Healthcare Financial Compliance Paper

The major role of the healthcare financial manager is to ensure compliance. There are guidelines required for patient billing and coding which is the lifeline of the revenue cycle for hospitals that must be adhered. For example, when physicians submit bills that may have questionable charges it is one of their responsibilities to make sure it is accurate and if not that the error is unintentional. Take for instance a physician in Colorado accused by the U.S. Attorney of fraud. “The doctor billed Medicare for treatments that occurred in nursing homes as if it occurred in his office. This problematic considering Medicare reimburses at a higher rate when treatment is performed in the office setting (Hirsch & Kaniadakis, 2015, p. 28). If this type of intentional fraud appeared in the hospital setting the financial manager would be on the front line along with the coders and billers for improprieties.
The financial manager is also responsible for correcting charge master level errors that could potentially lead to unintentional billing errors.
They must be knowledgeable of the big picture as well as the minutia. The financial information available to them will be important. As the healthcare industry evolves so will the roles of the financial manager especially if they want to “perpetually improve and position themselves in a competitive market” ( Kash, Spaulding, Johnson, & Gamm, 2014, p. 65).
Reference
Arbab Kash, B., Spaulding, A., Johnson, C. E., & Gamm, L. (2014). Success Factors for Strategic Change Initiatives: A Qualitative Study of Healthcare Administrators' Perspectives. Journal Of Healthcare Management, 59(1), 65-81 17p.
Danielsen, R. (2012). Afraid or A Fraud. (Cover story). Clinician Reviews, 22(9), 1.
Hirsch, B., & Kaniadakis, S. J. (2015). Intentional Fraud?...OH DPM Pleads Guilty. Mike Gauntner, WFMJ (NBC) [2/9/15]. Podiatry Management, 34(4), 28-28