COURSE INFORMATION
This course is designed for the working supervisors, assistant managers and department managers and for those who aspire to hold these positions in their healthcare organization. We recognize that managers with a basic financial background need an enhanced understanding of the concepts of health care financial management. Our goal is to provide sufficient guidance and enough information about the intricacies of healthcare financial management for both prospective and sitting managers to improve the skills they need to excel in the healthcare world. We recognize that students currently working in an entry or mid-level position in the healthcare financial management field may want to add an additional credential that will broaden their professional overview of the field and lead to potential upward mobility in their chosen field.
HM 605 begins with a discussion of the importance and uses of healthcare financial management information. The processes that healthcare organizations employ to organize their financial functions into concise formats of pertinent information for the users of financial information are studied. These healthcare financial statements that are usually produced monthly, quarterly and annually become the basis of organizational decision making for the healthcare organization. You will learn how to distinguish between an organization with a healthy balance sheet and income statement and an organization the is struggling or in financial distress by spotting the factors of viability in healthcare organizations. The differences between non-profit and for-profit healthcare organizations financial operations and community benefit obligations are also reviewed. The important role coding plays in a healthcare organizations revenue cycle becomes paramount to its cash flow management in both healthy and unhealthy organizations. Chargemaster models are also discussed.
Reimbursement models and methods used by the healthcare insurance industry to pay providers is demonstrated by the use of multiple examples and alternative payment models. Understanding the complexities of these models is important to the student as is know when their applications are the right choice. A complete review of both the Medicare and Medicaid programs is part of our course content. Legal and regulatory aspects of the industry, especially as they relate to insurance companies is reviewed in relation to healthcare providers and insurance company potential violations. The ACA, HIPPA, EMTALA and potential antitrust violations are part of the discussion as is corporate compliance and when self-reporting may be and option for an organization. The financial benefits of non-profit (501.c3) and for-profit organizations are demonstrated as is the basis for tax exemptions. The price setting rationale and reviewing the factors of influence reveals how the process relates to market prices is an interesting discussion. You will learn the various formats used in healthcare organizations and HMO contracting along with the other types of contracting models used in practice. Managed care models are discussed as are their legal and regulatory issues.
Upon completing this course, you will be able to distinguish between Financial and Managerial accounting information and accrual and cash basis accounting and the proper application for each. You will review the core principles of accounting, the 3 categories of net assets and the major types of asset valuation. Insight will be gained to the uses of financial report information. Understanding the format and content of financial statements and understanding the difference between monetary and non-monetary accounts are foundations of this course. Enhanced insight to how and why inflationary adjustments to deprecation are made will help you understand the accuracy of financial statements. You will also review the purpose and value of balanced scorecard reporting in addition to the 4 key elements of dashboard reporting. The financial statements of several types of healthcare organizations will provide you with practical knowledge about how and why they operate in different ways based on the standards that apply to each of them. By studying the operations of nursing homes, physician practices and HMO’s you will gain perspective of their different requirements. Understanding the different performance measures used in each segment of our healthcare system illustrates these points.
Course Code: HM 605
Contact hours of education: 60.
Instructor/Course Author: Mark C. Barabas, BS, DHA, LFACHE
Link to Resume: access here
TEXTBOOKS: There is one (1) required textbook for this course.
Health Care Budgeting and Financial Management 2nd edition, by William J. Ward Jr., Praeger
- ISBN-10: 9781440844287
- ISBN-13 : 978-1440844287
TIME FRAME: You are allotted two years from the date of enrollment, to complete this course. There are no set time-frames, other than the two year allotted time. If you do not complete the course within the two-year time-frame, you will be removed from the course and an “incomplete” will be recorded for you in our records. Also, if you would like to complete the course after this two-year expiration time, you would need to register and pay the course tuition fee again.
GRADING: You must achieve a passing score of at least 70% to complete this course and receive the 60 hours of awarded continuing education credit. There are no letter grades assigned. You will receive notice of your total % score. Those who score below the minimum of 70% will be contacted by AIHCP and will be permitted one more attempt to retake the online examination.
BOARD APPROVALS: The American Institute of Health Care Professionals (The Provider) is approved by the California Board of Registered Nurses, Provider number # CEP 15595 for 60 Contact Hours. Access information
The American Institute of Health Care Professionals, Inc. is an Approved Provider of Continuing Education by the Florida State Board of Nursing Provider # 50-11975.
OTHER STATE BOARDS OF NURSING
The American Institute of Health Care Professionals Inc: is a Rule Approved Provider of Continuing Education by the Arkansas Board of Nursing. CE Provider # 50-11975.
The American Institute of Health Care Professionals Inc: is a Rule Approved Provider of Continuing Education by the Georgia Board of Nursing. CE Provider # 50-11975.
The American Institute of Health Care Professionals Inc: is a Rule Approved Provider of Continuing Education by the South Carolina Board of Nursing. CE Provider # 50-11975.
The American Institute of Health Care Professionals Inc: is a Rule Approved Provider of Continuing Education by the West Virginia Board of Examiners for Professional Registered Nurses. CE Provider # 50-11975.
