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Platte County Memorial Hospital Healthcare Basics.

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Presentation on theme: "Platte County Memorial Hospital Healthcare Basics."— Presentation transcript:

1

2 Platte County Memorial Hospital Healthcare Basics

3 Learning Objectives How is healthcare funded Revenue Cycle What do we spend What can I do

4 Healthcare Funding Medicare Medicaid Private Insurance Other Govt Self pay

5 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

6 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

7 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)

8 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 - $1,072,000 Bad Debt $1,442,000

9 Let’s Make it Real

10 Revenue Cycle Physician Order – Including a Dx Documentation of completion of the order Charges (manual or from systems) Discharge Coding Billing Collections

11 Care Manager WFA MedSeries 4 Cerner LawsonPayroll General Ledger APMaterials SDSM/Eclipsys(TSI) Impac Medilinks Kronos System Flow

12 Charge Master File Daily Transactions PHRR560 Report DateGL AccountGL Account DescAcctChgChg DescQTYDateBatchAmountPatient Name 6/26/201426300.4201AMBULATORY CARE - HOSP 419790302601375INF IV THRPY FIRST HR6/25/201467543-343.00Sample 1 6/26/201426300.4201AMBULATORY CARE - HOSP 419790302601383INF IV THRPY ADDL HR6/25/201467543-149.30Sample 1 6/26/201426300.4201AMBULATORY CARE - HOSP 20236700172601375INF IV THRPY FIRST HR6/25/201467500-343.00Sample 2 6/26/201426300.4201AMBULATORY CARE - HOSP 20236700172601383INF IV THRPY ADDL HR6/25/201467500-149.30Sample 2 6/26/201426300.4201AMBULATORY CARE - HOSP 20236700172601383INF IV THRPY ADDL HR6/25/201467500-149.30Sample 2 6/26/201426300.4201AMBULATORY CARE - HOSP 20236700172601375INF IV THRPY FIRST HR6/26/201467504-343.00Sample 2 6/26/201426300.4201AMBULATORY CARE - HOSP 20236700172601383INF IV THRPY ADDL HR6/26/201467504-149.30Sample 2 6/26/201426300.4201AMBULATORY CARE - HOSP 20236700172601375INF IV THRPY FIRST HR6/24/201467543-343.00Sample 2 6/26/201426300.4201AMBULATORY CARE - HOSP 20236700172601383INF IV THRPY ADDL HR6/24/201467543-149.30Sample 2 6/26/201426300.4201AMBULATORY CARE - HOSP 20236700172601375INF IV THRPY FIRST HR6/25/201467543-343.00Sample 2 6/26/201426300.4201AMBULATORY CARE - HOSP 20236700172601383INF IV THRPY ADDL HR6/25/201467543-149.30Sample 2 6/26/201426300.4201AMBULATORY CARE - HOSP 20236700172601383INF IV THRPY ADDL HR6/25/201467543-149.30Sample 2 6/26/201426300.4201AMBULATORY CARE - HOSP 20236200122601375INF IV THRPY FIRST HR6/25/201467500-343.00Sample 3 6/26/201426300.4201AMBULATORY CARE - HOSP 20236200122601375INF IV THRPY FIRST HR6/26/201467504-343.00Sample 3 6/26/201426300.4201AMBULATORY CARE - HOSP 20236200122601375INF IV THRPY FIRST HR6/25/201467543-343.00Sample 3 6/26/201426300.4201AMBULATORY CARE - HOSP 20236200122601375INF IV THRPY FIRST HR6/24/201467543-343.00Sample 3 6/26/201426300.4201AMBULATORY CARE - HOSP 20236400102601375INF IV THRPY FIRST HR6/25/201467543-343.00Sample 4 6/26/201426300.4201AMBULATORY CARE - HOSP 20236400102601383INF IV THRPY ADDL HR6/25/201467543-149.30Sample 4 6/26/201426300.4201AMBULATORY CARE - HOSP 20236400107616725VISIT ESTABLISHED LEVEL 1 6/25/201467543-134.20Sample 4 Daily Transaction Report

13 Responsibilities https://www.youtube.com/watch ?v=AGt5f70K02Q PFS Error Worksheet Chart Audits Daily Stat Report Revenue and Usage Report R2W reports

14 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.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

15 Again Let’s Make it Real

16 Questions? Did this meet your expectations? What did you like about this Education? What would you change?

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