Healthcare Accounting in Miami

Gustavo A Viera CPA are expert Healthcare Accounting in Miami providing a wide variety of HealthCare Accounting financial Management Services

Healthcare Accounting in Miami Services for doctors, dentists, healthcare professionals and healthcare related businesses. Our services are designed to simplify the process for you by providing comprehensive accounting, tax and financial management services. Gustavo A Viera CPA has over 25 years of being Healthcare Accounting in Miami focusing on healthcare professionals and their businesses.

Our Healthcare Accounting in Miami have always been involved with Healthcare Accounting in Miami in some capacity. Our first job was in the Chartroom for a local hospital.  As Healthcare Accountants in Miami  we feel that we could provide value by speaking to physicians in their own language and having significant knowledge of Health Care Accounting. Over the past 25 years our Healthcare Accounting in Miami commitment to healthcare has grown stronger as the economic changes have forced the healthcare industry to look past their primary objective, that of providing care, to that of earning a living.

Our Healthcare Accounting in Miami expertise will aid the preparation of a tax return and especially AHCA Cost Report. Tax & Medicare laws are very complicated and filled with exceptions to every rule. Most clients do not know if the return is wrong or right, and it may not matter since defending an audit, even if you are 100% correct, can cost you thousands of dollars. In many cases, different Healthcare Accountants in Miami will see things differently and arrive at different conclusions based on the facts of your return. The most important thing is that YOU understand what is on your return. The IRS & AHCA have increased the fines and penalties for return errors and it is becoming increasingly more complicated to prepare a return or AHCA Cost Report.

We’ve had clients, who prepare their own AHCA Cost Report., come to him after the AHCA has suspended billing during a review.

Our Healthcare Accounting in Miami services are performed by healthcare accountants. With Gustavo A Viera CPA you can be assured that your Healthcare Accounting in Miami team has significant, relevant experience with healthcare providers like you. Your Healthcare Accounting in Miami team will consist of individuals who spend virtually all of their professional time serving the healthcare industry – not manufacturing, retail or other industries.

Viera provides audit and Healthcare Accounting in Miami services to healthcare entities ranging in size from small physician practices and ancillary providers to multi-state integrated healthcare organizations with assets in excess of $1 billion. This experience across the spectrum of healthcare allows our Healthcare Accountants to quickly identify the financial reporting areas of greatest risk to your organization and to more efficiently and effectively perform audit or accounting services. Further, our Healthcare Accounting teams are structured to allow our senior executives more time with our clients in order to provide the “hands on” experience and oversight.

The following is a partial listing of the types of Healthcare Accounting in Miami services Gustavo A Viera CPA offers our clients:

  • Audits, reviews, and compilations of financial statements
  • Audits in accordance with Government Auditing Standards and OMB Circular A-133
  • Internal control reviews and risk assessments
  • Impairment testing of intangible assets
  • Agreed-upon procedure reports and special reporting
  • Transaction accounting assistance, including allocation of purchase price
  • New accounting standard implementation
  • Forensic accounting and dispute resolution
  • Outsourcing of internal audit functions
  • Accounting policy and procedure manual development

As Healthcare Accounting in Miami focused on serving the healthcare industry (over 75% of our revenues are healthcare related), we have available the resources to supplement the extensive knowledge of our Health Care Accountants through the use of our dedicated reimbursement, clinical and healthcare tax departments. Our relationships with lending institutions, bond underwriters and rating agencies are such that Viera is a nationally recognized Healthcare Accountant  in connection with debt issues.

Our Healthcare Accounting services in Miami consults practices and healthcare related businesses at every stage of the business cycle across the spectrum of medical specialties and allied fields. We work with you to increase revenues, reduce costs and enhance client/patient satisfaction.


Home Healthcare Accounting

Home Healthcare Accounting

Home Healthcare Accounting for home healthcare, hospice, assisted living facilities and outpatient services are among the fastest growing and most competitive segments in the healthcare industry. At VieraCPA a Miami CPA Firm specializing in Home HealthCare Accounting we understand the complexities involved in running this type of healthcare practice, where regulation changes are the norm. Today, more than ever, your organization needs sound financial, Home Healthcare Accounting and tax advice to help your practice be successful and competitive. Our CPA Home HealthCare Accounting can offer unparalleled financial expertise whether you are a home healthcare practice, hospice provider, mental health practitioner or an assisted living facility.

We provide a complete range of Home HealthCare Accounting, tax, practice management and advisory services designed specifically for this type of healthcare practice.

