INTRODUCTION Within the healthcare environment there are many factors that need to be considered when examining organizational finances and making financial decisions that will have both short- and long-term effects on an organization or a medical practice. There are external agencies such as the federal or state government, which may set rate limits that impact revenues. Also, there are outside forces such as marketing structures and competition that influence pricing of healthcare services. Managers who oversee budgets and help to make financial decisions need an overall understanding of the forces shaping this environment. REQUIREMENTS Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide. You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course. A. Explain the activities of each step of the revenue cycle in the order they occur. 1. Describe the work of health information management (HIM) staff members during each step of the revenue cycle in which they would be involved. 2. Explain how coding and billing cycle processes impact healthcare organization revenue cycles. 3. Explain how the operating revenue impacts the revenue cycle. B. Explain how to evaluate the financial condition of a healthcare organization. 1. Explain how financial statements are reviewed for an organization to determine its profitability and risk. 2. Discuss factors that influence the financial viability of a healthcare organization. C. Discuss how the financial decision-making process impacts the operations of a healthcare organization. D. Discuss how each of the following Fraud & Abuse regulations impact the financial decisions made by a healthcare organization: Stark II Anti-Kickback Statute False Claims Act 1. Discuss the importance of Stark II to healthcare providers. 2. Discuss the importance of the Anti-Kickback Statute to healthcare providers. 3. Discuss the importance of the False Claims Act to healthcare providers. E. Analyze the factors that influence healthcare pricing in healthcare organizations. F. Discuss the relationship between financial planning and strategic planning. 1. Explain how a financial plan is developed. a. Recommend how a HIM manager should interact with the finance department to ensure the efficacy of a financial plan. G. Explain the financial management control process, including budgeting and financial planning. H. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
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