The American Institute of Health Care Professionals Inc: is a Rule Approved Provider of Continuing Education by the New Mexico Board of Nursing. CE Provider # 50-11975.
Course Refund & AIHCP Policies: access here
ONLINE CLASSROOM RESOURCES AND TOOLS
- Examination Access: there is link to take you right to the online examination program where you can print out your examination and work with it. All examinations are formatted as “open book” tests. When you are ready, you can access the exam program at anytime and click in your responses to the questions. Full information is provided in the online classrooms.
- Student Resource Center: there is a link for access to a web page “Student Resource Center.” The Resource Center provides for easy access to all of our policies/procedures and additional information regarding applying for certification. We also have many links to many outside reference sites, such as online libraries that you may freely access.
- Online Evaluation: there is a link in the classroom where you may access the course evaluation. All students completing a course, must, without exception, complete the course evaluation.
- Faculty Access Information: you will have access to your instructor’s online resume/biography, as well as your instructor’s specific contact information.
- Additional Learning Materials: some faculty have prepared additional “readings” and /or brief lecture notes to enhance your experience. All of these are available in the online classrooms.
COURSE OBJECTIVES: Upon completion of this course, you will be able to:
- Describe the importance of financial information in healthcare organizations
- Discuss the uses of financial information
- List the users of financial information and their uses for it
- Review the financial functions within an organization
- Describe the common ownership models of healthcare organizations and compare their advantages and disadvantages
- Review the revenue cycle for healthcare providers
- Understand the role of coding information for claim generation for healthcare providers
- Define the basic characteristics of charge masters and review the 2 major types used by healthcare providers
- Appreciate the role of claims editing employees in the bill submission process
- Understand factors that influence the financial viability of healthcare organizations
- Describe the financial environment of the largest segment of the healthcare industry
- Discuss the major reimbursement methods used in healthcare and their future applications
- Review and become conversant about the major aspects of benefits provided by the Medicare program
- Study the Medicare reimbursement models used to pay major providers and review the methods employees as they relate to a provider’s resource management
- Appreciate the complexity of the U.S. legal and regulatory environment as it relates to the healthcare industry
- Identify the different types of 3rd party payers including federal payers
- Understand the impact of Affordable Care Act and review the payer applications derived from it as they relate to alternative payment models as they transition from fee for service
- Review the most important aspect of the federal healthcare fraud and abuse laws and regulations that impact healthcare organizations and understand the consequences on non-compliance with the law and regulations
- Study the new price transparency regulations and No Surprise Act impacts healthcare organizations
- Understand how HIPPA, EMTALA, 501c3 and federal antitrust regulations impact healthcare providers
- Identify the major components of a healthcare organizations corporate compliance program including the application of internal controls
- Recognize provider conduct that might violate healthcare laws and regulations which could trigger self-reporting
- Describe the current basis for tax exemption of not-for profit organizations
- Introduce the elements of community benefit listed by key policy groups
- Assess the relative community benefits provided by proprietary and not-for-profit hospitals
- Develop a methodology for estimating the financial benefits received by not-for-profit healthcare organizations
- Identify a methodology for estimating the financial benefits provided by not-for -profit healthcare organizations
- Define basic methods of payment for healthcare organizations and providers
- Understand the general factors that influence pricing
- Review approaches to setting prices and the impact to reimbursement
- Determine if prices are defensible and market competitive
- Describe methods that are used to assess price defensibility
- List the important considerations when negotiating a health plan contract
- Define a health maintenance organization – HMO and a preferred provider organization – PPO
- Discuss the 4 main activities of health plans
- Identify the 5 types of health plans and their characteristics
- Recognize the forces that influence the development of integrated delivery systems
- Outline some of the methods by which providers are paid by health plans
- Review how managed care organizations establish their prices
- Describe the legal and regulatory issues that affect managed care organizations
- Recognize the differences financial and managerial accounting
- Understand the core principles of accounting that guide the preparation and dissemination of financial information by and for health care organizations
- Discuss the differences between accrual and the cash basis methods of accounting
- Identify the 3 categories of net assets
- Review the accounting conventions that affect the application of accounting principles
- Explain why it is important to know the scope of business being reviewed when using financial statements
- Understand the format and content of the balance sheet, the statement of operations, the statement of changes in net assets and the statement of cash flows
- Discuss the major types of asset valuation
- Describe the alternative units of measurement in financial reporting
- Define the major financial reporting alternatives
- List the uses of financial report information
- Compare the difference between monetary and non-monetary accounts
- Explain the purpose and value of balanced scorecard and dashboard reporting
- Define the 4 key elements of dashboard reporting
- Identify what is most important in long-term financial success
- Recognize what a healthcare organization’s primary financial objective should be
- Describe the critical drivers of financial performance
- Discuss the importance of and the types of performance measures
- Introduce the hospital cost-index measure
- List some of the major non-hospital and non-physician sectors of the healthcare industry
- Discuss the sources of revenue for the nursing home industry
- Review the major sources of revenue and expenses of medical groups
- Identify the major organizational types of physician groups
- Describe alternative HMO organizational arrangements