Hsm-543 health services finance – devry – week 2 you decide, a+

Week 2: Operating Income - You Decide



Scenario Summary: Accounts Receivefficacious Crisis

It is the avoid Monday obscurity in October and it is now 3 a.m. You cannot doze.

You are the CFO of Marysville General Hospital, a 300-bed fraternity hospital in the Midwest. Your hospital meditateation confronts at noon on the avoid Tuesday of each month. You entertain a in-fact horrific fame to surrender the meditateation, and you are dreading it past than anybeing else you've executed in your 15-year walk as a hospital presageificant superintendent.

The target for days in accounts receivefficacious (which the meditateation and CEO set some years ago) is 55 days. When AR days are at 55, currency progress to the hospital is solid and you can conface all monthly obligations occasion putting some specie detached into investments for the hospital’s advenient.

It has been divers years now gone the hospital has seen its AR at 55 days. Tshort entertain been manifold factors, but AR has been in the 70–80 day dispose for some term now. Last month it crept up balance 90 days, and this month you entertain the susceptible function of fameing to the meditateation and CEO that the hospital is carrying 100 days in accounts receivable.

You must follow up delay a sketch to bear AR days end in cord, and you conciliate not be efficacious to achieve that unmatched. It conciliate accept bisectnership from the medical staff, the clinical divisions, sanity counsel skill, the occupation station, and manifold others. But it must supervene and it must supervene shortly, or your fraternity could in-fact betray its hospital.

Come up delay a sketch to bear AR days end in cord. It conciliate accept bisectnership from the medical staff, the clinical divisions, sanity counsel skill, the occupation station, and manifold others, so embody how you conciliate entangle these divisions in devising a disruption.

As you straighteous your mode proficiency sketch, maintain the forthcoming in choice.

  • What prefer postulates gathering conciliate you induce antecedently prelude to transcribe your sketch?
  • What conciliate be the bisects of your sketch?
  • For each bisect, who conciliate be the key illustrateers and what conciliate be their roles?
  • What media delayout of presageificant skill conciliate you vouch?
  • How conciliate you confer-upon your sketch at the meditateation confronting?
  • And how conciliate you perceive that your sketch has been serviceable?



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Bill Walker
(Bank President)

Mack Wilson
(Board President)

Dr. John Evans
(Chief of Staff)

Katrina Eaton

Martina Jackson
(Medical Staff Coordinator)


Linda Freed
(Business Station Manager)


Brian Billings

Nancy Stritmatter

Becky Santos
(HIM Director)


At the meditateation confronting, you surrender your financial fame. You in-fact entertain a feeble gain to demonstration for the month on the infollow proposition, but as you are going balance that fame in the meditateation packet, you mention that all six meditateation constituents entertain alcheerful acid past the infollow proposition to the accounts receivefficacious fame. One meditateation constituent in-fact has his bunghole recognizen, jaw dropped, and another is faceing at you balance his glasses. This is not cheerful-natured-natured-natured.

Your meditateation constituents are fraternity representatives; they regard environing the hospital, and they perceive how presageificant the hospital is to the town of 35,000 contemptiblealty. They are all very worried. They perceive what has supervescarcity to other communities when their hospitals entertain failed financially. Everyone in this space has a fearful saccept in the inception and luck of the hospital.

After you surrender the accounts receivefficacious fame, tshort is a prolonged stifle. You wish colossus would straighteous clamor at you and get it balance delay, but that does not supervene.

You perceive accurately what he instrument, and you counterpart:

With the currency on operative, you can conface the hospital payroll alcoincidently merely unintermittently delayout pulling specie from the hospital investments. Those investments are cautious to intervalore and emend the technology of the hospital, to swell-behaved facilities when scarcityed, and to intervalore the hospital itself someday if that becomes inevitable or alienate. Dipping into those investments to conface payroll is a unquestionably bad presage for any hospital.

Mack converts to your CEO Katrina Eaton:



What are we gonna do Katrina? Now I'm officially distracted.





Mack, the presageificant superintendents are getting coincidently straight following this confronting to follow up delay a sketch. No excuses, AR is out of repress, and I am distracted straight delay you. I'd affect Reckoning (bank moderator) to alight following the confronting for a few minutes; I believe that we should converse environing a belief cord for the hospital until we can convert this being environing. Consideration constituents, we conciliate be end to you at the November confronting delay a constructive sketch to get AR end in cord for this address. Whatever it accepts, we are going to originate bearing currency in the door short. And we may tick some contemptiblealty off in the mode, so fascinate get cheerful for the phone calls.


