However, with the implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, we have begun to notice a positive trend, in the said decline in spending. There have been methods implemented to begin helping providers and organizations monitor their progress, reward them for proper adherence, and now there are

For all healthcare providers and facilities that provide services to patients, reimbursement is the life support of the organization. If no payments are received for services rendered, there will be a number of repercussions. For starters, there will be the obvious negative financial effect. The number of available staff will be impacted. Lack of staff means longer wait times. In many situations, third party payers will not cover all the costs and it becomes left up to the patient to pay. When that happens, there is always the chance the patient does not pay either. When a patient refuses to pay and their account becomes delinquent, the provider loses revenue instead of gaining the deserved reimbursement. Eventually the facility could face

This course is designed as an introduction to the terminology, processes, functions, and financial reports commonly encountered in health care operations. This course introduces the concepts of basic managerial financial functions, such as budgeting, reimbursement methods, and the responsibilities of health care financial

Procedures such as knee and hip replacement are also included. Any of the previously listed disorders or procedures occurring within 30 days of discharge will have a Medicare reimbursement rate cut of 1% the first year and an additional penalty of up to 3 % within the following years. This 30 day time period also includes new hospitals, the patient does not have to be readmitted to the initial hospital where care took place in order for it to count against the hospital. Unlike the HRRP Medicare has determined that “all causes” can be considered a readmission, and subjected to fines not just specified

As these medical debts accumulate over time, it will not only have a financial impact on the patient itself, but will also have a financial impact on healthcare organizations as well. Healthcare organizations will have to either lose the revenue or hire a medical collection agency to collect the debt. This collection process can be very costly as well as be time

After reading the following, “From bottom to top: How one provider retooled its collections” (Souza &McCarty, 2007). The article sheds light on the fact that Sutter Health is a non-profit public based- healthcare system. Not to mention it is based in Sacramento, in the northern part of California. This type of healthcare systems services patients and families where the system providers have joined force and share their expertise that have helped progress and advance the quality of healthcare. According to Souza & McCarty, they reference the fact that the non-profit network has initiated the interface having the intentions of developing revenue collection for healthcare facilities that can collect from self-paying patients. (2007, p.68). However, with a traditional payment system it does have its disadvantages meaning there are delays in the payment process of the effective revenue system in healthcare facilities. Mainly, is the limitations of the processing because of the result of not having the accessibility of precise information on accounts. Souza & McCarty further discuss that fact that Patient Financial Services staff are not in a position to have the real-time information that aids in processing the financial and operational indicators of the healthcare facility. (2007, p. 70). There were also unproductive and incompetent performance measures in the

“Representing over 20 percent of the U.S. Gross Domestic Product and accounting for approximately $1.5 trillion in revenue, health care is the single largest industry in the U.S. today.” (University of Phoenix, 2015). However, it is a vulnerable industry. The facility we are looking at is in New York, where the third highest losses in the country occur because of numerous problems dealing with Medicare and Medicaid reimbursements, cuts in funding, and pressures for discounted managed care, amongst others. The facility is called Elijah Heart Center (EHC). First we looked at the capital shortage because in an emergency, the hospital might not have enough cash to sustain itself. The challenge was to decide on the best strategy to solve the

The increase in individuals acquiring health insurance, due to the Affordable Care Act, causes an increased demand for physicians and physician services (ProCon.org, 2015). As a result of these increases, hospital systems are being face with what is now their biggest challenge, financial burden. The number one financial burden is medical reimbursement. However, stemming from the burden of medical reimbursement, several other challenges are brought forth, such as operating costs and the increased costs for staff, supplies, etc (Ache.org, 2016). Leaders within the hospital setting are having to adjust certain aspects of their operating system in order to keep their hospital systems afloat.

The main thing that stood out to me in the process is Claim Adjunction; is a claim where the payer or insurance provider reviews the claim thoroughly. Adjunction has a series of steps designed to evaluate whether the entire bill, a portion of the bill, or not pay the bill at all. Once the claim goes through adjudication, the conclusion to pay entirely, selected, or nothing of the bill is sent back to the doctor or medical practice in the form of a report. I think reviewing the bills can be combined with patient check in. When a patient is checked in then the office team should mention any co-payments or unpaid bills should be reviewed. When a patient is done with his/her appointment they would just like to leave and not

The major difference between healthcare finance terminology and business finance terminology is that these terms focus on factors unique to the health services industry. For example, the provision of health services is dominated by not-for-profit or¬ganizations (such as ours), which are inherently different from investor-owned businesses. Also, the majority of payments made to health¬care providers for services are not made by patients—the consumers of the services—but rather by some third-party payer (e.g., a commercial insurance company or a government program). Even the purchase of health insurance is dominated by employers rather than by the individuals who receive the services. These terms emphasize ways in which the unique features of the health services industry affect financial decisions. The healthcare industry is a service industry. It is not in the business of manufacturing, say, widgets. Instead its essential business is the delivery of healthcare services. It may have inventories of medical supplies and drugs, but those inventories are necessary to service delivery, not to manufacturing functions. Because the business of healthcare is a service, this overview of key healthcare terminology will focus on the practice of financial management in the services industry.

Understanding the financial analysis of healthcare organizations is strategic to the organization by understanding their stand on the amount of revenue they gain, healthcare assets, and their financial goals. This paper will provide a comparison on the performance of financial analysis of several California Healthcare Organizations such as; Scripps Health, Palomar Health, Sharp Healthcare, and Tri-City Healthcare. The four healthcare organizations will be illustrated with an overview about what the organizations have been doing financially , where they have been growing financially, and what have they accomplished over the past year from examining their financial statement. As the nation’s healthcare model continues to evolve,

Cost accounting in healthcare has more important than ever before, however it is usually treated as being too complex, costly or requires numerous means for organizations in healthcare. Adding to the issue more vital programs to include electronic medical records, charting and billing systems have been the main target and cause for budget strains for several years. The healthcare industry is currently experiencing a symbolic change and concern from all the parties involved with a goal to lessen the cost of healthcare. These healthcare organizations that do not have a cost accounting system should make it a priority to develop one. “The driving force behind the development of cost accounting systems in health care organizations has been the