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Management s estimates relating to third-party revenue recognition are based on subjective as well as objective factors This requires judgment that normally is based on management s knowledge of and experience with past and current events and on its assumptions about conditions it expects to exist and courses of action it expects to take As a result, the extent of management s estimates involving contractual allowances and adjustments may range from relatively straightforward calculations based on information that is readily available, to highly complex judgments based on assumptions as to future events All relevant information is used in making these estimates Approaches vary from entity to entity, depending on individual facts and circumstances Some entities with signi cant prior experience may attempt to quantify the effects of individual potential intermediary or other governmental (eg, Of ce of Inspector General or Department of Justice) or private payer adjustments, based on detailed calculations and assumptions regarding potential future adjustments Some may prepare cost report analyses to estimate the effect of potential adjustments Others may base their estimates on an analysis of potential adjustments in the aggregate, in light of the payers involved, the nature of the payment mechanism, the risks associated with future audits, and other relevant factors In some cases, the uncertainty surrounding a potential adjustment may be so great that management is unable to make a reasonable estimate of the nancial effect for inclusion in the nancial statements In such situations, disclosure regarding such uncertainties should be made in the notes to the nancial statements Future events (eg, nal settlements, ongoing audits and investigations, or passage of time in relation to the statute of limitations) may differ from management s assumptions and therefore require revision of the balance sheet accrual The audit and accounting guide Health Care Organizations requires that differences between original estimates and subsequent revisions be included in the statement of operations in the period in which the revisions are made and be disclosed, if material; they should not be treated as prior period adjustments unless they meet the criteria for prior period adjustments in SFAS No 16 The likelihood of such revisions, coupled with their potential material effect on the nancial statements, generally requires disclosure in accordance with SOP 94-6, Disclosure of Certain Signi cant Risks and Uncertainties Such disclosures might include the signi cance of government program revenues to the entity s overall revenues and a description of the complex nature of applicable laws and regulations, indicating that the possibility of future government review and interpretation exists SOP 00-1 illustrates this disclosure (e) REVENUE OF MANAGED CARE COMPANIES In recent years, the line between health care providers and health insurers has blurred substantially In managed care companies, a thirdparty payer (eg, an insurer or health plan) is involved in managing the provider delivery system as well as performing the nancing function One type of managed care company is the HMO HMOs are organized health care systems that are responsible for both the nancing and the delivery of a broad range of comprehensive health services to an enrolled population Premium revenue is the primary source of revenue for HMOs The HMO then provides or arranges for provision of covered services to its members, either by using its own facilities and physicians or by sending members to facilities and physicians with which it has contractual relationships Payment arrangements with those providers may be based on services provided, or they may involve capitation (under which the providers receive prepayment for services on a per member per month basis) Specialty managed care companies usually subcontract to comprehensive health plans to provide a speci ed type of services to an enrolled population Capitation payments often represent the primary source of revenue for these entities Issues related to revenue recognition under capitation arrangements are discussed at Subsection 363(d)(i) (i) Reporting Revenue Net or Gross Gross versus net reporting of revenue is a signi cant issue for many managed care organizations, particularly those that subcontract to comprehensive health plans In those situations, the question is whether the organization s statement of operations
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