Home HealthCare Accounting Services include the following:

Home Healthcare Accounting and Tax Services:

  • Financial statement preparation
  • Outsourced controller/CFO
  • Outsourced accounting and bookkeeping
  • Tax planning and preparation – business and individual
  • Payroll and payroll tax reporting
  • Accounting software support – QuickBooks
  • Annual cost reporting for Medicare and Medicaid providers
  • Houston incorporation
  • Entity selection – (Sole proprietor, LLC, S Corp, C Corp)
  • IRS Representation
  • Cash flow and budgeting analysis
  • Financial planning and analysis
  • Retirement planning

 Home Health Agencies Accounting Practice Management Services:

  •  Choosing the right type of entity – (Sole proprietor, LLC, S Corp, C Corp)
  • Strategic planning
  • Practice start-up consultation
  • Practice valuation
  • Contract review and negotiation
  • Capital acquisitions
  • Compliance/HIPAA programs
  • Nursing/therapy department cost efficiency analysis
  • MDS/Clinical analysis
  • Billing, insurance and accounts receivable management
  • Software system design
  • Reimbursement consulting
  • Operational review
  • Financing assistance
  • Business plans
  • Equipment acquisition planning
 Home Health Agency Accounting Practice Transition Services:
  •  Mergers and acquisitions
  • Buy/sell agreements
  • Lease vs. buy analysis
  • Real estate sale or purchase
  • Financing
  • Litigation support
  • Succession planning
  • Practice transitions – sale, merger, acquisition, partnership
 Home Health Agencies Accounting Wealth Management Services:
  •  Retirement planning
  • Succession planning
  • Estate planning
  • Asset protection
  • Insurance needs
  • Benefit plan selection and structuring

Home Health Agency Accounting experts. Call us 786-250-4450 for a free initial consultation.


Healthcare Accounting FASB Updates

Miami Healthcare Accounting Publishes FASB Updates

Current healthcare accounting practices and health care entities recognize patient service revenue at the time the services are rendered regardless of whether the entity expects to collect that amount. Stakeholders raised concerns that such health care accounting practices result in a gross-up of patient service revenue and the related provision for bad debts, according to Healthcare Accountants VieraCPA. Additionally, because health care entities make their own judgments regarding adjustments to revenue and bad debts, those judgments are different from one health care entity to another and comparability is impaired, making analysis difficult for healthcare accounting and financial statement users.

The objective of this Update is to provide financial statement users with greater transparency about a health care accounting entity’s net patient service revenue and the related allowance for doubtful accounts. This Update provides information to assist healthcare accountants and financial statement users in assessing an entity’s sources of net patient service revenue and related changes in its allowance for doubtful accounts. The amendments in healthcare accounting require health care entities that recognize significant amounts of patient service revenue at the time the services are rendered even though they do not assess the patient’s ability to pay to present the provision for bad debts related to patient service revenue as a deduction from patient service revenue (net of contractual allowances and discounts) on their statement of operations.

Healthcare Accounting Who Is Affected by the Amendments in This Update?

The amendments in this Update affect entities within the scope of Topic 954, Health Care Accounting, that recognize significant amounts of patient service revenue at the time services are rendered even though the entities do not assess a patient’s ability to pay. All other entities would continue to present the provision for bad debts (including bad debts associated with patient service revenue) as an operating expense.

What Are the Main Provisions?

The amendments in this Update require healthcare accountants to change the presentation of their statement of operations by reclassifying the provision for bad debts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts). Additionally, healthcare accounting entities are required to provide enhanced disclosure about their policies for recognizing revenue and assessing bad debts. The amendments also require disclosures of patient service revenue (net of contractual allowances and discounts) as well as qualitative and quantitative information about changes in the allowance for doubtful accounts.

How Do the Main Provisions of Healthcare Accounting Differ from Current U.S. Generally Accepted Accounting Principles (GAAP) and Why Are They an Improvement?

The Health Care Accounting amendments in this Update change the presentation of the statement of operations and add new disclosures that are not required under current GAAP for entities within the scope of this Update. The provision for bad debts associated with patient service revenue for certain entities is required to be presented on a separate line as a deduction from patient service revenue (net of contractual allowances and discounts) in the statement of operations. This change in the presentation of the statement of operations will be an improvement from current GAAP because it will result in the presentation of an amount of net patient service revenue (after any provision for bad debts) that is closer to the amount that the health care entity expects to collect, according to Healthcare Accountants VieraCPA. The new disclosures will assist users of financial statements to better understand how health care entities recognize patient service revenue and assess bad debts.

When Will the Amendments Be Effective?

For public entities, the healthcare accounting amendments in this Update are effective for fiscal years and interim periods within those fiscal years beginning after December 15, 2011, with early adoption permitted. For nonpublic entities, the health care accounting amendments are effective for the first annual period ending after December 15, 2012, and interim and annual periods thereafter, with early adoption permitted. Healthcare accountants adopting the amendments to the presentation of the provision for bad debts related to patient service revenue in the statement of operations should be applied retrospectively to all prior periods presented. The disclosures required by the amendments in this Update should be provided for the period of adoption and subsequent reporting periods.

How Do the Healthcare Accounting Provisions Compare with International Financial Reporting Standards (IFRS)?

