A

PROJECT REPORT ON
A STUDY ON ACCOUNTING IN HOSPITAL

A PROJECT REPORT SUBMITTED TO THE UNIVERSITY
OF
MUMBAI FOR THE AWARD OF THE DEGREE OF
MASTER IN MANAGEMENT STUDIES

BY
PRAMOD RAJENDRA YADAV
SWAYAM SIDDHI COLLEGE OF MANAGEMENT AND
RESEARCH BHIWANDI (KALYAN)
2014-2015





DECELARATION

I, Mr. PRAMOD YADAV student of SWAYAM SIDDHI
COLLEGE OF MANAGEMENT AND RESEARCH BHIWANDI -
421302, MMS/MBA, hereby declare that I have completed project on in the
academic year 2013-14. The information submitted is true and original to the
best of my knowledge.





PRAMOD RAJENDRA YADAV









ACKNOWLEDGEMENT

I am short of words to express my deep sense of gratitude
to my guide Dr. PRADEEP YADAV, for his help and his untiring efforts
and my college faculty mentor MRS. LAXMI PRABHA, constant
inspiration and stimulating guidance to me in my academic endeavor and in
my project.
I also thanks to all SBI group for the information given to
me that formed the basis of the study. I would also like to thank the college
for giving me this opportunity for doing this project.













INDEX
Sr. no. Topics
CHAPTER NO: 01
1 Introduction
a) Vision and Mission
b) Scope of the study
c) Methodology
d) Limitation
CHAPTER NO: 02
2 Purpose of the project
a) The revenue cycle
b) The expense cycle
CHAPTER NO: 03
3 Basic of Accounting
a) Accounting Method
i) Cash basis
ii) Accrual basis
CHAPTER NO: 04
4 Cardiac OT
a) Surgery
b) ECCP
c) Enhance external counter pulsation
d) Lithotripsy
e) Dexa
f) Ophthalmology
h) Dental
i) Diagnostic facilities
CHAPTER NO: 05
a) After care
i) Inpatient Aftercare
ii) Outpatient Aftercare



Conclusion
Recommendation


INTRODUCTION

Apex is a comprehensive healthcare in Mumbai with its
single multiple specialty hospital and clinic total 15 beds facility spread in
the hospital in western Mumbai is equipped with the latest medical
technology offering affordable medical treatment with personalized care
The hospital has some of the path breaking diagnostics
and surgical equipments. This combined with highly skilled medical,
nursing, administration and paramedical staff makes Apex hospital one of
the most trusted healthcare providers in Mumbai
Luxurious patient rooms to general ward; attractive health
insurance plan makes it possible for people to avail complete medical
benefit. Various health check-up packages for different age groups are
available at the preventive health check department of Apex hospital
The hospital offers a wide range of series to the
community, i.e. general consultation and hospitalization, maternity
gynecology, pediatrics surgery internal medicine radiology, laboratory
services, physical therapy, dentistry, mental health and pharmacy
Location
It is located in the western Mumbai. One of the finest residential location
gokuldham goregaon (E)
The hospital started functioning in .
Vision of Apex hospital
Create an enduring legacy in medical care and
wellbeing using state of the art technology and processes that stand for the
ultimate in care.


Mission of Apex
To offer best of the class health care service to primary
secondary and tertiary needs at affordable prices












Objective of the Report

The objective of the report is to know the accounting
management of hospital as social organization and also to present a
comparative scenario of financial management of Apex hospital.
And also
To know the function of various departments
To study the dependence of all departments
To get real exposure of alicing world
















Scope of the Report

The scope is limited within the office of APEX and
especially within the Accounting Unit of Apex. Here I mentioned a part of
financial works of APEX giving emphasis on their accounting, informing the
patient, register patients, Organize and maintain forms and office stationery,
organize overflowing paper documents, and check if there is enough stock of
medical bags, and bottles in the consulting rooms. In the summer internship
I have done the work as an accountant like registered the all patient names
with their check-up fee, prepare the balance sheet and handling billing
systems.














Methodology

The method is mainly discussion and sharing of
information with staff members of APEX and review of their operational
documents and manuals. APEX CARE has used to prepare this report. I also
incorporated with verbal suggestions of the staff members, which helped me
a lot to enhance my knowledge.











Limitations

Proper guidance from more professionals of similar
sector could enrich this report and also could make it more informative and
comparable. But their time constraints could not allow me to do that, which
seemed to me a limitation to prepare this report. Another limitation is that,
comparable information is not available in this report as I was only
permitted to complete my internship in a single organization, i.e. Apex.















