No More Worries!

Our orders are delivered strictly on time without delay

Paper Formatting

Double or single-spaced
1-inch margin
12 Font Arial or Times New Roman
300 words per page

No Lateness!

Our orders are delivered strictly on time without delay

Our Guarantees

Free Unlimited revisions
Guaranteed Privacy
Money Return guarantee
Plagiarism Free Writing

Healthcare Finance Overview

Prepare a presentation for new hire orientation that addresses the organization's three types of revenue sources: Medicaid, Medicare, and managed care. For each revenue source, explain the purpose of the program, how the organization is reimbursed, and the benefits of the program.

Introduction: Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in sequence.

Healthcare finance has changed dramatically with the advent of the Affordable Care Act (ACA) in 2010. Its effects continue to impact organizations and individuals. The healthcare industry has transitioned to a unique and complex entity as a result of the ACA's legal and regulatory ramifications. The shift in delivery systems requires healthcare leaders to possess new skill sets (Office of the Legislative Counsel, 2010).

Healthcare leaders at all levels within an organization must be comfortable with financial statements and basic accounting principles. As an early careerist, you may be involved in conversation to evaluate existing and new healthcare service lines. You may be asked to participate in various financial activities, such as team budgeting activities and development of a departmental budget. As a mid or advanced careerist, you may be evaluating higher-level organization financing options, determining cash flow needs, or presenting financial information to the CEO and board.

Finally, one of the number one things that you will do as a healthcare leader is manage expenses. There are many variables to managing expenses in healthcare, from managing fixed assets, payroll and capital expenses. You will look at the classifications of expenses and costs, and review depreciation and how that is calculated. You will also review the difference between variable and fixed costs in healthcare and how those can be managed effectively.

Regardless of your position within the organization, understanding healthcare finance is a critical success factor for effective and responsible healthcare leadership.

Reference
Office of the Legislative Counsel. (2010). Compilation of patient protection and Affordable Care Act. http://housedocs.house.gov/energycommerce/ppacacon.pdf

Scenario: Sustainable healthcare organizations today need to balance the clinical and fiscal facets of the operation. People at all levels in a healthcare organization need to understand how the organization makes money (accounts receivable) and how it chooses to allocate or spend these resources (accounts payable).

Early careerists in a healthcare organization may participate in any or all of the following financial activities:

Evaluate existing and new healthcare service lines.
Develop a departmental budget.
Provide input to strategic planning or finance department meetings.
Mid-level or advanced careerists may be asked to:

Evaluate higher-level organization financing options.
Anticipate cash flow needs.
Present financial information to the CEO and board.
For the purpose of this assessment, assume you are a manager in a healthcare organization. Your organization likes to educate employees about the organization's fiscal operations from the very start—at new hire orientation. You have been asked to prepare a presentation for new hire orientation that addresses the organization's three types of revenue sources: Medicaid, Medicare, and managed care.

Preparation: You will prepare a presentation with speaker notes and slides on the three revenue sources for healthcare organizations: Medicare, Medicaid, and managed care. The last three slides of your presentation should cover the quality metrics for each revenue source and include a 3–5 minute audio recording. You may use PowerPoint or Kaltura to record your presentation. The audience for your presentation is new hires attending orientation.

Conduct independent research on Medicare, Medicaid, and managed care.

Full Answer Section

"My name is [Your Name/Manager Title], and today, we're going to take a fundamental look at how our organization sustains its operations and continues to provide exceptional care. Understanding our revenue sources is a critical piece of the puzzle for everyone, regardless of your role."
"Think of it this way: just as our clinical teams ensure patients receive the best possible care, our financial health ensures we have the resources—from state-of-the-art equipment to competitive salaries—to deliver that care effectively. Today, we'll focus on our three primary revenue streams: Medicaid, Medicare, and Managed Care."

Slide 2: Introduction to Healthcare Revenue Title: Why Understanding Revenue Matters Key Points:

Balancing Clinical & Fiscal: Healthcare organizations must operate sustainably.
Accounts Receivable: How we get paid for services rendered.
Accounts Payable: How we allocate and spend resources.
Your Role: Every employee contributes to financial health through efficient operations and quality care.

Image: A balance scale with "Clinical Excellence" on one side and "Financial Stability" on the other. Speaker Notes:

"In today's healthcare environment, a sustainable organization like ours needs to skillfully balance two crucial aspects: clinical excellence and fiscal responsibility. We are committed to providing the highest quality patient care, and to do that consistently, we must also be financially sound."
"Our revenue sources represent our 'accounts receivable' – the money flowing into the organization for the services we provide. This is how we literally make money."
"On the flip side, 'accounts payable' is how we manage our expenses – from salaries and supplies to new technologies and facility maintenance. Understanding the revenue side helps us make informed decisions about our expenditures."
"Whether you're directly involved in budgeting, patient billing, or delivering care, your work impacts our financial health. Every efficient process, every accurate documentation, and every positive patient outcome contributes to our ability to continue our mission."

Slide 3: Revenue Source 1: Medicare Title: Medicare: Healthcare for Seniors & Specific Populations Sub-points:

Purpose: Federal health insurance for:
- Individuals 65+
- Younger people with certain disabilities
- Individuals with End-Stage Renal Disease (ESRD) or ALS
Reimbursement for [Organization Name]:
- Part A (Hospital Insurance): Inpatient services (hospitals, skilled nursing facilities, hospice). Reimbursement often via Diagnosis-Related Groups (DRGs) – a fixed payment based on patient diagnosis, not actual cost.
- Part B (Medical Insurance): Physician services, outpatient care, preventive services, durable medical equipment. Reimbursement typically via Physician Fee Schedule (PFS) for professional services and Ambulatory Payment Classifications (APCs) for outpatient hospital services.
- Part C (Medicare Advantage): Private plans (HMOs, PPOs) contract with Medicare to provide Part A & B benefits, often with additional benefits. We are reimbursed by these private plans.
- Part D (Prescription Drug Coverage): Private plans.
Benefits to Our Organization & Patients:
- Organization: Stable and significant payer for a large patient population, offering predictable revenue streams for inpatient and outpatient services.
- Patients: Comprehensive coverage for essential healthcare needs, including hospital stays, doctor visits, and preventive care, significantly reducing out-of-pocket costs for eligible beneficiaries.

Image: Medicare logo or an image representing older adults receiving care. Speaker Notes:

"Our first major revenue source is Medicare. This is a federal health insurance program primarily for people aged 65 or older, but it also covers younger individuals with certain disabilities and those with End-Stage Renal Disease or ALS."
"Medicare is divided into several 'Parts.' For us as a healthcare organization, the main reimbursement comes from Part A and Part B. For inpatient hospital services under Part A, we are largely reimbursed through what's called Diagnosis-Related Groups, or DRGs. This means Medicare pays us a fixed amount based on the patient's primary diagnosis, regardless of the actual cost or length of stay. Our efficiency directly impacts our profitability here."

Sample Answer

New Hire Orientation: Understanding Our Revenue Streams

Presentation Audience: New Hires Presenter: [Your Name/Department Manager] Duration: Approximately 15-20 minutes (plus 3-5 minutes audio for quality metrics) Format: Slides with Speaker Notes

Slide 1: Title Slide Title: Welcome to [Organization Name]! Understanding Our Revenue Streams Image: A welcoming image, perhaps showing diverse healthcare professionals, or a simplified infographic of money flowing into an organization. Speaker Notes:

"Good morning, everyone, and a warm welcome to [Organization Name]! We're thrilled to have you join our team. As you embark on your journey here, you'll find that healthcare is a dynamic and multifaceted industry, not just clinically but also financially."