IFRS does not currently require similar presentation or disclosures as set forth in the amendments in this Update. However, the Boards recently completed redeliberations on an Exposure Draft, Revenue Recognition (Topic 605): Revenue from Contracts with Customers. In redeliberations of that Exposure Draft, the Boards tentatively decided to present impairment losses (that is, bad debts) from contracts with customers as a separate line item adjacent to the revenue line item (as contra revenue), consistent with the provisions of this Update. In addition, the Boards tentatively decided that disaggregated revenue information should be disclosed. The Boards plan to reexpose the tentative decisions reached in redeliberations of that Exposure Draft in the second half of 2011.


Business Trends

Sample Healthcare Business Plan

Healthcare Business Plan

For application of licensure with AHCA and certification with Medicar

As Miami Healthcare Accountants specializing in Healthcare Accounting, we prepare custom Healthcare Business Plan for startup Home Healthcare Agencies or Change of Ownership. VieraCPA have been Healthcare Accountants for more than 20 years. We provide a wide range of Healthcare Accounting services to HHA throughout Florida.

AHCA now requires a Healthcare Business Plan along with the Proof of Financial Ability to Operate for new HHA’s or change of ownership to be prepared by a CPA. The Healthcare Business Plan requires very specific knowledge of healthcare accounting which our Healthcare Accountants are diligent in keeping up with every new law.

We have prepared a partial sample Healthcare Business Plan to help Home Healthcare Agency owners understand the requirements and in depth analysis required by AHCA. The Healthcare Business Plan should start with the Executive Summary.


XYZ Corp. is a Home Healthcare Agency, organized on June 1, 2011 as a private for profit corporation looking to be licensed by AHCA in Florida and certified by Medicare and Joint Commission accredited.

XYZ Corp. is planning on operating a Home Health Agency in the Miami-Dade Area and licensed by AHCA in Florida and certified by Medicare and Joint Commission accredited.

The initial capital contribution, as calculated on Form 3100-0009 AHCA Proof of Financial Ability to Operate, is $000,000 to be deposited in full prior to submission of licensed by AHCA in Florida and certified by Medicare and Joint Commission accredited, prepared and signed by a Healthcare Accountants CPA. (read more….)

The Healthcare Business Plan should continue with the objectives and mission statement section which looks something like this:


The objectives of the company are:

1)      Recruit and train a specialized technical force to provide Skilled Nursing, Therapies and Home Health Aide services beyond the expected standard.

2) Develop among the company personnel a culture of efficiency, work quality and personal responsibility on service rendered.


XYZ Corp. is dedicated to providing quality home health care and other health services to patients in Florida, offering a high level of professionalism, efficiency and compassion; complementing services provided by hospital, doctor’s clinics and other health institutions that require home care.

Next we have to get into the nuts and bolts of Healthcare Accounting and projected revenue streams:


The company plan to offer the following services:

a) Skilled Nursing at RN and LPN level

b) Home Health Aide and CNA

c) Physical Therapy

d) Occupational Therapy

e) Social Worker Services

f) Speech Therapy

The Market Analysis is the most complex and where we as Healthcare Accountants with over 20 years of Healthcare Accounting experience really add value. The Healthcare Business Plan market analysis data is statistical in nature. Here is a sample:


The State of Florida has, an estimated population of 18,801,310 in 2010: from this total about 17.2 % are 65 or older (U.S. Census Bureau, Quick Facts).

However, projections show that that percentage will grow even more 13.82% by 2015 and 2030 (taken from Data on County Aging Services Needs Assessment, University of South Florida, October 3, 2007), even the Florida state general population rate of increase in the last 8 years was over 14.7% and the above mentioned projection foresees a growth of over 15% from 2000 to 2010. It is our conclusion that the market for serving the needs of older population (those over 65) will have an increase in demand in these Counties in the next 5—10 years.

The Healthcare Business Plan continues with Level of Competition, Market Strategy, Timeline, Personnel, Recruiting & Retention Strategy, Admission Policies and more.

If you’re thinking about starting or buying an HHA, give us a call for a free initial consultation.

Good Luck!

Gustavo A Viera CPA



Healthcare Accounting: Managing Cash Flow

Healthcare Accounting: Managing Cash Flow

Healthcare accounting is complex and cash flow management is a process of best practice which involves; forecasting cash needs, providing idle funds, calculating disbursements, covering shortfalls, collecting payments, and reimbursing banks for all these actions by your Healthcare Accountants.

Cash flow management involves tax and healthcare accounting evaluation. Therefore, every business requires best practice involving staff handling tax and healthcare accounting by their healthcare accountants. Additionally, there is need for coordination between the staff in the treasury, healthcare accounting and operations department. These best practices along with powerful electronic tools assist in collection of data on financial information and formatting. This is necessary for generation of reports to help healthcare accountants and managers in making decisions.

In order to facilitate best practices in managing cash flow there are some important steps which can be taken. These include:

Selecting a Healthcare Accounting Firm:

When companies shop for the right Healthcare Accountants for support with cash management they tend to look for quality of services rather than low cost. Healthcare Accountants therefore offer their business clients with Electronic Data Interchange (EDI) and automated processes. Automated processes may be payrolls and account payables and others. This ensures security against theft as well as affordable healthcare accounting outsourcing option for organizations. This is one of the reasons why Healthcare Accountants consolidate their accounts with few firms and are not dependent on a single healthcare accounting as a best practice.

