Healthcare Accounting: Choosing the Best Accountant for Your Practice

If you're a healthcare practice owner in or around Raleigh, NC, you understand the unique financial challenges that come with managing a healthcare business. From intricate insurance billing to navigating complex compliance regulations, the financial landscape of the healthcare industry is quite specific. 

Whether you're looking to optimize your tax strategy, enhance financial forecasting, or ensure compliance, our small business accountants at C.E. Thorn, CPA, PLLC can assist with the financial statements and tax preparation of your healthcare practice.

Understanding Healthcare Accounting Needs

Revenue Cycles

The revenue cycle of a healthcare practice encompasses the entire financial journey of a patient, from scheduling an appointment to receiving payment for services rendered. 

This cycle includes:

• Patient registration
• Insurance verification
• Charge capture
• Claims submission
• Payment posting
• Accounts receivable management
• Cash flow statements
• Balance sheet management

Insurance Billing

Insurance billing is a pivotal aspect of healthcare finance. Accurate submission of claims to insurance companies, following the correct coding and documentation guidelines, is essential to receive prompt payments. 

Healthcare accounting practices deal with understanding different insurance plans, each with its rules and requirements. Failure to adhere to these standards can lead to claim denials, delayed reimbursements, and even legal consequences.

Compliance

Compliance in running a healthcare practice refers to adhering to various regulations and industry standards, such as HIPAA (Health Insurance Portability and Accountability Act) and MACRA (Medicare Access and CHIP Reauthorization Act). Non-compliance can result in severe penalties, reputation damage, and legal actions. 

Managing these financial aspects while ensuring compliance is a delicate balance that requires constant vigilance and an extensive knowledge base of someone who understands the nuances of healthcare accounting. 

Impact of Regulations and Industry Standards on Healthcare Accounting

The healthcare industry is heavily regulated, and these regulations have a direct impact on healthcare accounting practices. 

Healthcare accountants must navigate complex regulations when recording financial transactions, managing revenue, and preparing financial statements. Industry standards also influence how financial data is reported, impacting decision-making and transparency within the practice.

Need for Accountants with Medical Billing Expertise

Given the intricacies of healthcare billing codes and medical terminology, having a healthcare accountant who understands these nuances is crucial. 

Medical billing codes, such as CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases, 10th Revision), play a pivotal role in accurate claims submission and reimbursement. 

An accountant for healthcare practices who is well-versed in medical terminology can bridge the gap between clinical and financial aspects, ensuring accurate documentation and billing.

Qualifications to Look for in a Healthcare Accountant

Hiring the right healthcare accountant for your healthcare practice can significantly impact your financial stability, compliance, and overall success. Healthcare accounting is a specialized field that demands a unique skill set to navigate the intricacies of medical billing, insurance regulations, and compliance standards. 

Education and Certifications

The qualifications of a healthcare accountant extend beyond a basic understanding of financial principles. Certifications such as Certified Public Accountant (CPA) and Certified Management Accountant (CMA) hold immense significance in healthcare accounting. 

A CPA certification indicates that a person is capable of financial accounting, auditing, and taxation– all essential aspects of healthcare finance management. On the other hand, a CMA certification emphasizes management accounting, strategic planning, and decision support– skills that are crucial for making informed financial decisions within a healthcare practice.

Industry Experience

Hands-on accounting experience with those in the healthcare industry provides accountants with an understanding of the industry's unique challenges and opportunities. Healthcare accounting practices operate within a complex landscape of regulations, insurance billing, and revenue cycles. 

An accountant with hands-on experience in healthcare accounting may offer knowledge of industry-specific nuances, enabling them to address financial challenges effectively and identify opportunities for growth.

Familiarity with Healthcare Software

Healthcare practices rely on software tailored to their industry's needs, such as medical billing and practice management systems. An accountant who understands such software solutions can work with you on your financial processes, including claim submissions and bookkeeping.

Compliance Expertise

Compliance with healthcare regulations, such as the Health Insurance Portability and Accountability Act (HIPAA), is of utmost importance. HIPAA governs the protection of patient information, and violations can result in hefty fines and legal repercussions. 

A healthcare accountant must understand these regulations to ensure that financial processes and data management align with HIPAA requirements, safeguarding patient privacy and practice integrity.

Analytical and Communication Skills

In addition to technical qualifications, an ideal healthcare accountant should possess strong analytical skills to interpret complex financial data and trends. Effective communication skills are essential too, as accountants for healthcare often collaborate with medical staff, administrators, and external stakeholders. Clear communication ensures that financial information is comprehensible to non-financial professionals, facilitating informed decision-making.

Tailored Financial Strategies for Healthcare Practices

Running a successful healthcare practice requires more than just providing top-notch medical care– it demands a comprehensive approach to financial management. Tailored financial strategies are essential to navigate the unique challenges and opportunities presented by the healthcare industry. 

Tax Planning

Tax preparation for healthcare practices is intricate due to the industry's distinct tax implications. Healthcare providers may have various sources of income, including patient fees, insurance reimbursements, and government grants. 

Effective tax planning for private practicesinvolves understanding which income is taxable and which might be eligible for deductions or exemptions. Proactive tax strategies can help healthcare practices optimize their tax liability while remaining compliant with tax regulations.

Financial Forecasting

Financial forecasting is indispensable in healthcare settings, where revenue can be influenced by factors such as patient volumes, insurance reimbursements, and changes in medical trends. A healthcare accountant can assist in creating financial statement forecasts. 

This enables the healthcare practice to predict revenue and manage cash flow effectively. When healthcare providers can estimate revenue, they can make informed business decisions, allocate resources wisely, and maintain financial stability.

Budgeting and Expense Management

Budgeting is crucial for healthcare practices to control costs, allocate resources efficiently, and achieve financial goals. Medical equipment, staff salaries, rent, utilities, operational expenses, and other small business expenses demand careful planning. 

An accountant who understands the unique needs of healthcare practices can create budgets that align with the practice's goals, ensuring that financial resources are allocated appropriately.

Managing Healthcare Regulatory Changes

Healthcare regulations are constantly evolving, affecting reimbursement rates, billing procedures, and compliance standards. An accountant can keep the practice informed about regulatory shifts and help adjust financial strategies accordingly, ensuring ongoing compliance and financial viability.

Risk Management and Contingency Planning

Healthcare practices face various risks, including malpractice claims, changes in insurance policies, and unexpected disruptions. A well-structured financial strategy should include risk management and contingency planning. Accountants can help healthcare practices establish reserve funds, insurance coverage, and other measures to mitigate financial risks and maintain stability during challenging times.

Contact Our Healthcare Accounting Firm at C.E. Thorn, CPA, PLLC Today 

If you need accounting services for your healthcare practice, look no further than C.E. Thorn, CPA, PLLC. For 3 decades, we have worked with small businesses and private practices, including healthcare practices, in the greater Raleigh, North Carolina area.

With attention to healthcare regulations, medical billing nuances, and industry-specific financial challenges, C.E. Thorn, CPA, PLLC is available to assist with your accounting needs.

To schedule a consultation today, call us at  919-420-0092 or fill out the contact form below to get started.