Kaplan University Healthcare Finance and Management Worksheet I need an expert in (Healthcare Finance and Management) to solve this question set.It’s very

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ESSENTIALS OF
HEALTH CARE
FINANCE
EIGHTH EDITION
William O. Cleverley, PhD
Chairman and Founder
Cleverley & Associates
Worthington, Ohio
James O. Cleverley, MHA
President
Cleverley & Associates
Worthington, Ohio
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Library of Congress Cataloging-in-Publication Data
Names: Cleverley, William O., author. | Cleverley, James O., author.
Title: Essentials of health care finance / William O. Cleverley and James O.
Cleverley.
Description: Eighth edition. | Burlington, Massachusetts : Jones & Bartlett
Learning, [2018] | Includes bibliographical references and index.
Identifiers: LCCN 2016047263 | ISBN 9781284094633
Subjects: | MESH: Costs and Cost Analysis | Financial Management | Health
Services—economics
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Contents
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi
Content of the Book. . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Contributor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Chapter 1 Financial Information and
the Decision-Making Process. . . . . . . 1
Information and Decision Making. . . . . . . . . . . . . . . . . . . 4
Uses and Users of Financial Information. . . . . . . . . . . . . 5
Financial Organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Forms of Business Organization. . . . . . . . . . . . . . . . . . . . . 8
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Chapter 2 Billing and Coding for Health
Services. . . . . . . . . . . . . . . . . . . . . . . . 11
Generating Healthcare Claims . . . . . . . . . . . . . . . . . . . . .
Scheduling and Registration. . . . . . . . . . . . . . . . . . . . . . .
Provide Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medical Documentation and HIM/Medical Records. . .
Charge Entry and Charge Master. . . . . . . . . . . . . . . . . . .
Billing and Claims Preparation . . . . . . . . . . . . . . . . . . . . .
Claims Editing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Claim Payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appendix 2-A Sample UB-04 Form and Sample
CMS-1500 Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
14
14
15
19
25
26
27
27
29
Chapter 3 Financial Environment of
Healthcare Organizations . . . . . . . . 31
Financial Viability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sources of Operating Revenue. . . . . . . . . . . . . . . . . . . . .
Healthcare Payment Systems . . . . . . . . . . . . . . . . . . . . . .
Medicare Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medicare Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32
34
36
40
41
52
Chapter 4 Legal and Regulatory
Environment . . . . . . . . . . . . . . . . . . . 97
Part I. Knowledge of the Law and Regulations
Is an Essential Part of Healthcare Financial
Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Part II. Primary Regulatory Issues
Confronting Healthcare Organizations
Today . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Legal Audits and Investigations. . . . . . . . . . . . . . . . . . . 126
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Chapter 5 Measuring Community
Benefit . . . . . . . . . . . . . . . . . . . . . . . 131
Tax Exemption Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Community Benefit Areas. . . . . . . . . . . . . . . . . . . . . . . . .
The Community Value Index®. . . . . . . . . . . . . . . . . . . . .
Estimating Financial Benefits in Not-for-Profit
Healthcare Firms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Estimating Financial Benefits Provided
by Not-for-Profit Healthcare Firms. . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appendix 5-A Schedule H Form. . . . . . . . . . . . . . . . . . .
132
133
135
139
142
144
147
Chapter 6 Revenue Determination. . . . . . . . . 151
Payment Methods and Their Relationship
to Price Setting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methods for Controlling
Revenue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Generic Principles of Pricing . . . . . . . . . . . . . . . . . . . . . .
Price Setting for Healthcare
Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Justifying Healthcare Firm Prices. . . . . . . . . . . . . . . . . .
Health Plan Contract Negotiation. . . . . . . . . . . . . . . . .
Health Plan Payment Schedules. . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
152
153
154
155
158
163
166
168
iii
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iv
Contents
Chapter 7 Health Insurance and
Managed Care . . . . . . . . . . . . . . . . . 171
Chapter 12 Financial Analysis of Alternative
Healthcare Firms. . . . . . . . . . . . . . 285
HMO and Managed-Care Development. . . . . . . . . . .
Integrated Delivery Systems . . . . . . . . . . . . . . . . . . . . . .
Paying Providers in a Managed-Care
Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Setting Prices in Capitated Contracts. . . . . . . . . . . . . .
Medicare and Medicaid Risk Contracts. . . . . . . . . . . .
Legal and Regulatory Issues. . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Long-Term Care Facilities and Nursing Homes. . . . .
