The Twin Rivers Café

The Twin Rivers Café had the objective of preparing a budget to secure an amicable rate. They operated under a modified version of the GBR and aimed to establish a customer base. The cafe's revenue was determined by a historical base adjusted for various factors. The management and activity of the cafe played a crucial role in maintaining the budgeted amount in charges. The company's revenue and spending variance for July highlighted the need for improvement in quality and monitoring tools. Suggestions were given to the Twin Rivers Café to focus on quality, measurement tools, and effective services to increase revenue.

THE TWIN RIVERS CAFÉ
The Twin Rivers Café

The Twin Rivers Café2
Table of Contents
THE TWIN RIVERS CAFÉ...........................................................................................................................................1
Objective of preparing a budget for Twin Rivers Café.............................................................................................3
Company’s Revenue and Spending Variance for July..............................................................................................3
Management and Activity.........................................................................................................................................4
Advise the Twin Rivers Café....................................................................................................................................6
REFERENCE..................................................................................................................................................................8

The Twin Rivers Café3
The Twin Rivers Café
Objective of preparing a budget for Twin Rivers Café
The cafe had 2 years and 9 months to gain the volume of customer and complexity to
secure an amicable rate. Temporary rates were established so that the cafe could operate while
building their base. The budget under which they operate currently is considered a modified
version of the GBR. Once the base is established the rates will change. The Twin Rivers cafes
under the Global Budget, know what the revenue will be at the beginning of the fiscal year. The
cafe’s revenue is determined by a historical base which is adjusted to inflation, infrastructure
requirements volume increases in population, changes in payer mix, and quality-based programs.
The HSCRC sets the rates of each cafe based on care Prospective Payment System. The Twin
Rivers Café is paid on per case basis but the state negotiates the rates with the payers for one rate
across all payers. These rates apply to inpatient and outpatient cases. Each cafe has a capped
amount in which they can charge. If the charges exceed the capped budget, there are penalties
and if they are too low the rates can be adjusted at a lower rate. The goal is to maintain the
budgeted amount in charges at the end of the fiscal year(Winters, 2018). It also wants to improve
its condition and increasing revenue which is other goal for which it will require to perform
several activities.
Company’s Revenue and Spending Variance for July
The cafes are given a predetermined budgeted amount they can charge for services in a
year. The reimbursement is not limited so, it is important to receive every dollar that can be
collected. Charity and bad debt are budgeted into the number to assist with some of the write-
offs. These are expected to occur. Billing is timely because each insurance payer has a different
timely filing agreement with the cafe. Some are 30, 60, and 90 days while Food is a year from

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the date of service. Claims not billed within these time frames are lost revenue. The patient is not
responsible for the charges not billed promptly (Metzler, 2016). This variances show all factors
which decreased its revenue and put it in a position where it requires to more focus on improving
its quality and investing in technologies. It is also stated that patients are not responsible for
charges that are not billed promptly, it means company is responsible as there is a lack of
monitoring and controlling tools.
Planning and actual budgets for the month ended July 31, 2018
PLANNING ACTUAL
Budgeted meals quantity (q) 18 000 17 800
Revenues (£4.50q) £81 000 £80 100
Expenses:
Raw material (£2.40q) 43 200 42 720
Wages and salaries (£5 200+
£0.30q)
10 600 10 540
Utilities (£2 400 + £0.05q) 3 300 3 290
Facility rent (£4 300) 4 300 5 100
Insurance (£2 300) 2 300 2 600
Fuel 2 480 2 490
Net Operating Income £14 820 £13 360
Management and Activity
The Twin Rivers Café Global Budget Revenue is a complex system and has many
moving parts. For the initial time of the Food Waiver, the case-mix was a large common