Models for Accurate Cash Forecast:

There is a lot of uncertainty about cash flow. This is why Healthcare Accountants use forecast models as best practice to assist them with disbursements. Forecasts are made based upon the daily, monthly, seasonal, and cyclic patterns and trends. There are three forms of forecasts to help companies in assessing how well it fares;

  •  Short term: covering 1 day to 2 weeks
  •  Medium term: a few weeks, 1 year or may be 2 years
  •  Long term: covering 1 year, 2 years or more

The best healthcare accounting practice most Healthcare Accountants ensure is to use the “rolling format” which continuously updates incoming receipts and assists in disbursements. Additionally, this increases accuracy of forecasts and assists the company in “cash critical periods.”

Maximized Investments:

It is a best healthcare accounting practice for Healthcare Accountants to have clear, transparent investment policies indicating their objectives, guidelines and acceptable investments. These assist managers in making decisions according to opportunities. The aim is to increase yield of investments at low costs. Additionally, companies use Sweep accounts.

These are effective because they allow companies to “sweep” or move the idle cash into overnight investments at the end of the day. Sweep accounts allow companies to use zero balance accounts to write checks and drafts without penalty charges. The amount of money is drawn from central accounts to make payments for the company.

Regular Cash Management System Review:

Identifying weak areas in a company’s healthcare accounting is a best practice which helps in improving the cash management system. This provides the assurance that the company’s financial data is reliable and accurate without the need for an audit. Therefore, this best practice ensures that collection and payment processes are reviewed regularly for evaluation of cash flow and its management.

Cash flow Management is one of the most effective and recommended best practices. It is necessary because it ensures accurate audit reports and annual financial statements of businesses and other financial institutions.


Healthcare Accounting Services & Nonprofit Healthcare Organizations

Healthcare Accounting Services & Nonprofit Healthcare Organizations

Miami Accounting Service  Gustavo A Viera CPA specializing in Healthcare Accounting Services describes the federal income tax treatment of healthcare organizations that are exempt from tax under §501(a) of the Internal Revenue Code.

Healthcare Accounting Services VieraCPA notes that since many nonprofit healthcare organizations qualify for exemption under §501(c)(3) and how a healthcare organization may qualify as a charity, emphasizing the evolution of the current requirement that the organization be organized and operated for the promotion of health. Miami Accounting Service VieraCPA specializing in Healthcare Accounting Services describes the types of healthcare organizations that may qualify under §501(c)(3) and tells how they may achieve public charity status, either as a per se public organization, a publicly supported organization, or a supporting organization.

Healthcare Accounting Services VieraCPA site presents an overview of the federal income tax laws applicable to nonprofit healthcare organizations, such as hospitals, managed care organizations, and integrated delivery systems. In recent years the healthcare industry has experienced unprecedented change  and growth. Miami Accounting Service VieraCPA specializing in Healthcare Accounting Services notes that hospitals have added ancillary operations to their systems and joint venture arrangements between hospitals and physicians are common. The IRS has ruled on a number of whole-hospital joint ventures and they have been reviewed by the courts as well. More guidance from the IRS for joint venture arrangements, and in particular ancillary joint ventures, is expected to continue as joint ventures become more prevalent.

Healthcare Accounting Services VieraCPA states the importance of these contemporary joint ventures and analyzes the related federal income tax issues. Financing these ventures and the income derived from these operations all must be analyzed for federal income tax purposes. Many of these arrangements and transactions have created a new set of issues for healthcare administrators, Miami Accounting Service specializing in Healthcare Accounting Services and the IRS to resolve, and in some cases present issues of first impression; not only with respect to whether the particular arrangement or transaction may produce unrelated business taxable income, but more importantly, whether the activity may adversely affect the organization’s ongoing tax-exempt status.

In a nutshell, Healthcare Accounting Services VieraCPA notes the requirements for tax-exempt recognition, and what is required to maintain it; physician-hospital relationships; managed healthcare organizations; tax-exempt financing; unrelated business income tax issues; taxable subsidiaries; employment tax issues; IRS audits of hospitals; fundraising activities; and reporting rules.

Miami Accounting Service VieraCPA specializing in Healthcare Accounting Services addresses the IRS has been stressing for some time the importance of a conflicts of interest policy. In the wake of the Enron scandal, and influenced by the Sarbanes-Oxley Act, the governing bodies of healthcare organizations, both for-profit and non-profit, have had to re-examine their corporate responsibilities. Many of these principles are discussed in this Portfolio generally.

Healthcare Accounting Services VieraCPA also details the federal anti-kickback and anti-referral statutes, with which healthcare organizations must comply to maintain their tax-exempt status. It discusses this important body of nontax law which has significant tax implications for all healthcare organizations participating in the Medicare and Medicaid programs.