Medical Groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
172
177
181
183
188
189
190
Chapter 8 General Principles of
Accounting. . . . . . . . . . . . . . . . . . . . 195
Financial Versus Managerial Accounting . . . . . . . . . .
Principles of Accounting. . . . . . . . . . . . . . . . . . . . . . . . . .
Accrual Versus Cash Accounting . . . . . . . . . . . . . . . . . .
Fund Accounting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Conventions of Accounting. . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
196
197
203
206
207
207
Chapter 9 Financial Statements . . . . . . . . . . . 211
Organizational Structure. . . . . . . . . . . . . . . . . . . . . . . . . .
Balance Sheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Statement of Operations (Revenues
and Expenses). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Statement of Changes in Net Assets . . . . . . . . . . . . . .
Statement of Cash Flows. . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appendix 9-A Case Example Audited
Financial Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . .
212
213
217
219
220
220
225
286
294
297
301
Chapter 13 Strategic Financial Planning. . . . 307
Strategic Planning Process. . . . . . . . . . . . . . . . . . . . . . . .
Developing the Financial Plan . . . . . . . . . . . . . . . . . . . .
Integration of the Financial Plan with
Management Control. . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
308
314
327
327
Chapter 14 Cost Concepts and Decision
Making . . . . . . . . . . . . . . . . . . . . . . 335
Concepts of Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cost Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Break-Even Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
336
343
348
354
Chapter 15 Product Costing. . . . . . . . . . . . . . . 361
Healthcare Cost Accounting. . . . . . . . . . . . . . . . . . . . . .
Relationship to Planning, Budgeting,
and Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Costing Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Two Required Systems for Healthcare Costing. . . . .
Relative Value Costing . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
362
364
365
368
371
373
Chapter 10 Accounting for Inflation. . . . . . . . 243
Chapter 16 The Management Control
Process . . . . . . . . . . . . . . . . . . . . . . 377
Reporting Alternatives. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Uses of Financial Report Information. . . . . . . . . . . . . .
Case Example: Williams Convalescent
Center. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Essential Elements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Budgeting Process . . . . . . . . . . . . . . . . . . . . . . . . . . .
Zero-Base Budgeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Benchmarking at the Departmental Level. . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
244
246
247
254
378
382
391
392
393
Chapter 11 Analyzing Financial Position. . . . 259
Chapter 17 Cost Variance Analysis . . . . . . . . . 401
Developing an Effective Financial Reporting
System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Case Example: Harris Memorial Hospital. . . . . . . . . . . 264
Summary: Harris Case. . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Cost Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Investigation of Variances. . . . . . . . . . . . . . . . . . . . . . . . .
Variance Analysis Calculations . . . . . . . . . . . . . . . . . . . .
Variance Analysis in Budgetary Settings. . . . . . . . . . .
402
403
406
410
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Contents
Variance Analysis in Managed-Care or Bundled
Payment Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Chapter 18 Financial Mathematics. . . . . . . . . 425
Single-Sum Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
Annuity Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434
Chapter 19 Capital Project Analysis . . . . . . . . 439
Participants in the Analytical Process. . . . . . . . . . . . . .
Classification of Capital Expenditures . . . . . . . . . . . . .
The Capital Project
Decision-Making Process . . . . . . . . . . . . . . . . . . . . . . .
Justification of Capital Expenditures. . . . . . . . . . . . . . .
Discounted Cash-Flow Methods. . . . . . . . . . . . . . . . . .
Selection of the Discount Rate. . . . . . . . . . . . . . . . . . . .
Valuation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
440
443
445
447
448
452
453
453
Chapter 20 Consolidations and Mergers . . . . 457
Defining the Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M&A Activity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Overview of Theories of M&A Activity. . . . . . . . . . . . .
Factors Affecting M&A Activity. . . . . . . . . . . . . . . . . . . .
Why Do Mergers Succeed or Fail?. . . . . . . . . . . . . . . . .
Valuations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
458
459
462
463
463
464
470
v
Chapter 21 Capital Formation. . . . . . . . . . . . . 475
Equity Financing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Long-Term Debt Financing . . . . . . . . . . . . . . . . . . . . . . .
Alternative Debt Financing Sources. . . . . . . . . . . . . . .
More Recent Developments. . . . . . . . . . . . . . . . . . . . . .
Early Retirement of Debt. . . . . . . . . . . . . . . . . . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
477
480
485
490
493
495
Chapter 22 Working Capital and Cash
Management. . . . . . . . . . . . . . . . . 503
Cash and Investment Management
Structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . …
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