platte county memorial hospital healthcare basics
TRANSCRIPT
Platte County Memorial Hospital
Healthcare Basics
Learning Objectives• How is healthcare funded• Revenue Cycle• What do we spend• What can I do
Healthcare Funding
• Medicare• Medicaid• Private Insurance• Other Govt• Self pay
Medicare
• Reasonable Cost Reimbursement• Cost report• Costs related to patient care
• PPS – Prospective payment system• CAH- Criteria
• Less than 25 beds (can be used for swing beds)
• Avg Length of stay less than 4 days• Licensed by the state as a CAH
Medicaid
• State run programs• Federal Matching Dollars• Wyoming current program
• Level of care reimbursement• Maternity/surgical
$6,826• Maternity/Medical
$3,749• Newborn Nursery $
740• Rountine care
$5,380• Outpatient reimbursement cost
based via an intergovernmental transfer calculation
Commercial
Wyoming is very unique• % of charges and our
actual reimbursement runs from 88% - 97% of charges.
• Other parts of the country are on fixed payments or risk sharing.
• Moving to population based health reimbursement (capitation and risk)
Charity and Bad Debt
• PCMH average collection for self pay patients is 12 cents on the dollar
• All hospitals owned or operated by Banner Health, including the one(s) where you received your care, offer a Basic and an Enhanced Financial Assistance Program to uninsured patients. An uninsured patient is someone who does not have any health coverage at all, whether through insurance or any government program, and who does not have any right to be reimbursed by anyone else for their healthcare expenses.
PCMH Charity care in 2013 - $1,072,000Bad Debt $1,442,000
Let’s Make it Real
Revenue Cycle
• Physician Order – Including a Dx• Documentation of completion of the
order• Charges (manual or from systems)• Discharge• Coding• Billing• Collections
Care Manager
WFA
MedSeries 4Cerner
LawsonPayroll
General LedgerAP
Materials
SDSM/Eclipsys(TSI)
Impac
Medilinks
Kronos
System Flow
Charge Master File
Daily TransactionsPHRR560
Report Date GL Account GL Account Desc Acct Chg Chg Desc QTY Date Batch Amount Patient Name6/26/2014 26300.4201 AMBULATORY CARE -
HOSP41979030 2601375 INF IV THRPY FIRST HR -1 6/25/2014 67543 -343.00 Sample 1
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
41979030 2601383 INF IV THRPY ADDL HR -1 6/25/2014 67543 -149.30 Sample 1
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023670017 2601375 INF IV THRPY FIRST HR -1 6/25/2014 67500 -343.00 Sample 2
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023670017 2601383 INF IV THRPY ADDL HR -1 6/25/2014 67500 -149.30 Sample 2
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023670017 2601383 INF IV THRPY ADDL HR -1 6/25/2014 67500 -149.30 Sample 2
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023670017 2601375 INF IV THRPY FIRST HR -1 6/26/2014 67504 -343.00 Sample 2
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023670017 2601383 INF IV THRPY ADDL HR -1 6/26/2014 67504 -149.30 Sample 2
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023670017 2601375 INF IV THRPY FIRST HR -1 6/24/2014 67543 -343.00 Sample 2
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023670017 2601383 INF IV THRPY ADDL HR -1 6/24/2014 67543 -149.30 Sample 2
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023670017 2601375 INF IV THRPY FIRST HR -1 6/25/2014 67543 -343.00 Sample 2
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023670017 2601383 INF IV THRPY ADDL HR -1 6/25/2014 67543 -149.30 Sample 2
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023670017 2601383 INF IV THRPY ADDL HR -1 6/25/2014 67543 -149.30 Sample 2
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023620012 2601375 INF IV THRPY FIRST HR -1 6/25/2014 67500 -343.00 Sample 3
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023620012 2601375 INF IV THRPY FIRST HR -1 6/26/2014 67504 -343.00 Sample 3
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023620012 2601375 INF IV THRPY FIRST HR -1 6/25/2014 67543 -343.00 Sample 3
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023620012 2601375 INF IV THRPY FIRST HR -1 6/24/2014 67543 -343.00 Sample 3
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023640010 2601375 INF IV THRPY FIRST HR -1 6/25/2014 67543 -343.00 Sample 4
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023640010 2601383 INF IV THRPY ADDL HR -1 6/25/2014 67543 -149.30 Sample 4
6/26/2014 26300.4201 AMBULATORY CARE - HOSP
2023640010 7616725 VISIT ESTABLISHED LEVEL 1
-1 6/25/2014 67543 -134.20 Sample 4
Daily Transaction Report
Responsibilitieshttps://www.youtube.com/watch?v=AGt5f70K02Q
PFS Error WorksheetChart AuditsDaily Stat ReportRevenue and Usage ReportR2W reports
• That leaves us with 4¢, which we can use to reinvest in ourselves by hiring more people, providing pay increases, purchasing new equipment and building new facilities.
.06 Depreciation
.03 Interest
.04 Operating profit
.16 Supplies
.20 Operating Expenses
.51 Compensation and Benefits
Again Let’s Make it Real
Questions?• Did this meet your expectations?• What did you like about this
Education?• What would you change?