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Healthcare Financial Operations Manual for Independent Practice Associations 1st Edition

by James W. Karling (Author), Reed Tinsley (Author), Joe D. Havens (Author)

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Only recently, the physician setting up his own practice was considered an anachronism. And doctors loosely affiliated with an independent practice association (IPA) fared no better. Lacking capital, financial management, and the mechanisms for adequate medical and information system management, many IPAs around the country were coping with financial instability. From the outset, IPAs seemed doomed to obsolescence by the organizational efficiencies and superior resources of third-party payors. Yet, in the early 1990s, IPAs underwent a remarkable turnaround?building infrastructure, investing in MIS systems, and accepting risk?transforming themselves into genuine competitors in healthcare quality and efficiency with HMOs. In fact, IPAs have become an increasingly common healthcare delivery model, offering distinct advantages over other payors to physicians interested in the administrative gains and security of a group practice, while still retaining their autonomy. Healthcare Financial Operations Manual for Independent Practice Associations is the first comprehensive guide to setting up an IPA, detailing the many operational, legal, and logistical complexities of managing a physician-owned organization. Since controlling the financial and tax aspects of an IPA is critical to its survival, the Manual addresses an entire range of financial accounting concerns, including accounting concepts and methods for an IPA, internal control procedures, insurance issues, tax issues, policy guidance, and profit-making issues. Specific topics addressed include:

How to manage and report primary, specialty, and inpatient care
How to credential IPA providers
How to negotiate contracts for single specialty and multispecialty IPAs
Antitrust laws and IPAs?with a case study of a Florida IPA
Why IPAs fail

The book also clearly outlines how to acquire and negotiate a managed care contract and, with the help of its disk, provides a host of checklists, forms, and five sample contracts (not included in the book) that allow the user to chart his or her progress and get quickly up to speed on the essential paperwork. The Manual also provides hands-on advice on setting up an efficient computer system for an IPA, reflecting the acknowledged role of a first-rate information system in an IPA?s success. Offering candid, real-world guidance on setting up and successfully administering an IPA, Healthcare Financial Operations Manual for Independent Practice Associations is the complete reference to making an IPA work?for both doctor and patient. JAMES W. KARLING, CPA, is founder and President of Karling & Associates, an eighteen-person CPA firm located in San Ramon, California, which specializes in providing consulting and accounting services to the healthcare and managed care industry. Prior to founding Karling & Associates in 1994, Jim was a partner for eighteen years with Ernst & Young and has also been National Director of Arthur Young & Company?s healthcare practice. He has been a frequent speaker at healthcare programs and seminars and has published a number of articles on healthcare financial issues. REED TINSLEY, CPA, is director of Horne CPA Group?s Physician Services Division. His entire practice is centered in the healthcare industry and he works closely with physicians, medical systems, and other delivery systems with managed care contracting issues. A leading speaker on a variety of healthcare topics, his seminars have been sponsored by the American Medical Association. He is cochair of the CPA section of the IPA Association of America and the author of Performing an Operational and Strategic Assessment of a Medical Practice and Valuation of a Medical Practice, also from Wiley. JOE D. HAVENS, CPA, is shareholder in charge of the Horne CPA Group?s Hattiesburg, Mississippi, office and a member of its board of directors. He heads a team of healthcare consultants to physicians, medical groups, IPAs, hospitals, and managed care organizations as they develop strategies for healthcare reform. Havens also recently completed a five-part video series on healthcare subjects sponsored by Westcott Communications that is being promoted nationally to CPAs, consultants, and healthcare professionals. He coauthored the IPA Association of America?s Financial Accounting Manual for IPAs.

The IPA finally comes of age?in the first comprehensive guide to successfully managing one

In only a few short years, independent practice associations (IPAs) have been able to transform themselves?shedding their image as a healthcare delivery system ranking a distant second to HMOs. Revitalized with a new infrastructure, improved medical management and information systems, and forms of risk assumption, the IPA is suddenly marketable. Expanded geographic coverage, lower overhead, and a wide range of specialties are only part of the reason. Its other advantages?practical and administrative?are detailed in the first comprehensive guide to setting one up and making it work: Healthcare Financial Operations Manual for Independent Practice Associations. Focusing largely on survival issues, the Manual addresses a host of key financial accounting concerns, including accounting concepts and methods for an IPA, internal control procedures, insurance issues, tax issues, policy guidance, and profit-making issues, including such specifics as:

Management tools and reporting for primary, specialty, and inpatient care
Credentialing IPA providers
Risk pool accounting and auditing

Also clearly outlined are tips on how to acquire and negotiate a managed care contract (for both single specialty and multispecialty IPAs) as well as hands-on advice on setting up an efficient, first-rate claims payment system. And the book?s disk provides a complete package of checklists, forms, and five sample contracts (not included in the book) essential to managing an IPA. The book also includes a summary "Physician and IPA Toolkit" appendix, offers cautionary advice on why IPAs fail, and describes the current status of antitrust laws and IPAs. Healthcare Financial Operations Manual for Independent Practice Associations is a complete primer to setting up what is now one of the most efficient and cost-effective healthcare delivery systems available, one that meets the bottom-line needs of both doctor and patient.

