Chapter 39 Auditing Health Care Organizations.docx
- 文档编号:11923069
- 上传时间:2023-04-16
- 格式:DOCX
- 页数:47
- 大小:49.54KB
Chapter 39 Auditing Health Care Organizations.docx
《Chapter 39 Auditing Health Care Organizations.docx》由会员分享,可在线阅读,更多相关《Chapter 39 Auditing Health Care Organizations.docx(47页珍藏版)》请在冰豆网上搜索。
Chapter39AuditingHealthCareOrganizations
窗体底部
39
AuditingHealthCareOrganizations
39.1OVERVIEWOFTHEINDUSTRY
(a)HealthCareServices,
(b)HospitalSegment,
(c)LawsandRegulations,
(d)Third-PartyReimbursementorPayment,
39.2ACCOUNTINGPRINCIPLESANDPRACTICES
(a)AuthoritativePronouncements,
(b)RevenuefromHealthCareServices,
(c)Third-PartyPayorConsiderations,
(i)EstimatingRevenueRelatedtoGovernmentalPrograms
(d)DeferredThird-PartyReimbursementandPayment,
(e)AccountingforContractswithHospital-BasedPhysicians,
(f)ContinuingCareRetirementCommunities,
(g)CapitalizationofInterest,
(h)FinancialStatementPresentation,
39.3RISKFACTORSANDAUDITREACTION
(a)InherentRisks,
(i)Tax-ExemptStatus,
(ii)SourcesofLong-TermFinancing,
(iii)MedicalMalpracticeClaims,
(b)AuditStrategy,
(c)Materiality,
(d)SingleAuditActandRelatedAuditConsiderations,
39.4AUDITCONSIDERATIONS
(a)PatientRevenueCycle,
(i)Admitting/RegistrationFunction,
(ii)DailyHospitalServiceCharges,
(iii)AncillaryServiceCharges,
(iv)OutpatientServiceCharges,
(v)DischargeandBillingFunctions,
(vi)SubstantiveTestsofAccountsReceivable,
(vii)CostReports
(viia)SignificantEstimatesRelatedtoGovernmentProgramRevenues
(viii)NonpatientRevenues,
(b)PurchasingCycle,
(i)Payroll,
(ii)SuppliesandOtherExpenses,
(c)Inventories,
(d)FixedAssetsandIntangibles,
(e)TestsofRestrictedNetAssets,
(f)AnalyticalProcedures,
(g)MalpracticeInsurance,
(h)IllegalActsRelatedtoGovernmentPrograms
(i)ConsiderationsforTax-ExemptDebtIssuers
39.1OVERVIEWOFTHEINDUSTRY
Healthcareisoneofthefastest-growingindustriesintheUnitedStates.Thesystemofhealthcaredeliveryorganizationsisextensive,encompassingthefollowingsegments:
∙Hospitals
∙Nursinghomes
∙Healthmaintenanceorganizations(HMOs)andotherprovidersofprepaidcare
∙Continuingcareretirementcommunities(CCRCs)andassisted-livingfacilities
∙Homehealthagencies
∙Medicalgrouppractices
∙Clinics
∙Otherambulatorycareorganizations
Expendituresforhealthcarerepresentapproximatelyone-seventhofthenationaleconomy,approaching$1trillionannually.Thefederalgovernmentisthemajorpayorforhealthcareservices,principallythroughtheMedicareandMedicaidprograms.StatesalsoparticipateinthefundingandadministrationofMedicaidprogramsand,insomecases,inspecialpaymentsforuncompensatedcare.MostAmericansreceivehealthcarecoveragethroughtheiremployersandvarioustypesofinsuranceprograms-BlueCross,HMOs,andawidevarietyofotherprogramsandprivateinsurers.Insurersofferavarietyofmanagedcareplans-preferredproviderorganizations(PPOs)ornetworks,point-of-service(POS)plans,andHMOs.APPOisamanagementorganizationthatcontractswithanetworkofproviderswhoagreetodeliverhealthcareservicestoenrollees.POSplansarehybridsofHMOsandtraditionalindemnityplans.Theyprovidefinancialincentivestomemberstousenetworkproviders,butallowout-of-networkcarewithahigherco-payment.Managedcareisgrowingsignificantly,withexpansionrecentlyintoMedicareandMedicaidmanagedcareprogramsasthefederalandstategovernmentsattempttocontrolhealthcarespending.
Respondingtofinancialpressures,thehealthcareindustrycontinuestoreexaminethedeliveryofhealthcareservicesinordertofindcost-effectivewaystoprovidehigh-qualityhealthcare.Drivingthereorganizationofhealthcaremarketsareseveralforces:
payors'demandsforcostcontainment,uncompensatedcareforservicestoindigentpopulations,reductionsingovernmentspending,anagingpopulation,newdiseasesrequiringcostlytreatments,andemergingandexpensivenewtechnologies.
Asmanagedcarebecomesmoreprevalent,providersfinditdifficulttoprosperasstand-aloneorganizations.Toparticipateinamanagedcareenvironment,hospitalsandphysicianshavejoinednetworksthatgenerallyrequiredirectcontractingwithpayors,adoptednewreimbursementarrangementssuchascapitation,andincreasedtheirabilitytoofferawidearrayofessentialservices.Providersincreasinglyaresharingintheriskoftreatingpatientpopulationsthroughreceivingpredetermined,per-personmonthlypayments(capitation)thatmaynotnecessarilytakeintoaccountthelevelofservicesdelivered.