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denominator in the decision to raise or lower the rates. As the quality measures become more
important with the implementation of the Affordable Care Act it is has made the case-mix less
important but still a measurable metric for a rate increase and reduction. The elements that affect
the case-mix are volume and severity of illness. The higher the severity of illness, the better the
case-mix looks. That is great for the facility but that means that the customer is more ill. It is
bittersweet for the facilities. Quality measures such as Possibly Preventable Complications
(PPCs) or as they are also known as The Twin Rivers CaféCafe Acquired Conditions (MHACs)
and death statistics are extremely important as they show the quality of care provided to the
customer. Some PPCs cannot be avoided and those are expected. The quality of documentation
queries when documentation is not clear and the interpretation of the coders also plays a part in
the PPC assignment. Education provided to the clinicians, CDI and coders provides
improvement in documentation and assignment of codes. Readmission rates are important
because if the patient is readmitted within 30 days it appears as though we were not able to
adequately treat the patient or that we discharged them too soon. Denials are bain of every
facility's existence. Claims can be denied administratively or clinically, either way, it is revenue
that the facility loses out on. Reducing denials is very important for increasing or stabilizing
revenue. Administrative denials can be claims that were not authorized, not filed in a timely
fashion or possibly coding issues. Food safety act 1990 will provide knowledge regarding food
legislation in England. These food services will serve or sell good quality of products to
customers because they will bad quality of food will have negative impact on health of
customers. The food served by cafe must be made with fresh ingredients. Customers have right
to ask cafe about what ingredients have been used by them in food. In case of cafe has not
answered these question of customers then cafe will pay according to the food safety act 1990.

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Management have to answer questions of customers and work according to customers. Clinical
denials are medical necessity denials and sometimes may also be related to coding but maybe
Food one day admissions. Most of the Food one day stays may be better served as an observation
patient. Statistics are reviewed regularly. Customer who expire in the facility who have a risk of
mortality score below a 3 are reviewed for additional codes that will increase the risk of
mortality. Customer with a 2 or less are not at risk for dying and need to be reviewed. If the
facilities receive more deaths than are expected it is looked upon as a quality of care issue and
that is why the comfort measures code is so important for customer on palliative care who expire
while an inpatient(Alberta, et al., 2017). So, from the above it can be said that case mix is the
main concern whose management can help The Twin Rivers Café in managing its activities in an
efficient manner. It can also help it out in accomplishing its goals of maintaining the budgeted
amount in charges at the end of the fiscal year.
Advise the Twin Rivers Café
The facilities cannot make up revenue by adding new services. For example, a small
community facility that serves medical, general surgical and OB customer would not be able to
increase their rates by adding open-heart surgeries or transplants. The rates are already
established and the care for that customer would be more than the facilities could handle
financially. Quality scores can increase the rates which motivates the facilities to continuously
improve the care. Denials decrease revenue and sometimes they cannot be overturned. PPCs can
be difficult to eliminate causing higher scores and a possibility of penalty. In some cases, it may
be difficult to get a provider to respond to a query or an operative note may be missing from a
record. The absence of a discharge summary or a pathology note can cause a decrease in the
original weight of the claim. It can also be advised to the Twin River Cafe that it should make

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an effective use of measurement tools by which it can measure effectiveness of its performance
and quality of products which it provides to people. By knowing and measuring effectiveness it
can make changes in its other strategies in order to take advantages and increasing revenue. It
may be reviewed later and increase case mix. Sometimes it may also decrease case-mix
especially if a condition has been ruled out. The information received either by web, book
resources or via interview were well aligned. The interviews were able to clarify some additional
information not found in printed materials. Practical experience also was an enhancement to the
research, each facility has its process for auditing, coding records and all other functions related
to revenue cycle, revenue integrity, and performance improvement and documentation quality.
One thing can be certain and that is all teams must work together to make the process work.
Working together and helping each other creates a much better outcome(Agi, 2017). It can also
be suggested to this company that it should mainly focus on the quality of food and services
provided to tourists and patients. The main aim of this company is to increase revenue and sales
by providing qualitative food to patients and tourists. For providing qualitative food and services,
it is important for the Twin Rivers Café to make its employees able who can provide effective
and attractive services to patients. It can attract people to the great extent which can increase its
sales and revenue as well. Proper controlling can also help it out in knowing all factors which is
becoming the reason of decreased revenue.

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REFERENCE
Books and journals
Agi, W., (2017). Vocational Aspiration of Youths in Rivers State of Nigeria: Implications for
Counselling. Journal of Political Science and Leadership Research, 3(1), pp.40-47.
Alberta, C., Arrington, S., Aulepp, A., Ayalp, E., Baker, A., Beglin, R., Campbell, A., Cantuba,
D., Cardenas, M., Chu, A. and Duan, K., (2017). Café Shapiro Anthology, Selected
Poems and Short Stories from the 20th Annual Café Shapiro.
Metzler, M.M., (2016). Arts Access and the Politics of Empowerment in the Twin Cities.
Winters, E., (2018). The world is not enough. The Monist, 101(1), pp.83-98.