Finally, Miami Accounting Service VieraCPA specializing in Healthcare Accounting Services notes a number of other issues that have become significant in the healthcare field in recent years. These include transactions with hospital staff physicians; deferred compensation and profit-sharing arrangements with physicians and staff; healthcare partnerships and joint ventures; the status of managed care organizations, including health maintenance organizations; integrated delivery systems and the purchase of physician practices; the unrelated business income tax; the creation and use of for-profit subsidiaries; tax-exempt financing; employment tax issues; IRS healthcare audits; tax and reporting requirements related to fund-raising; and general compliance, filing, and disclosure issues.  Medicare and Medicaid fraud and abuse are addressed. Although not involving federal income tax issues, compliance with the anti-fraud statutes and anti-referral statutes is integrally related to continuing tax-exempt status. Moreover, there are many instances where the IRS rules are at odds with federal fraud and abuse laws. For example, many of incentives permitted by the IRS in the case of physician recruitment would implicate either the federal Anti-Kickback Statute or the anti-referral law, commonly referred to as the “Stark Laws.” Gainsharing arrangements are another example where the IRS provided a favorable ruling only to be found by the Office of Inspector General of the Department of Human Services to violate the federal fraud and abuse laws. This friction is discussed as well as other instances involving transactions with tax-exempt healthcare organizations that may be affected by both federal income tax consequences and the federal fraud and abuse laws.

The Worksheets contain selected IRS publications and determination letters related to current tax issues in the healthcare area. They also include the relevant Medicare and Medicaid statutes.

Healthcare Accounting Services VieraCPA allows you to benefit from:

Hundreds of hours of original research on specific tax planning topics from leading practitioners in this area

  • Invaluable practice documents including tables, charts and lists
  • Plain-English guidance from world-class experts
  • Real-world and in-depth analysis that lets you explore various options
  • Time-saving access to relevant sections of tax laws, regulations, court cases, IRS documents and more
  • Alternative approaches to both common and unique tax scenarios



Healthcare Accounting & Medicare Cost Report

Healthcare Accounting & Medicare Cost Report

Within the last 25 years our Healthcare Accounting Service in Miami have prepared hundreds of Medicare Cost Report and our commitment to Healthcare Accounting Service has grown stronger as the financial changes have forced the healthcare industry to look past their primary objective, that of providing care, to that of earning a living.

Our Healthcare Accounting Service abilities will aid the preparation of a tax return and especially Medicare Cost Report. Tax & Medicare laws are complicated and filled using exceptions to every regulation. Most clients do not know if the return is wrong and right, and it may well not matter since defending an audit, even if you are 100% correct, can cost you thousands of dollars. In many cases, different Healthcare Accounting Service will discover things differently and get different conclusions good facts of your go back. The most important thing is that you understand what is on the return. The IRS & MEDICARE get increased the fines and penalties for return errors plus its becoming increasingly more complicated to arrange a return or Medicare Cost Report.

We’ve had clients who prepare their own Medicare Cost Report, come to him after the Medicare has suspended billing during a review.

Healthcare Accounting Service

Our Healthcare Accounting Service are precisely that – healthcare accountants. With Gustavo A Viera CPA you will be assured that your Medicare Cost Report company has significant, relevant experience with healthcare providers like you. Your Healthcare Accounting Service team will involve individuals who spend virtually all of their professional time serving that healthcare industry – not necessarily manufacturing, retail or some other industries.

Viera provides audit and Healthcare Accounting to healthcare entities ranging in dimensions from small physician practices and ancillary providers to help multi-state integrated healthcare organizations with assets for longer than $1 billion. This experience across the spectrum of healthcare enables Healthcare Accounting Service to quickly identify the financial reporting areas of greatest risk to your small business and to more efficiently and effectively perform audit or accounting services. Further, our Healthcare Accounting Service teams are structured providing our senior executives more hours with our clients so as to provide the hands on encounter and oversight.

The following can be a partial listing of the categories of audit and Healthcare Accounting solutions Gustavo A Viera CPA offers our clients:

· Audits, feedback, and compilations of fiscal statements

· Audits in acquiescence with Government Auditing Principles and OMB Circular A-133

· Internal control reviews and risk assessments

· Impairment testing of intangible possessions

· Agreed-upon procedure reports together with special reporting

· Transaction accounting assistance, including allocation of final cost

· New accounting standard setup

· Outsourcing of inside audit functions

· Accounting insurance coverage and procedure manual advancement

As Healthcare Accounting Service dedicated to serving the healthcare market (over 75% of our revenues are healthcare related), we have available that resources to supplement the extensive knowledge of our Healthcare Accounting Service through the use of our dedicated reimbursement, scientific and healthcare tax sections. Our relationships with loaning institutions, bond underwriters and rating agencies are in a way that Viera is a nationally recognized Healthcare Accounting Service in connection with debt issues.