Providershaverestructuredtheirorganizationsinternallyandexternallytoadapttothemanagedcareenvironment.Hospitals,physicians,andcarriershavecreatedverticallyintegratednetworksthroughphysicianhospitalorganizations(PHOs),integrateddeliverynetworks,consolidations,jointventures,acquisitions,andmergers.Thesetypesofarrangementsaffordprovidersnumerousadvantagessuchasincreasedbargainingpower,thecapacitytocontractdirectlywithpayors,consolidationofcostlyservices,awidearrayofserviceofferings,acost-effectivewaytomanageadministrativeandinformationfunctions,andaprominentmarketpresencetoattracthealthcarebuyers.Contributingtothetrendtowardhospitalmergersisashifttooutpatientcareduetotechnologicaladvancements,witharesultinggrowthinexcessbedcapacity.Largefor-profithospitalsystemshaveexpandedbypurchasingotherfor-profitaswellasnot-for-profithospitals.PhysiciansalsohavejoinedtogethertoformgrouppracticesandIndependentPhysiciansAssociations(IPAs),oftencontractingwithmanagedcareorganizations.Undersomeformsofmanagedcare,physiciansaresubjecttothemonitoringofplanadministrators(physicianprofiling),practiceinaccordancewithacceptedguidelines(clinicalpathways,practiceguidelines),andreceivecapitatedreimbursementastheirpredominantformofpayment.
(a)HealthCareServices
Servicesprovidedbyhealthcareprovidersaregenerallydescribedbyasix-levelclassification.Thoselevelsindicate,butdonotstrictlydefine,thetypeoforganization,thelevelofmedicaltreatmentinvolved,ortheseverityoforprognosisforthemedicalsituation.Thelevelsare:
∙Preventive.Healtheducationandpreventionprogramsprovidedbybusinessandotherorganizations,suchasschoolsandfamilyplanningclinics
∙Primary.Earlydetectionandroutinetreatmentofhealthproblems,suchasoftenareprovidedbyphysicians'offices,industrialandschoolhealthunits,andhospitaloutpatientandemergencydepartments
∙Secondary.Acute-careservices,typicallyprovidedbymedicalpersonnel,throughhospitals,usingelaboratediagnosticandtreatmentprocedures
∙Tertiary.Highlytechnicalservices,suchasforpsychiatricandchronicdiseases,providedthroughspecialtyfacilitiesandteachinghospitals
∙Restorative.Rehabilitativeandfollow-upcare,typicallyprovidedbyhomehealthagencies,nursinghomes,andhalfwayhouses
∙Continuing.Long-term,chroniccare,typicallyprovidedbyCCRCs,geriatricdaycarecenters,andnursinghomes
Thetypesofprovidersofhealthcareserviceshaveincreasedinrecentyears.Inadditiontohospitals,thereareambulatorysurgerycenters,freestandingspecialtyclinics,physiciangrouppractices,hospices,daycarecentersfortheelderly,specializedhomehealthagencies,rehabilitativecarecenters,nursinghomes,CCRCs,andHMOs,amongothers.
Often,fourormorepartiesmaybeinvolvedinarranginghealthcareservices,including:
∙Thepatient
∙Thephysician
∙Ahealthcareorganizationthatprovidesinstitutionalorotherservices(hospital,nursinghome,ambulatorysurgicalcenter,etc.)
∙Athird-partypayor(suchasgovernmentalagenciesincludingMedicare,whichprovidesmedicalinsurancecoverageformostpatientsovertheageof65,andMedicaid,whichprovidescoverageforindigentpatients,andcommercialinsurancecompaniessuchasBlueCross,HMOs,etc.)
Self-payandcharitypatients,whodonothaveaccesstothird-partycoveragefortheirhealthcareserviceneeds,alsoutilizesuchservices.
(b)HospitalSegment
Hospitalsarethelargestsegmentofthehealthcareindustrymeasuredbybothdollarsofrevenueandthevarietyofprofessionalservicesdelivered.Accordingly,theemphasisinthischapterisonauditinghospitals,althoughmanyoftheprinciplesandpracticesdiscussedareapplicabletoothertypesofhealthcareprovidersaswell.
Patientcareistheessentialandprincipalfunctionofhospitals.Hospitalsoftenplayothervitalrolesfortheadvancementofhealthcare,however,includingmedicaleducationandresearch.Manylargergeneralhospitalshavebecometotalcommunityhealthcenters,providingawiderangeofoutpatientservicesinadditiontotraditionalinpatientcare.Onecharacteristicofthegrowthofthehealthcenterconcepthasbeentheemergenceofsuchdiverserelatedorganizationsasrealestateholdingcompaniesandmedicalmanagementcompanies.Theseorganizationsarearesponsetochangesinthereimbursement,regulatory,tax,operating,andfinancialenvironmentfacinghospitalmanagement.
Hospitalsmaybeclassifiedbytypeofownershipandmodeofoperation,asfollows:
∙Government.Hospitalsoperatedbygovernmentalagenciesandprovidingspecializedservicestospecificgroupsandtheirdependents,suchasthemilitary,veterans,governmentemployees,theindigent,andthementallyill.
∙Investor-owned(proprietary).Hospitalsownedbyindividualproprietorsorgroupsofproprietorsorbythepublicthroughstockownership.Theobjectiveofsuchhospitalsistooperateforprofit.
∙Voluntarynot-for-profit.Hospitalsoperated
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- Chapter 39 Auditing Health Care Organizations
链接地址:https://www.bdocx.com/doc/11923069.html