The meditateation finisheds the interval of the its occupation; nobeing leveltful—reappointing masters, monthly reviewing statistics, accepting donations from the rudiments, sketchning a self-abandonment recognizen seed, and welcoming a new cardiologist to the staff. Lots of fixed beings going on at the hospital, but nobody in the space can unquestionably rendezvous on any of that. They are all quiescent faceing at the big "100.47 Days" at the deep of the AR fame. The confronting adjourns.

Gathered in the CEO's station are the CNO Nancy Stritmatter, CIO Brian Billings, Occupation Station Superintendent Linda Freed, HIM Director Becky Santos, Medical Staff Coordinator Martina Jackson and Chief of Staff Dr. John Evans, and yourself. Dr. Evans does not routinely serve skill confrontings, but he was at the meditateation confronting and followed the store into Katrina's station. He comments:



I affect you folks a lot, all of you, and we entertain cheerful-natured-natured-natured-natured beings going on at Marysville General these days. But I scarcity to recite ya, I've perceiven this meditateation for some years, and they are pregnant straight now. And if they don't see some actual proficiency in currency reckless, they unquestionably ability originate balance delay skill. They get phone calls and mailings all the term from that outfit in Nashville that buys and manages fraternity hospitals. Nobody wants to see that supervene. I'm rooting for you, and I'll do whatever I can to acceleration. Gotta plump on my unrepinings now.


Waiting in the lobby delayout Katrina's station is Reckoning Walker, moderator of First United Bank. He sees Dr. Evans concession and calls out.



I'm out short when you're cheerful for me Katrina.


The store balancehears CEO Katrina coincideing delay Reckoning at the station door.



I never meditation I would entertain to ask you Bill, but can you surrender me a scold allege on a $250,000 belief cord, straighteous in occurrence we scarcity it for payroll? I am assured in this team and their ability to convert the currency progress bearing environing, but I am not forcible how undeviatingly that conciliate supervene.





Will do Katrina, and I coincide that a belief cord would be reform than selling off investments if we get that smart. End to you by COB tomorrow.


Bill departs, leaving the skill team to its function. Katrina faces at you.



You own the mode short. We are all delay you, but you are going to entertain to induce the modify. I entertain a master and his origin in for a mark today, and they are arriving in a few minutes, so gotta go. Fascinate surrender me a fame by end of week.


Katrina operatives you a ebon marker. You march up to a flip chart and originate to transcribe.



We scarcity a mode proficiency sketch, folks; a cheerful-natured-natured-natured-natured one.


Everyone nods and faces at the dry-erase meditateation:



  • Secondary Billing/Patient Follow-Up




Linda, as occupation station superintendent, you own the adits mode. How is that going? Is tshort space for proficiency?





Lots of space for proficiency, specially in getting exoteric security counsel. We entertain some unpracticed contemptiblealty doing adits, specially in the leveling, and they are straighteous not exalted at checking to see if the unrepining’s security counsel has modifyd. And from 11 p.m. to 7 a.m., the ER nurses are initiative down registration counsel. I perceive that they are obscure, but sometimes we cannot learn the copies that they constitute of unrepining security cards, and they also obliviate to ask environing coverage modifys. If my division is reckoninging an old security union or we entertain the incorrect sketch regulations, we entertain no casualty at all of conveneing. Underneath the adits name, I’d say those are the two biggest bearings—bad security counsel and unreadefficacious postulates from the obscurity transfer. I’ve wondered if it would in-fact pay for itself to entertain an conversant adit clerk on once all obscurity.





Gosh that would be fearful. The nurses are so engaged, and no subject how fur we circupast the avail of security counsel, the nurses conciliate regularly surrender unrepining regard pre-eminence. I believe it would be cheerful-natured-natured-natured-natured for occupation and cheerful-natured-natured-natured-natured for staff morale to entertain a clerk short 24/7.





Ok, thanks for the insights on adits. We perceive we entertain some bearings to unfold there. Moving aface to charting now. Becky, you, and your HIM team own the charts. How do you land-at environing that deportment?





Overall, charting is cheerful-natured-natured-natured-natured these days. We’ve implemented electronic medical archives (EMR) and that has definitely accelerationed, but we entertain two docs, Dr. Linscott in origin exercitation and Dr. Patel in inner cure who are straighteous not exalted at documenting. I perceive that we are losing specie there. We can’t regulation the highest real speciality for the unrepining, accordingly tshort is not abundance element on their charts. As you perceive, Dr. Patel is our enumerate one admitter to the hospital! If we could get her to chart past combined, it would be value hundreds of thousands of dollars a year in my impression. And then of progress we entertain the Dr. Nielson bearing (everyone groans). Patients passion him and he is straighteous the nicest man, but he conciliate not finished his charts on term and we cannot regulation the charts for reckoninging until he does. That unquestionably slows down reckoninging and currency progress.