Purpose of the project
This project will provide an overview of the healthcare
industries and hospital financial accounting and reporting issues. The reader
will gain insight to the industry and d to the accounting and reporting issues
facing hospital today. The accounting cycle can best be explained by quickly
viewing the revenue cycle, expense cycle, capital items, the budget and the
monthly close and reporting process
1) Revenue cycle
Revenues are generated when services are provided to
patient. Section for a more detail description of revenue and net
revenue all hospitals have a system in place to capture charges for the
services provided.
Bills are generated after the patient is discharged.
There is typically a short lag between the discharge and when the bill
is produced (often referred to as dropped) to ensure that all charges
were adequately captured and billed in accordance with regulation or
payer requirements.
Hospitals generally the patients insurance carrier on
behalf of the patient and keep the patient informed as to the status of
the claim. Once the insurance carrier adjudicates the claim, the
hospital will write off discounts as appropriate and build the patient
for any patient portion due. As identify by the carrier.



2) The expense cycle
Expenses are the result of commitment for cost incurred
in the provision of patient services or operation of the hospital;
Successful hospital have a define process to bind the organization to
financial commitments. A typical process starts with a purchase
request or requisition to be completed by the department leader. This
document include information on the proposed purchase, including
vendor, amount, description of item to be purchased, the general
leader account code, the budget amount, and the business justification
for the purchase. The purchase requisition generally submitted to
senior leadership or administration for review and approval. Upon
approval, the purchase requisition is sent to the hospital purchasing
department, where a formal purchase order is completed and purchase
order is communicated to the vendor.

Basic of accounting
This section will provide general overview of the basic
accounting, including the basic accounting matters the general leaders
chart of accounting, and the types of account used.







Accounting methods
There are three basics accounting methods used by healthcare
organization

1) Cash basis
Cash basis accounting recognized income and expense
only when cash is received or disturbed. It is simple method of
accounting that ignores liability for purchases made but not yet
received and assets earned but not yet collected

2) Accrual basis
The accrual bias of accounting is used for most business.
This method seeks to accrued Revenues and expenses to the
proper period in which they are earned. This is the last part of
monthly closed process for the controller and staff. For the
monthly financial statement to be accurate, the controller and the
staff must ensure that all transactions for the month are properly
recorded, regardless of whether cash has been received or paid.
3) Fund accounting
Fund accounting is typically used by government entitles
and academic medical Centres. Fund accounting establishes
specific funds for the various varieties of uses.



Cardiac OT

Total asepsis maintained by filters and microbial-
logical surveillance. Equipped with state of the art 0.T table, IABP, Arterial
Blood Gas, anesthesia machine, ventilators, heart-lung machine, electrolyte
monitors and defibrillators.







Surgery

Coronary artery bypasses graft surgery (CABG).
On pump/off pump (Beating Heart surgery).
Alular heart surgery /vascular surgery (Repair & Replacement).
Thoracic surgery.
Closure of ASD-VSD &PDA. (Congenital Heart Surgeries).














ECCP

Enhanced external Counter Pulsation
Bypass Surgery It is the latest development in the field of cardiology
for the treatment of angina, coronary artery disease and heart failure.

EECP therapy works to improve circulation to the heart muscle,
increasing oxygen-rich blood flow to the heart and reducing the heart
work load.



Who Needs EECP Treatment
Chronic chest pain (Angina).
Alternative procedure instead of invasive procedure like
Angioplasty or Bypass surgery.
Exertion after any sort of physical exercise.
Stroke patients.

Benefits of EECP Treatment

Totally OPD Procedure, no hospitalization and no recovery time.
No risk, non-surgical safe treatment.
Cost effective as compared to invasive procedures.







Lithotripsy

Apex Hospital introduces a specialized End urology &
Laparoscopic set-up which consist of
Dedicated 9" HF Digitalized C-arm image intensifier system.
Well equipped O.T.
Complete armamentarium of modern end scopic & Laparoscopic
instruments.
Uroflowmetry & Ultrasonography.
Extra-corporeal shock wave lithotripsy commonly called
ESWL or Lithotripsy is a safe, effective, non - invasive and easy procedure
for kidney stones. High energy shock waves are used to pulverize the kidney
stone into sand like particles, which the body eliminates through the urinary
tract. Since the shock wave is generated outside the body, the procedure is
termed Extra-Corporeal shock wave lithotripsy (ESWL). The name is
delivered from the roots of 2 Greek words- "Litho" meaning stone, "Trip"
meaning to break.
Dexa

Bone density scanning also called Dual energy X-ray
absoptiometry (DXA) or bone densitometry is an enhanced form of X-ray
technology that is used to measure bone loss. DXA is today's established
standard for measuring Bone mineral density (BMD). DXA bone density
testing is the most accurate method available for the diagnosis of
Osteoporosis and is also considered an accurate estimator of fracture risk.











