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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.