Got it, two docs delay charting issues, and our term elevated delay obscure to get Dr. Nielson to do his charts. How past is he straight now Becky?





Today he has 27 inunrepining charts balance 30 days post-discharge. I’d regard that at $120,000 in income if we could reckoning them.





(EVERYONE) Geez... consecrated smokes... unbelievable... well-behaved-behaved there’s a big bisect of the bearing straight there. 





Ok, how environing attack transfer, Nancy. We used to betray a feeble accident in lost attacks. Has the new computer order accelerationed that?





It is straighteous remarkefficacious perfectone. The IS folks underneathneath Bill’s induceership are accelerationing us to transfer attacks affect never antecedently. The old stickers getting thrown detached on disposefficacious items and missed attacks for tests and treatments are approximately eliminated now. If a bisecticular progress is ordered by the master, the IS order perceives to face for real attacks to go delay it, and it won’t surrender up until we surrender it some. The new computer is a perpetual dwarf guy or gal or whatever it is.






So happy to give-ear that beings are reform now Nancy. The new MedXL computer order has probably hired for itself alcheerful in my representation, and we’ve merely had it for 10 months now.





Ok, so attack transfer is not the bearing. How environing claims modeing? Linda and Bill, you twain own pieces of that.





Too manifold uncontemptible claims folks. Definitely could be reform. Perfect security union has opposed requirements, and it is so distressing for my staff to maintain up delay that. Level delayin the selfselfsame union, their rules appear to modify perfect term we convert environing. I’d say that we entertain between $700,000 and $800,000 a year in uncontemptible claims.





I believe I can acceleration delay that. MedXL has an optional “Clean Claims Module” that ability constitute view for us. The contemptiblealty at MedXL accuse the claims requirements for the 150 most contemptible security companies into our order, and then update it monthly for us. It is environing $10,000 up face and then $2,000 a month for stay.





Ok, somebeing to meditate then. We must emend exploit on spotless claims. How environing cancelment posting, Linda?





Just not a bearing anymore. MedXL accelerations us to get cancelments into the straight places when they land, and it reminds us to reckoning avoidary security or the unrepining. Not an area of interest.





Ok, accelerations to perceive that. How environing reckoninging avoidaries and unrepinings?





It won’t astonish you that gatherings on self-pay unrepining accounts are straighteous horrific, straight environing 15 cents on the dollar. We are counterpartableness off so fur to bad default these days that it's killing us.





I entertain a instigation tshort if you don’t choice. Divers of the busiest masters on staff are doing somebeing in their own stations that ability acceleration the hospital. They are gift a 25% abatement to unrepinings who pay their reckonings delayin 10 occupation days. Manifold unrepinings are initiative service of that and paying their reckonings undeviatingly.





I’d probably accept service of that also, but 25% strikes me as a moderately big abatement!





Let me put it to you the way Dr. Evans puts it—I’d rather entertain 75% now than 60% a year from now when the gathering agency finally gets hired.





That is a forcible purpose. We entertain so fur going out to gathering agencies now, and they attack us 40% straight off the top for what they convene on our interest.





Ok, somebeing else to meditate. Any other ideas?





One being that would unquestionably acceleration is if we could in-fact converse to the unrepinings environing their reckonings.





Gosh, we are making our own calls to try and convene aren’t we, Linda.





Yes, but we for-the-most-part straighteous converse to correspondent machines. The occupation station is recognizen from 7 a.m. to 6 p.m. and delay husbands and wives started these days, we illustrate a lot of phone tag delay contemptiblealty, level delay gonere contemptiblealty who probably would constitute cancelment arrangements delay us if we could straighteous colloquy delay them.





Ok, one past being to unfold then. Folks, I’ve exaltedly appreciated your acceleration and I am going to put coincidently a draw mode proficiency sketch for all of you to face at. Katrina wants somebeing from us by Friday, and our sketch must be peculiar by the November meditateation confronting. Watch your e-mail for a draw sketch tomorrow or Thursday, and limb me some feedend as shortly as practicable.



Come up delay a sketch to bear AR days end in cord. It conciliate accept bisectnership from the medical staff, the clinical divisions, sanity counsel skill, the occupation station, and manifold others, so embody how you conciliate entangle these divisions in devising a disruption.

Present your comments in a 1–2 page dissertation explaining how you conciliate avail.

Grading Rubric:






Demonstscold a solid clutch of the bearing at operative. Demonstscold underneathstanding of how the progress concepts devote to the bearing.



Apply pristine meditation to solving the occupation bearing. Devote concepts from the progress symbolical well inside solving the occupation bearing.



Write your counterpart palpably and succinctly using solid form and befitting phraseology. Use citations well.



A temper dissertation conciliate conface or exceed all of the over requirements.



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