Essentials of Health Care Finance,9780763742362

Essentials of Health Care Finance

by
Edition: 6th
ISBN13: 9780763742362
ISBN10: 0763742368
Format: Hardcover
Pub. Date: 2006-11-01
Publisher(s): JONES & BARTLETT PUBLISHERS
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Summary

Essentials of Health Care Finance stands firmly in its place as the leading textbook on healthcare finance. No other text so completely blends the best of current finance theory with the tools needed in day-to-day practice. Useful for all course levels as well as a professional reference, this text offers a comprehensive introduction to the field. The sixth edition has been thoroughly revised to reflect the current economic environment in the healthcare industry. Features: Detailed information on Medicare payment rules for a variety of healthcare settings including hospitals, nursing homes, home health agencies, and private practices A new chapter detailing the interaction between pricing and managed care contract negotiation Critical coverage of CPT and ICD 9 procedure and diagnosis codes illustrating their relationship to billing and payment Many examples and illustrations of key financial concepts using real world data to illustrate the application of concept to real world healthcare firm situations Problems and solutions at the end of each chapter to engage the student in further study Helpful chapter-by-chapter Instructorrs"s Manual, PowerPoints, and Testbank to simplify course instruction

Table of Contents

Preface xi
Acknowledgments xiii
About the Authors xiii
Financial Information and the Decision-Making Process
1(12)
Information and Decision Making
3(2)
Uses of Financial Information
5(1)
Financial Organization
6(2)
Forms of Business Organization
8(2)
Summary
10(3)
Billing and Coding for Health Services
13(20)
Generating Health Care Claims
14(1)
Registration
15(2)
Medical Record/Coding
17(2)
Charge Entry/Chargemaster
19(2)
Billing/Claims Preparation
21(4)
Claims Editing
25(1)
Summary
26(7)
Financial Environment of Health Care Organizations
33(40)
Financial Viability
34(1)
Sources of Operating Revenue
35(1)
Health Care Payment Systems
36(5)
Medicare Benefits
41(1)
Medicare Payment: Hospital Inpatient
41(3)
Medicare Payment: Physicians
44(2)
Medicare Payment: Hospital Outpatient
46(1)
Medicare Payment: Skilled Nursing Facilities (SNFs)
47(1)
Medicare Payment: Home Health Agencies (HHAs)
48(2)
Summary
50(23)
Legal and Regulatory Environment
73(28)
Federal Enforcement Actions
79(3)
Antitrust Policy Statements
82(13)
Management Responsibility for Compliance
95(2)
Summary
97(4)
Revenue Determination
101(22)
Payment Methods and Their Relationship to Price Setting
102(1)
Generic Factors of Pricing
103(2)
Price Setting for Health Care Services
105(3)
Justifying Health Care Firm Prices
108(1)
Reasonableness of Charges for Case Hospital---ROI Method
109(2)
Reasonableness of Charges for Case Hospital---Comparison-of-Charges Method
111(1)
Managed-Care Contract Negotiation
112(4)
Managed-Care Payment Schedules
116(2)
Summary
118(5)
Managed Care
123(24)
Health Maintenance Organizations (HMOs) and Managed-Care Development
124(1)
Underwriting
125(1)
Marketing
125(1)
Utilization Review
125(1)
Claims Administration
126(1)
Staff Model HMO
126(1)
Group Model HMO
126(1)
Individual Practice Association (IPA) Model HMO
126(1)
Network Model HMO
126(1)
Alternative Health Insurance Plans
127(2)
Integrated Delivery Systems
129(4)
Paying Providers in a Managed-Care Environment
133(1)
Salary or Budget
134(1)
Fee for Service
134(1)
Capitation
134(1)
Withholds and Risk Pools
134(1)
Setting Prices in Capitated Contracts
135(5)
Medicare and Medicaid Risk Contracts
140(1)
Legal and Regulatory Issues
141(1)
Summary
142(5)
General Principles of Accounting
147(16)
Financial Accounting
148(1)
Managerial Accounting
149(1)
Principles of Accounting
149(1)
Accounting Entity
149(1)
Duality
150(1)
Cost Valuation
151(1)
Required Return on Investment and Valuation Alternatives
152(1)
Accrual Accounting
153(4)
Fund Accounting
157(1)
Conventions of Accounting
158(1)
Summary
159(4)
Financial Statements
163(22)
Organizational Structure
164(1)