Our Medicare Cost Report consults practices and healthcare related small businesses at every stage with the business cycle across that spectrum of medical areas and allied fields. We help you to increase income, reduce costs and increase client/patient satisfaction.

Business Trends

Miami Health Care Accountants Optimistic about Business Growth

Health Care Accountants Optimistic about Business Growth

Miami Health Care Accountants are more optimistic about business growth predictions for 2012 in their respective states than the nation as a whole, according to a new survey of Health Care Accountants in Florida, Texas and California.

Those polled were most confident about the Health Care Accountants industry, and their own Health Care Accountants. Information technology tops the list of capital investments planned in the coming year. Survey respondents also anticipate some new hiring in the next 12 months. Health care costs continue to be a top concern of businesses along with government regulation and uncertainty in the tax laws.

Healthcare Accounting Service

The poll was conducted for Health Care Accountants industry and Institute of CPAs.

It polled nearly 13,000 Health Care Accountants in who are partners or sole owners of public Health Care Accountants or serve as CEOs, CFOs or presidents of companies in various industries. More than 2,100 Health Care Accountants completed the survey.

“The poll showed that Health Care Accountants in the three states feel confident about the prospects for growth in the Health Care Accountants industries they work in and serve, but still have concerns about factors beyond their control”,  said Health Care Accountants VieraCPA in a statement. This includes increasing health care costs and government regulation, and the lack of available credit to grow theirs or their clients’ businesses.”

Only 6 percent of the Health Care Accountants who responded predict robust growth in the United States, but the numbers climb as they evaluated the growth outlook for their own state (9 percent), Health Care Accounting Service industry (20 percent), and organization (26 percent).

The Health Care Accountants surveyed did not report significant decreases in workforce or revenues since the financial crises took hold, and say they expect both areas to increase marginally in the next year. These Health Care Accountants business leaders expect marginal (53 percent) or substantial (7 percent) revenue growth in the next year, with marginal (32 percent) and substantial (2 percent) growth in employment. Less than 10 percent of respondents predict a reduction in employment.

Information technology topped the list of investment and spending priorities over the next year. Sixty percent of the surveyed Health Care Accountants said their organizations plan to invest marginally or significantly more in this area followed by 40 percent planning capital spending increases. Product development and marketing/advertising will remain relatively flat with more than 50 percent citing no change in either category.

Health Care Accountants and their clients listed the ability to obtain funding as a significant area of concern. Approximately 76 percent do not think small businesses have access to adequate credit to grow or sustain their operations. The financial crisis and forecasts for slow growth greatly reduce their or their clients’ ability to obtain loans, according to 70 percent of the Health Care Accountants polled. Health Care Accountants also cite health care costs as a concern, with 98 percent of those surveyed responding affirmatively when asked if the cost of health care benefits was a worry for businesses in their states.

Some are looking into this area for savings, with 94 percent agreeing that companies are reevaluating employee/benefit costs, while 63 percent are aware of companies dropping or reducing employee health insurance coverage. Labor costs, workers’ compensation, and public pension funding were also seen as problems, with public pension exposure taking the highest percentage among the three.




Proof of Financial Ability to Operate

Healthcare Accounting Specialist Explains Proof of Financial Ability to Operate

As you may know, part of the process to complete the Health Care Licensing Application, the Florida Agency for Health Care Administration (AHCA) and the Florida Statutes requires that each applicant to establish AHCA Proof of Financial Ability to Operate and to show per Healthcare accounting requirements the anticipated provider revenue and expenditures, the basis for financing anticipated cash-flow requirements of the provider, and an applicant’s access to contingency financing. To establish AHCA proof of financial ability to operate, information is provided in detailed forms and schedules which include the monthly projected summary of revenue and expenses, the monthly projected cash flow statements for 24 months and the two annual balance sheets and detailed footnotes that include summaries of significant assumptions, accounting policies and other informative disclosures as required by Generally Accepted Accounting Principles (GAAP). Typical Excel based spreadsheets may be cumbersome to design for this purpose.  Because of the special requirements to produce monthly income statements and cash flows for 24 months, customized projection software is needed to meet the reporting requirements. Subsequent to approval, certain Medicare providers will have to file an annual Medicare Cost Reports.

To show AHCA proof of financial ability to operate per Healthcare accounting requirements the forms and schedules must accompany any initial or change of ownership (CHOW) application for the following types of health care providers.

•  Adult Day Care Centers

•  Assisted Living Facilities

•  Health Care Clinics

•  Home Health Agencies

•  Home Medical Equipment

•  Hospice

•  Intermediate Care Facilities for the Developmentally Disabled

•  Prescribed Pediatric Extended Care Center

•  Skilled Nursing Facilities

All schedules must be prepared in accordance with generally accepted accounting principles (GAAP). A Certified Public Accountant (CPA) must compile, examine, or apply agreed-upon procedures to prospective financial statements, including summaries of significant assumptions and Healthcare accounting policies. Such a requirement is usually not required for the annual Medicare Cost Reports

To establish AHCA proof of financial ability to operate each applicant can select the type of financial statement to be given to the Provider.  As mentioned above, the three choices are :

1.  Compiled

2.  Agreed-upon procedures

3.  Examined

To establish AHCA proof of financial ability to operate and to learn more about your financial statement options and Healthcare accounting requirements:

Before you select the level of service from the CPA , the following will serve as a brief analysis of each option.