ROOMS

Apex Multi Specialty Hospital offers dedicated ICCU beds
to ensure privacy. Each bed has a dedicated nurse attending to the patient.
We cater to all class of patients offering them inpatient admissions to
various categories including luxury suites Medical ICU - for cardiac &
medical emergency Surgical ICU - for post cardiac & general surgery
patients.
Equipments
Siemens ventilators
Philips multipart monitors
AED with external pacemaker
Infusion pumps
Temporary pacemaker
Intra-Aortic Balloon Pump
Cardiac Ambulance

Total asepsis maintained by filters and microbial-logical
surveillance. Equipped with state of the art 0.T table, IABP, Arterial Blood
Gas, anesthesia machine, ventilators, heart-lung machine, and electrolyte
monitors and defibrillators surgery. Coronary artery bypasses graft surgery
(CABG). On pump/off pump (Beating Heart surgery).





Ophthalmology
We are well equipped with the state of the art equipments comprising
Auto refractokerato-meter.
Auto lenso-meter.
5 slit lamp with application tono-meter.
A scan (Axis PRP - II Italy).
Pachy-meter.
Bausch and Lomb millennium surgical system.
Operating microscope from Zeiss.
Operation theatre with epoxy fluorine & steel wall for better asepsis.
Following procedures are performed
Refraction
Cataract Surgery
Pterygium Surgery Squint Surgery
Padiatric Surgery
Lasik
Dental







I, at Apex Hospital simply known cure is in care. With complete team of
orthodontists, prosthodontists, periodontists and aesthetic dentists using
state-of-art equipments.

Our specialities

Maxillo Facial Surgeries
One sifting root canal
Smile modification, tooth jewelry, tooth whitening and cosmetic filling
Implants, Gum surgery and wisdom molar surgery
Straightening of teeth with invisible braces.



Diagnostic Facilities








Computerized Pathology Lab
Digital X-ray
Stress Test
2D Echo with Color Doppler
Ultrasonography
Mammography
EEG
EMG
ECG
Pulmonary function Test
Complete Health Check-Up Plan



LIST OF DOCTORS AND VISITING DOCTORS
Sr
no.
Name of the doctors Specialty Day and timing
1 Dr Shilpa Choudhary
Ambekar
Gynecologist &
Obstetrician,
Laparoscopic
Surgery,
Mon-Friday
5pm to 8pm
2 Dr Kewle's ENT Gynac Cure Gynecologist &
Obstetrician
Tue and wed
10am to12 pm
3 Dr Tambe Gynecologist &
Obstetrician, IVF
Infertility,
Sonography
Mon and
Thursday
10am to 12 pm
4 Dr R M Borade Obstetrician,
Diagnostic Centre,
Nursing Home
Sat and sun
2pm to 4pm
5 Kalpana Nursing Home Doctor General
Physician, Doctors
& Surgeons
Tue and wed
2pm to 4pm
6 Dr Rupali K Patnekar Doctor General
Physician, Dentist,
Doctors & Surgeons
Mon- sat
3pm to 5pm
7 Dr Vinay Rao Doctor General
Physician, Clinic,
Doctor Cardiologist
Mon, wed and
Friday
6pm to 8pm
8 Dr Prachi Dargainya

Doctor General
Physician, Doctor
Physiotherapist,
Health & Fitness
Consultants
Tue, wed, sat
and sun
5pm to 7pm
9 Dr.deepa Paranjpey Doctor General
Physician, Doctors
& Surgeons
Tues and sun
5pm to 7pm
10 Dr Gala Bharat Morarji Doctor General
Physician, Clinic,
Diagnostic Centre
On call
11 Chetna S Doshi Doctor General
Physician, Doctors
On call
& Surgeons
12 Deepa 's Skin Care Doctor General
Physician,
Dermatologist,
Doctors & Surgeons
On call
13 Dimple M Doshi Doctor General
Physician,
Gynecologist &
Obstetrician,
Doctors & Surgeons
On call
14 Dr. Dilip C Vora Doctor General
Physician, Doctors
& Surgeons
On call
15 Dr.manisha Doctor General
Physician, Doctors
& Surgeons
On call
16 Dr. Pradeep Doctor General
Physician, Doctors
& Surgeons
Mon to sun
10am 11pm
17 Dr Prem Gynecologist &
Obstetrician
Mon to sun
11pm to 8 am