Editorial Reviews

From the Back Cover

Only recently, the physician setting up his own practice was considered an anachronism. And doctors loosely affiliated with an independent practice association (IPA) fared no better. Lacking capital, financial management, and the mechanisms for adequate medical and information system management, many IPAs around the country were coping with financial instability. From the outset, IPAs seemed doomed to obsolescence by the organizational efficiencies and superior resources of third-party payors. Yet, in the early 1990s, IPAs underwent a remarkable turnaround-building infrastructure, investing in MIS systems, and accepting risk-transforming themselves into genuine competitors in healthcare quality and efficiency with HMOs. In fact, IPAs have become an increasingly common healthcare delivery model, offering distinct advantages over other payors to physicians interested in the administrative gains and security of a group practice, while still retaining their autonomy. Healthcare Financial Operations Manual for Independent Practice Associations is the first comprehensive guide to setting up an IPA, detailing the many operational, legal, and logistical complexities of managing a physician-owned organization. Since controlling the financial and tax aspects of an IPA is critical to its survival, the Manual addresses an entire range of financial accounting concerns, including accounting concepts and methods for an IPA, internal control procedures, insurance issues, tax issues, policy guidance, and profit-making issues. Specific topics addressed include:How to manage and report primary, specialty, and inpatient careHow to credential IPA providersHow to negotiate contracts for single specialty and multispecialty IPAsAntitrust laws and IPAs-with a case study of a Florida IPAWhy IPAs fail

The book also clearly outlines how to acquire and negotiate a managed care contract and, with the help of its disk, provides a host of checklists, forms, and five sample contracts (not included in the book) that allow the user to chart his or her progress and get quickly up to speed on the essential paperwork. The Manual also provides hands-on advice on setting up an efficient computer system for an IPA, reflecting the acknowledged role of a first-rate information system in an IPA's success. Offering candid, real-world guidance on setting up and successfully administering an IPA, Healthcare Financial Operations Manual for Independent Practice Associations is the complete reference to making an IPA work-for both doctor and patient. JAMES W. KARLING, CPA, is founder and President of Karling & Associates, an eighteen-person CPA firm located in San Ramon, California, which specializes in providing consulting and accounting services to the healthcare and managed care industry. Prior to founding Karling & Associates in 1994, Jim was a partner for eighteen years with Ernst & Young and has also been National Director of Arthur Young & Company's healthcare practice. He has been a frequent speaker at healthcare programs and seminars and has published a number of articles on healthcare financial issues. REED TINSLEY, CPA, is director of Horne CPA Group's Physician Services Division. His entire practice is centered in the healthcare industry and he works closely with physicians, medical systems, and other delivery systems with managed care contracting issues. A leading speaker on a variety of healthcare topics, his seminars have been sponsored by the American Medical Association. He is cochair of the CPA section of the IPA Association of America and the author of Performing an Operational and Strategic Assessment of a Medical Practice and Valuation of a Medical Practice, also from Wiley. JOE D. HAVENS, CPA, is shareholder in charge of the Horne CPA Group's Hattiesburg, Mississippi, office and a member of its board of directors. He heads a team of healthcare consultants to physicians, medical groups, IPAs, hospitals, and managed care organizations as they develop strategies for healthcare reform. Havens also recently completed a five-part video series on healthcare subjects sponsored by Westcott Communications that is being promoted nationally to CPAs, consultants, and healthcare professionals. He coauthored the IPA Association of America's Financial Accounting Manual for IPAs.

The IPA finally comes of age-in the first comprehensive guide to successfully managing one

In only a few short years, independent practice associations (IPAs) have been able to transform themselves-shedding their image as a healthcare delivery system ranking a distant second to HMOs. Revitalized with a new infrastructure, improved medical management and information systems, and forms of risk assumption, the IPA is suddenly marketable. Expanded geographic coverage, lower overhead, and a wide range of specialties are only part of the reason. Its other advantages-practical and administrative-are detailed in the first comprehensive guide to setting one up and making it work: Healthcare Financial Operations Manual for Independent Practice Associations. Focusing largely on survival issues, the Manual addresses a host of key financial accounting concerns, including accounting concepts and methods for an IPA, internal control procedures, insurance issues, tax issues, policy guidance, and profit-making issues, including such specifics as:Management tools and reporting for primary, specialty, and inpatient careCredentialing IPA providersRisk pool accounting and auditing

Also clearly outlined are tips on how to acquire and negotiate a managed care contract (for both single specialty and multispecialty IPAs) as well as hands-on advice on setting up an efficient, first-rate claims payment system. And the book's disk provides a complete package of checklists, forms, and five sample contracts (not included in the book) essential to managing an IPA. The book also includes a summary "Physician and IPA Toolkit" appendix, offers cautionary advice on why IPAs fail, and describes the current status of antitrust laws and IPAs. Healthcare Financial Operations Manual for Independent Practice Associations is a complete primer to setting up what is now one of the most efficient and cost-effective healthcare delivery systems available, one that meets the bottom-line needs of both doctor and patient.