1.  Compile – A compilation engagement is the lowest level of service that an accountant can perform on prospective financial presentations that is intended for third parties. Despite it being the lowest level of service, it is a very common deliverable provided by a CPA and often a cost effective solution for many companies, when required or accepted by third parties and acceptable healthcare accounting practices utilized. Compilation procedures includes assembling, to the extent necessary, the prospective financial information based on the responsible party’s assumptions. Performing the required compilation procedures, including reading the prospective financial statements with their summaries of significant assumptions and healthcare accounting policies, and considering whether the prospective financial statements appear to be (1) presented in conformity with American Institute of Certified Public Accountants(AICPA) guidelines and (2) not obviously inappropriate. The compilation procedures are not performed for the purpose of providing any assurance on the presentation or on the underlying assumptions. The accountant may prepare the financial statements or then reads them when they are prepared by the Company’s management  to make sure that they appear appropriate in form and content. Because the accountant does not perform any other procedures, the accountant does not obtain any assurance that the financial statements are free of material misstatement. A compilation report is issued by the CPA.

2.  Agreed-upon procedures – With an agreed-upon procedures engagement the accountant is engaged by a client to perform specific procedures and report findings. The accountant does not perform an examination or provide an opinion. Rather, the accountant reports only procedures and findings. In this type of an engagement, the accountant performs whatever procedures the users of the prospective statements specify. It is a flexible form of engagement; the procedures may be as extensive or cursory as the specified parties want, but should include more than a mere reading of the prospective financial statements. The service may be lower than a compilation, between a compilation and an examination, or as high as an examination.

3.  Examined – An examination engagement is a professional service that involves extensive corroborative procedures, resulting in the CPA’s expression of positive assurance about the presentation and the underlying assumptions. It is similar to an audit of historical financial statements and is the highest level of service that CPA’s can provide on prospective financial statements. The examination involves (a) evaluating the preparation of the prospective financial statements,(b) evaluating the support underlying the assumptions,(c) evaluating the presentation of the prospective financial statements for conformity with AICPA presentation guidelines, and (d) issuing an examination report.

Some additional insight factors to consider when choosing the levels of service

In an examination engagement an opinion is given by the CPA and it states that (i) the prospective financial statements are presented in conformity with AICPA guidelines and (ii) the assumptions provide a reasonable basis for the responsible party’s projection, the assumptions provide a reasonable basis for the responsible party’s projection given the hypothetical assumptions. Because an examination is an extensive service, it is more expensive to provide than the other two alternatives. Examinations are typically performed when the prospective presentation is associated with a decision involving a large amount of money or when a regulatory agency (such as a securities commission or health care authority) requires it.

Notwithstanding the statutory requirement for either a compilation, or agreed-upon procedures or examination to establish the AHCA proof of financial ability to operate, you may want to consult with your counsel and the healthcare accounting authority before hiring the accountant to prepare the Florida AHCA Proof of Financial Ability application.

We can help you with …..

•Due diligence on acquisitions of Home Health Agencies  that are  primarily Medicare based.

•To provide the AHCA proof of financial ability to operate, we can assist  you with the Florida AHCA Proof of Financial Ability application including assistance with compiled prospective(projected) financial statements that are required to be completed by a Certified Public Accountant for Home Health Agencies that are primarily Medicare based. We have developed specialized projection software that was customized to meet the AHCA requirement(s) for a Medicare based Home Health Agency that shows the monthly projected summary of revenue and expenses and the monthly projected cash flow statements for 24 months and the two annual balance sheets.

•Setting up accounting systems with QuickBooks and related training after obtaining your license from the State of Florida.

We have prepared dozens of projections  over the years in various industries and recently successfully assisted a Medicare based Home Health Agency and HME   in completing and filing a AHCA proof of financial ability to operate (CHOW) and to attain a license from The Florida Agency for Healthcare Administration (AHCA) by completion of the  Proof of Financial Ability To Operate application, which included preparation of the projections, forms and schedules referred to above and communication with the AHCA reviewer.

Business Trends

Healthcare Accounting Strategies for Process-Based Cost Reduction

Healthcare Accounting Strategies for Process-Based Cost Reduction

Facing mounting Healthcare Accounting financial pressures and a payment system increasingly focused on quality of care over volume, Home Healthcare Accounting HHA’s are realizing that traditional Healthcare Business Plan cost-containment efforts directed at line-item cuts in labor and supply purchase prices are neither sufficient nor effective long term Health Care Business Plan . To create sustainable levels of improvement, Home Healthcare Agencies Healthcare Accounting need to approach Healthcare Accounting cost reduction from a more strategic viewpoint and change processes of care so they can better utilize resources and capture efficiencies. Following such an approach isn’t easy. All too often, process based cost-management  Healthcare Business Plan initiatives fall victim to inadequate goals, poor understanding of progress, and insufficient physician and executive support. With this in mind, the following report focuses on ways Home Healthcare Agencies Health Care Business Plan are structuring their decision making to avoid these common pitfalls and various strategies for uniting clinical and financial leadership to create and support cost-effective process change.

