Managing Healthcare Costs and Revenues Essay

With these types of organizations they have different methods of payments and reimbursements. They have guidelines through the government that they will have to abide by. The government sponsored payers are Medicaid and Medicare. The majority of patients that are treated are on Medicare or Medicaid. With patients not insured each type of organization handles reimbursement differently. For- Profit hospitals it is bad debt, which is when charges of patient are written off. With not –for –profit organizations it is considered charity care. This type of care has to be documented and reported on tax status.Managing Healthcare Costs and Revenues Essay

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The private insurers are patients with other insurances. Under Medicare and Medicaid, services that are provided by the hospitals are paid by a prospective reimbursement. Prospective reimbursement is established before the services are provided. They have a defined dollar amount per day and per diagnosis. They also use a fee scheduled by CPT code or procedure code which is usually used for physicians. Since these types of insured patients only are billed a certain amount, most procedures are not fully reimbursed. Retrospective reimbursement is determined after the services have been delivered. This is one of the reasons organizations are struggling. Along with less reimbursement, the CPT codes or procedure codes have to be correct according to the procedure ordered. “If an organization wants to get paid, its better off taking the time to make sure all its codes are accurate, timely , and meet all payers’ requirements ”(Kapsambelis, 2004, p. 3).Managing Healthcare Costs and Revenues Essay

With these types of organizations they have different methods of payments and reimbursements. They have guidelines through the government that they will have to abide by. The government sponsored payers are Medicaid and Medicare. The majority of patients that are treated are on Medicare or Medicaid. With patients not insured each type of organization handles reimbursement differently. For- Profit hospitals it is bad debt, which is when charges of patient are written off. With not –for –profit organizations it is considered charity care. This type of care has to be documented and reported on tax status.Managing Healthcare Costs and Revenues Essay

Task 1: Examining Financial Resource Management
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.Managing Healthcare Costs and Revenues Essay

The first essay investigates whether health care is a priced factor in asset returns.
Specifically, in the search for empirical relationships between macroeconomic factors
and asset returns, health care appears to be a significant US economic force receiving less
attention than others such as (aggregate) inflation, production, or consumption measures.
We use the medical care component of the Consumer Price Index to measure medical
inflation shocks as a candidate macroeconomic factor whose riskiness the market
rewards. Incorporating multiple model specifications during the period 1967-2009, we
find this inflationary component to be a relatively robust source of priced risk in US stock
returns.Managing Healthcare Costs and Revenues Essay
The second essay demonstrates how a genetic algorithm (GA) technique with
standard parameters and the appropriate fitness function can generate five-asset portfolios
that effectively hedge macroeconomic risks, including health care cost inflation.
Investigating 40 macroeconomic series-year combinations, the GA generates 36 (11)
hedging portfolios that are weakly (unambiguously) preferred to unmitigated risk
exposure in an out-of-sample analysis between 2005 and 2008. This same technique can
create parsimonious mimicking or tracking portfolios for investable assets such as mutual
funds and exchange-traded funds (ETFs), particularly in the down market of 2008.

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Dedication
I dedicate this work, as with all my efforts, to my wife, Melissa, and our children. You
are simultaneously my greatest heroes and biggest fans.

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Acknowledgements
Thank you to my committee, Dr. John M. Geppert (Chair), Dr. Donna M.
Dudney, Dr. Gordon V. Karels, and Dr. David B. Smith, for your time, energy, and
assistance. In particular, completing this research would have been literally impossible
without you, Dr. Geppert. In 17 years with the Air Force, I have met many, many
patriots, public servants, and teachers; your commitment to this country, your
community, and your students places you in the upper tail of the distribution. You
H[HPSOLI\WKHZRUG³WHDFKHU´DQG I am forever indebted to you for mentoring me.Managing Healthcare Costs and Revenues Essay
Dr. Jennings and Lieutenant Colonel (Retired) Fraser, you initiated my interest in
this topic by allowing me to participate in your research. Thank you.
Mom and Dad, you taught me work ethic and perseverance and have endlessly
supported me. I strive to become to my children a IUDFWLRQRIZKDW\RX¶ve been to me.
You know how much you have impressed upon my life. Thank you.
Bob, Rita, and Mary, these past three years never would have occurred without
you. You gave us a reason for being here and have supported our family for the duration.
Thank you.
Uncle John, you uniquely know the instrumental, no critical, role you have played
in this chapter of my life. I will forever remember it and hope to pay it forward someday.
Thank you.
Jeff and Jirka, through this experience, in my vernacular, we have become
³brothers-in-arms.´ Whether it was for personal or professional reasons, I have leaned on
you both many times; you have never wavered. I will reciprocate anytime. Managing Healthcare Costs and Revenues Essay