Session Description
Many bankruptcy professionals are being called upon to help healthcare provider organizations as this industry faces unprecedented business distress. Whatever the professional's role, some basic understanding of healthcare finance can strengthen decision-making and performance.
This session will provide a high-level view of the unique fiscal considerations in the healthcare provider organization, specifically: 1) accounting and financial statements; 2) cashflow including the massive revenue cycle and accounts payable functions; 3) a murkier part of cashflow buried in the various governmental and private payer reimbursement models, and 4) fraud.
Beginning with accounting and financial statements, the mystery of gross revenue, net revenue, and accounts receivable on the income statement will be examined. Even experienced healthcare CFOs can trip up on accounts receivable calculations given the complexities of payer reimbursement models and payment practices, as well as the payer market changes occurring at an ever-faster pace.
Healthcare provider cashflow management consists of voluminous variations and constant change, more so in revenue cycle but also in accounts payable. Years ago, revenue cycle was simply called “billing.” The term revenue cycle more accurately describes the revenue generation process which can involve every function in the healthcare provider organization, from physician and nursing care to lab work and housekeeping.
Third, fundamentals of the most common healthcare reimbursement models will be discussed starting with basic fee-for-service reimbursement and moving through other models to the present attempts at value-based reimbursement. It may be surprising that while the industry grapples with the new value-based models, a sizable part of reimbursement is still fee-for-service.
Finally, there will be brief mention of fraud and embezzlement which can develop in the troubled healthcare provider organization and may be a significant contributor to poor financial performance.
Learning Outcomes
Participants will gain a high-level perspective on the unique fiscal considerations in the healthcare provider organization to inform their work in advising clients in this troubled industry. A solid base of knowledge in healthcare finance will support accurate financial performance projections, prioritization of turnaround strategies, and organization valuations. Given the esoteric complexities in this field, attendees will also gain an appreciation for situations where using healthcare financial specialists may be helpful.
First, participants will understand special aspects of income statements for healthcare provider organizations, in particular the difficulty of estimating accounts receivable due to the variability in the payer market, reimbursement models, and billing policies and procedures.
Second, attendees will be able to discuss the umbrella structure of cashflow in the healthcare provider organization from revenue generation to accounts payable.
They will understand the fundamentals of the “revenue cycle” which spans the entire healthcare provider organization. They will also be able to outline some mid-level billing functions, common operational problems with billing in the distressed healthcare organization, and practical solutions to address them, including artificial intelligence (AI).
On the other side of cashflow management, participants will understand the cash management structure and issues in vendor contracting, purchasing, and accounts payable in the healthcare organization.
Next, participants will gain a deeper awareness of how various healthcare reimbursement models in the marketplace – e.g., Medicare Advantage, health maintenance organizations (HMOs), high-deductible plans, accountable care organizations (ACOs), etc. – affect the financial performance of healthcare provider organizations.
Finally, attendees will be made aware of some places fraud and embezzlement may develop in the distressed healthcare organization.