Aftercare

Inpatient aftercare
After inpatient surgery, most patients are taken to a
recovery room and monitored by nursing staff until they regain full
consciousness. If there are complications or if the patient develops
respiratory or cardiac problems, he or she is transferred to a surgical
intensive care unit equipped to deal with acute needs. Intensive care units
(ICU) are highly advanced facilities in which patients are monitored by
special equipment that measures their heart rate, breathing, blood pressure,
and blood oxygen level. Some patients require a respirator to breathe for
them and additional intravenous lines to deliver medication and fluids. Once
stabilized, patients are transferred to their hospital room.
After returning to the room, the patient is encouraged to
sit up, start walking, and do as much as possible to return to a normal level
of activity. Special diets may be provided, as well as pain-killing
medications and antibiotics if needed. A respiratory therapist will usually
visit the patient with breathing equipment intended to help the patient's lung
function return to normal. A physical therapist may introduce the patient to
an exercise program or to skills needed to manage with temporary or
permanent physical limitations.
Discharge personnel help the patient plan to go home. Some
hospitals follow up with an outpatient nurse or social worker service.
Pharmaceutical services may be offered to fill take-home prescriptions
without the requirement of visiting an outside pharmacy. Medical
equipment, like wheelchairs or crutches and other durable equipment may be
provided by the hospital and then purchased by the patient for use at home.
Outpatient aftercare
Outpatient or ambulatory surgery services make up
almost half of all surgeries in the United States as a result of advances in
surgical equipment and technique that allow for laser treatments and other
minimally invasive procedures. Outpatient procedures require comparatively
little aftercare for the patient due to both the nature of the surgical procedure
and the advantages of being able to use regional or local anesthesia.
Aftercare in hospital outpatient clinics, ambulatory surgery centers, or
office-based practices requires that patients recover from anesthetics in the
facility. After the anesthetic has worn off, the patient is briefly monitored for
complications and released to go home. Many surgical procedures now
allow patients to go home after a short recovery period on the same day as
the surgery, and benefit from minimal pain and a speedier recovery.








The hospital billing process
The billing process includes submitting charges to third
party payers and patients, posting patient transactions and follow-up on
outstanding accounts. Information collected during the patient visit is
utilized to complete the taste required to bill for services rendered
Purpose of the billing processing
The purpose of the hospital billing process to obtain
reimbursement for services and items rendered by the hospital.
Reimbursement is received from patients, insurance carriers and government
programs the hospital billing process begins when a patient arrives at the
hospital for diagnosis and treatment of an injury illness, disease, or
condition the patients demographic and insurance information is obtained
and registered in the Apexhospitals information system patient care services
and items provided during the patients stay are recorded on the patients
account charges are posted to the patients account by various departments
when the patient leaves the hospital all information and charges are prepared
for billing.
The billing process
It involves all the functions required to prepare charges
for submission to patients and third-party payers in order for the hospital to
obtain reimbursement. It includes patient registration, posting charges to the
patients account chart review and coding, preparing claim forms and patient
invoices or statement for charges submission, and monitoring and follow-up
of outstanding accounts.
Diagram n billing process


















Reception responsibilities
1. Register patients according to hospital protocol:-
Primary work given to me at Apexhospital was to maintain basic
information about the patients who were hospitalized. Some of the basic
details of the patient were:-
Name
Age
Gender
Address and contact details
And other necessary details

2. Organize and maintain form and office stationery required for front
desk activities:-
All the documents and basic details of the patients were filed
electronically in Apexhospital by me.

3. Organize overflowing paper documents
In regular basis all the newly daily paper or documents was arranged
or organized physically and electronically by me.
Some were like:-
Bills
Medical drugs record
Etc
4. Check if there is enough stock of medical bags and bottles in the
consulting rooms:-
In a Apex hospital daily auditing has been done electronically by me
to fill the gap of shortage in medical stocks
5. Handle any form of emergency effective and efficiently in
Apexhospital