Fundamentals of Health Care Financial Management (4^th Ed.)
A Practical Guide to Fiscal Issues and Activities, 4th Edition
Jossey-Bass Public Health Series

In this thoroughly revised and updated fourth edition of Fundamentals of Health Care Financial Management, consultant and educator Steven Berger offers a practical step-by-step approach to understanding the fundamental theories and relationships guiding financial decisions in health care organization. Using cases set in a fictional mid-sized hospital, the book takes the reader into the inner workings of the finance executive's office.

As in the previous editions, this book introduces students to key practical concepts in fundamental areas of financial management. This innovative introduction to the most-used tools and techniques includes health care accounting and financial statements; managing cash, billings and collections; making major capital investments; determining cost and using cost information in decision-making; budgeting and performance measurement; and pricing.

Also covered in depth are the financial implications of Patient Protection and Affordable Care Act, which will increase patient volume, reduce bad debt, factor quality and patient satisfaction into the financial picture, and significantly affect how hospitals and physicians are paid for services.

Students focusing on the business side of health care will find Fundamentals of Health Care Financial Management: A Practical Guide to Fiscal Issues and Activities, 4^th Edition a valuable text for understanding the workings of the health care financial system.

Figures, Tables, and Exhibits vii

Preface xv

Acknowledgments xix

The Author xxi

Chapter 1: January 1

What Is Health Care? 3

What Is Management? 5

What Is Financial Management? 6

Why Is Financial Management Important? 8

Ridgeland Heights Medical Center: The Primary Statistics 9

Pro Forma Development 13

Living with the Finance Committee and Board of Directors’ Calendar 19

Year-End Closing 24

Chapter 2: February 31

Accounting Principles and Practices 32

Objectives of Financial Reporting 34

Basic Accounting Concepts 35

Basic Financial Statements of a Health Care Organization 36

Uses of Financial Information 37

The Financial Statements 39

Preparing for the Auditors 52

Analysis of Sensitive Accounts 54

February Finance Committee Special Reports 56

Chapter 3: March 61

Strategic Financial Planning: Five-Year Projections 63

RHMC Strategic Financial Planning 67

Ratio Analysis 74

The Capital Plan and Its Relationship to the Strategic Plan 84

Chapter 4: April 91

Medicare and Medicaid Net Revenue Concepts 94

Calculation of Medicare and Medicaid Contractual Adjustments 100

Implications of the Balanced Budget Act of 1997 109

Implications of the Medicare Modernization Act of 2003 115

Implications of the Patient Protection and Affordable Care Act of 2010 (PPACA or ACA) 117

Managed Care Net Revenue Concepts 131

Preparation of the Medicare and Medicaid Cost Report 137

Presentation of the Audited Financial Statements to the Finance Committee 140

Chapter 5: May 145

Fundamentals of Revenue Cycle Management (RCM) 146

Calculation of the Allowance for Doubtful Accounts and Bad-Debt Expense 165

Calculation of the Allowance for Contractual Adjustments 170

Chapter 6: June 175

Budget Preparation: The Beginning 177

Budget Calendar 177

Volume Issues 185

Capital Budgeting: June 190

Accounting and Finance Department Responsibilities 195

June Finance Committee Special Agenda Items 198

Chapter 7: July 203

Budget Preparation: The Middle Months 204

Capital Budgeting: July 221

Regulatory and Legal Environment 223

Other Regulatory and Business Compliance Issues 227

Corporate Compliance 228

Accreditation Issues 229

Patient Satisfaction Issues 232

Chapter 8: August 235

Capital Budget: August 236

Operating Budget 246

Budget Variance Analysis 249

Budget Variance Parameters 252

Flexible Budgeting 252

August Finance Committee Special Agenda Items 260

Chapter 9: September 263

Operating Budget 265

Capital Budget: September 275

Cash Budget 277

Physician Practice Management Issues 280

Current Physician Practice Issues—2013 292

Additional Physician-Hospital Integration Issues 294

Monthly Physician Reporting 295

Chapter 10: October 299

Information Systems Implications for Health Care Financial Management 301

Information Technology Strategic Plan Initiatives 304

HIPAA Implementation Issues 306

Selection of a New Health Care Information System 310

Budget Presentation to the Board Finance Committee 316

October Finance Committee Special Agenda Items 328

Chapter 11: November 331

Preparation of the Budget Results and Delivery to the Department Managers 333

Budgeting and Spreading Contractual Adjustments by Department 337

Issues Involving RHMC’s Cost Structure 340

How to Improve the Organization’s Cost Structure 344

Supply Chain Management in Health Care 352

Benefits of Tax Status for Health Care Organizations 356

Preparation and Implications of the Annual IRS 990 Report 360

Chapter 12: December 367

Getting Ready for Year-End Reporting—Again 371

Open-Heart Surgery Pro Forma 371

December Finance Committee Special Agenda Items 380

Looking into the Future of Health Care Finance 383

Future Conclusions 397

References 401

Index 407

STEVEN BERGER, CPA, is founder and president of Healthcare Insights, LLC, which specializes in health care and financial management training and consulting. Healthcare Insights has also created INSIGHTS, the health care industry’s best practice decision support software. He has nearly 30 years’ experience in the field and recently served a three-year term of membership on the Healthcare Financial Management Association (HFMA’s) National Board of Examiners.