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New Employee Orientation 2

Overview of Financial Services

Bruce Cross

on 19 February 2013

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Transcript of New Employee Orientation 2

By: Bruce Cross, MHA
Business Manager Overview of Financial Services Where do we fit in? Registration verifies benefits and demographics and then registers patient in the system to generate a patcom.
Financial Counseling talks with patients when benefits are exhausted and helps get Charleston/Dorchester funding. Utilization Review gathers clinical information from the units and obtains pre-authorization days and concurrent stay days from insurance companies. Steven Ratliff runs critical financial and patient activity reports for senior management to review. Hyun Lee runs analysis on our P&L statements and other key performance indicators to include quality measures such as readmission rates, patient satisfaction and cost per discharge. QUALITY DASHBOARDS FINANCIAL SERVICES OVERVIEW UTILIZATION REVIEW PROFIT AND LOSS STATEMENTS INPATIENT REGISTRATION A FEW THINGS ABOUT HOW WE ARE PAID...... Medicare pays via a per diem scale.
The rate declines each day the patient is in the hospital.
Medicaid pays per diem by DRG.
HMO plans pay either per diem by DRG or flat per diem rate regardless of DRG.
Some commercial plans still by a % of charge rate but those are very few. When an insurance that we have a contract with pays, we take the negotiated payment and the patient pays either a portion of the allowed amount or nothing.
We end up writing the difference between the allowed amount (negotiated rate) and the charge off. For Example: We charge $10,000 for a 5 day stay. We have negotiated a rate with the patient's insurance to accept $750 per day as the allowed amount. The patients insurance covers 80% of the allowable. So insurance will then pay us $3000 and the patient will be responsible for $750. We write off the rest, $6250. What about if someone has no insurance???? Self-Pay folks get a 50% discount and can apply for Financial Aid. They also are evaluated to see if they are eligible for disability benefits and other assistance such as Medicaid. IN CLOSING................
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