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MEDICAL PROBLEM-医疗问题案例分析-The Brookside Medico Clinic (BMC) h


The Brookside Medico Clinic (BMC) has a 9 physician, five office medical practice in Brisbane. Its offices, which provided a wide array of services were managed from an executive office at a separate location. The practice worked hard to apply good internal controls consistently in each office. All personnel clearly understood BMC’s straightforward money-handling procedures.
In the medical office, income arrives in two ways –
• payment made by a patient at the time of service (patient payment with balance being paid by a medical insurance company)
• payment from a medical insurance company (e.g. Medicare, MBF).
Every BMC office handled patient fees according to the same prescribed procedures. The receptionist recorded each patient’s visit in a spiral notebook. The date of office designation was written on the top of each page in the notebook. There were columns for the patient’s name, the time of arrival, the physician to be seen, the patient’s insurance carrier, the amount of any co payment, and how the cop-payment was tendered. This record was called the daily co-pay log. Cash, cheques, and credit cards were accepted. At the end of the day, at least two people double-checked that every patient’s visit had been recorded properly. The staff also verified the amount and type of each co-payment tendered. Totals for cash, cheques, and credit card sales were entered at the bottom of each sheet, along with a grand total and the initials of both verifiers.
After the day’s receipts were tallied on a spreadsheet (Patient’s Receipts by Day.xlsx), the page was photocopied and that copy and all the cash and cheques received that day were placed in a clasped manila envelope and secured in a locked drawer. Credit card payments were handled electronically, so those weren’t included in the envelope.
A BMC-employed courier would collect the envelopes for each office every morning – or sometimes every other day depending on the patient volume – and take the proceeds to the bank. When this courier arrived at each office, the receptionist – Michelle would open the locked drawer and remove the clasped envelope. Together they would recount the entries on the page and verify that the correct amounts of cheques and cash were present in the envelope. The courier then would prepare the transit bank deposit forms from the bank. With the bank deposit ticket form out, the courier would remove the customer copy of the form and attach it to the copy of the daily co-payment log, and these documents were sent to the executive office for filing.
Michelle was also responsible for posting the individual payments received to the Patient Record System. Theoretically, the patient records should contain accurate information on what co payments were paid each visit. However, sometimes patients paid an incorrect amount – usually too much. These errors would not be picked until the insurance company payment was received. In these situations, Michelle’s postings would result in the relevant patient’s accounts being in credit. However, these credits were recorded in the accounting system as if they were new payments from the patient for the next month.

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