Balance Sheet
165(10)
Statement of Revenues and Expenses
175(3)
Statement of Cash Flows
178(1)
Statement of Changes in Unrestricted Net Assets
178(1)
Summary
178(7)
Accounting For Inflation
185(16)
Reporting Alternatives
186(2)
Uses of Financial Report Information
188(2)
Case Example: Williams Convalescent Center
190(1)
Monetary versus Nonmonetary Accounts
191(4)
Summary
195(6)
Analyzing Financial Statements
201(28)
What Is Required to Develop an Effective Financial Reporting System?
202(1)
What Is Most Important: Sustainable Growth
203(2)
What Are the Critical Drivers of Performance?
205(1)
Measurement of Critical Variables
205(1)
Relevant Benchmarking Data
206(1)
Case Example: Alpha Health Care System
207(8)
Cost Position---A New Approach
215(1)
Hospital Cost Index (HCI)
216(1)
Overall Cost Factors
217(6)
Summary
223(6)
Financial Analysis of Alternative Health Care Firms
229(22)
Long-Term Care Facilities and Nursing Homes
230(6)
Medical Groups
236(4)
Health Plans
240(3)
Summary
243(8)
Strategic Financial Planning
251(28)
The Strategic Planning Process
252(1)
Financial Policy Targets
253(2)
Requirements for Effective Policy-Making
255(4)
Developing the Financial Plan
259(10)
Integration of the Financial Plan with Management Control
269(1)
Summary
270(9)
Cost Concepts and Decision Making
279(28)
Concepts of Cost
280(2)
Traceability
282(1)
Cost Behavior
282(3)
Controllability
285(2)
Future Costs
287(1)
Cost Measurement
288(1)
Direct and Indirect Cost
288(2)
Variable and Fixed Cost
290(1)
Estimation Methods
291(2)
Using Excel for Simple Linear Regression
293(1)
Data Checks
294(2)
Break-Even Analysis
296(5)
Summary
301(6)
Product Costing
307(22)
Activity-Based Costing
309(2)
Relationship to Planning, Budgeting, and Control
311(3)
The Costing Process
314(2)
Standard Development
316(3)
Variance Analysis
319(2)
Relative Value Unit Costing
321(1)
Summary
322(7)
The Management Control Process
329(24)
Essential Elements
330(2)
Phases of Management Control
332(3)
The Budgeting Process
335(1)
Statistics Budget
336(1)
Expense Budget
337(3)
Revenue Budget
340(2)
The Cash Budget and Budgeted Financial Statements
342(1)
Zero-Base Budgeting
343(1)
Benchmarking at the Departmental Level
344(1)
Summary
345(8)
Cost Variance Analysis
353(24)
Cost Control
354(1)
Investigation of Variances
355(1)
Classical Statistical Theory
355(1)
Decision Theory
356(2)
Variance Analysis Calculations
358(1)
Macroanalysis
358(2)
Departmental Analysis of Variance
360(2)
Variance Analysis in Budgetary Settings
362(4)
Variance Analysis in Managed Care Settings
366(3)
Summary
369(8)
Financial Mathematics
377(16)
Single-Sum Problems
378(2)
Annuity Problems
380(3)
Summary
383(10)
Capital Project Analysis
393(26)
Participants in the Analytical Process
395(2)
Classification of Capital Expenditures
397(2)
The Capital Project Decision-Making Process
399(3)
Justification of Capital Expenditures
402(6)
Discounted Cash Flow Methods
408(4)
Selection of the Discount Rate
412(1)
Valuation
413(1)
Summary
413(6)
Consolidations and Mergers
419(22)
Defining the Terms
420(1)
Merger and Acquisition Activity
421(2)
Overview of Theories of Merger & Acquisition Activity
423(1)
Factors Affecting M&A Activity
424(1)
Why Do Mergers Succeed or Fail?
424(2)
Valuations
426(4)
Valuation Example
430(2)
Accounting for Business Combinations
432(1)
Antitrust Considerations
433(1)
Summary
433(8)
Capital Formation
441(30)
Equity Financing
443(3)
Long-Term Debt Financing
446(5)
Alternative Debt Financing Sources
451(4)
More Recent Developments
455(4)
Early Retirement of Debt
459(2)
Summary
461(10)
Working Capital and Cash Management
471(16)
Cash and Investment Management Structure
473(2)
Management of Working Capital
475(5)
Short-Term Bank Financing
480(1)
Investment of Cash Surpluses
481(1)
Summary
482(5)
Developing the Cash Budget
487(10)
Determining Required Cash and Investment Reserves
488(1)
Case Example---Defining Required Cash Balances
489(1)
Sources and Uses of Cash
490(1)
Preparing the Cash Budget
491(3)
Summary
494(3)
Glossary 497(18)
Common Health Care Financial Management Acronyms 515(8)
Index 523

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