Financial Resource Management and Healthcare Reimbursement

Financial Resource Management and Healthcare Reimbursement
Introduction:
There are many factors to be considered when examining organizational finances and making decisions that have long-term effects on a medical practice. In healthcare organizations, there are multiple payers that influence reimbursement. There are external agencies such as the federal or state government, which may set rate limits that impact revenues, and there are outside forces such as marketing structure 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.
Read the attached “Financial Resource Management and Healthcare Reimbursement.” For this task, you will act in the role of the manager as you consider how to develop a financial plan for the clinic for the upcoming fiscal year, including projections for the future.
Task:
A. Create an agenda to present to Dr. Ross in a preliminary meeting with him before meeting with the entire physician group.
1. Summarize the types of financial information the physician group would need to understand to have a clear picture of the clinic’s current financial status.
a. Discuss what is influencing the pricing for the pediatric services.
b. Discuss what is influencing revenue collection.
c. Illustrate how this information should be analyzed to assist in the decisions to be made for the practice.

B. Explain how issues presented in the scenario may impact the future revenue of the practice by doing the following:
1. Discuss the consideration to be given to the pediatric endocrinologist’s request.
2. Discuss the aspects that need to be considered in adding pediatric oncology.
3. Present the components that should appear in a managed care contract with Indian Health Service.

C. Discuss how you could develop a financial plan for the clinic using a management control process for the budget implementation.

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