Healthcare Accounting Need for Process-Focused Cost Management

Formal examination of Healthcare Accounting cost management processes is becoming increasingly important to Home Healthcare Agencies and Health Care Accounting Healthcare Business Plan for a number of reasons. Optimizing financial performance is key as the industry struggles with the effects of a continued weak economy, including a rise in the number of self-pay; stagnant or declining revenue from outpatient services as consumers with high-deductible health plans put off elective care; and reduced Medicaid payments as state governments wrestle with massive budget deficits.1 At the same time, demands on capital remain high as organizations seek achieve electronic health record meaningful use and deal with the ongoing need to invest in facility upgrades or expansion. For the past several years, Healthcare Accounting cost-containment efforts have concentrated largely on traditional Healthcare Accounting targets, such as supply costs and labor. For the most part, Home Healthcare Accounting have been trimming supply costs by negotiating lower prices and more advantageous contracts, standardizing product choices, engaging physicians in supply-chain projects, and holding departmental managers accountable for supply costs and savings. Labor reductions have focused on reducing staff, reducing contributions to retirement plans, and freezing or cutting salaries. These Healthcare Business Plan avenues for cost control are narrowing, however. As leadership has gathered the “low-hanging fruit” with intense scrutiny of line items, the need for more substantial, year-over-year savings continues. As a result, healthcare executives are focusing increasingly on Health Care Business Plan process reengineering. More than 80 percent of HFMA Healthcare Financial Pulse survey respondents believe process improvement will be a core cost-management Healthcare Business Plan strategy for the foreseeable future.2 Payment change is a key factor driving Home Healthcare Agencies’ need for a more sophisticated approach to cost management. Home Healthcare Agencies have always pushed for efficiency while supporting patient safety and clinical quality, but with payment change, these efforts have taken on new levels of financial urgency. Quality and patient satisfaction are being factored into Medicare payment, while private payers are pushing for performance-and risk-based payment structures, capitated contracts, and pay-for-performance incentives. In this environment, reducing expense is not enough. Leadership also needs to ensure these efforts support delivery of high-quality care. As Home Healthcare Agencies adapt to these process-focused, value-driven shifts in cost management, key will be developing the right structures for collaborative decision making, setting priorities, tracking improvement, and creating widespread systems of accountability.

Healthcare Accounting and Business Plan & Decision Making

Healthcare Accounting Cost control should no longer be considered a unilateral function of the administrative or financial side of an organization. It should factor in both clinical and a Health Care Accounting financial processes and their linkages so cost cutting can streamline service delivery without compromising quality. Cost management decisions should therefore rely on input from financial and clinical leadership. At University of Alabama (UAB) Hospital, Birmingham, one of the top 20 largest academic medical centers in the United States, leadership has aligned strategic and business imperatives with the organization’s pillar goals of quality, satisfaction, and finance. The organization’s three- to five-year strategic Health Care Business Plan financial forecast projects anticipated growth and determines the related timing with which efficiency gains need to be realized. “Key leadership, which includes the CEO and the board, establishes the strategic plan,” says CFO Mary Beth Briscoe. “We evaluate market share and anticipated changes in payment to determine the magnitude of required operational improvements. From this strategic overview, we develop more tactical plans to achieve the improvements within our three pillar goals.” For key initiatives, University Hospital first forms an oversight or executive committee with members from various disciplines, which includes nursing, medical staff, finance, and operations. This committee provides perspective on the effects of any changes in policies and practices and identifies any potential fallout or unintended consequences. Critical initiatives utilize a project management framework and are led by appropriate clinical and non-clinical leadership. An executive steering committee may include clinical chairs and department heads. “This is the key strategic committee that reviews and evaluates all recommendations and determines the optimal implementation plan,” says Briscoe. “Their charge is to ensure that all perspectives are considered, identify barriers to change, provide guidance on eliminating or mitigating those barriers, identify alternatives, and execute change.” Members of this group are carefully selected. “To be successful, all stakeholders must have a representative in the process,” says Briscoe. “We choose strategic, broad thinkers—people who can think longitudinally across the process and the organization and who have influence to affect process change.” The group is committed to ensuring process changes do not compromise clinical outcomes, safety, or satisfaction for the sake of cost reduction and that the net impact of any process change is beneficial to the hospital and patients. “It is only at this point, once the organization has gathered the correct information, assessed the alternatives, and evaluated the impact on cost, quality, and satisfaction, that it is ready to implement change,” notes Briscoe.