Revenue and Expense Recommended Updates

POLICIES & PROCEDURES

Mission Accounting

Washington University School of Medicine’s mission is to “lead in advancing human health through the best clinical care, innovative research and the education of tomorrow’s leaders in biomedicine. . .”

 

The items below provide a summary of how we account for these three distinct areas.  By accounting for each mission we can measure the progress that we are making and most importantly the return on our investments.

 

Function Summary (PDF)

                Clinical Mission

                Research Mission

                Instruction Mission

                Other Activities

 

 

Clinical Mission

 

 

Sales and Services Revenue:

 

Sales and Service associated with Affiliated Hospitals should use a Budget/Subclass of 71.  All of Sales and Services Revenue should remain on 72.

 

Affiliated Hospitals include any hospital that we currently do have a profit sharing arrangement. Our current list includes:

 

 

Barnes Jewish Hospital

St. Louis Children’s Hospital

Barnes Jewish West County Hospital

Orthopedic Center in Chesterfield

Children’s Specialty Care Center Chesterfield

Siteman Cancer Center South County (formerly referred to as Phase I)

Center for Advanced Medicine South County (formerly referred to as Phase II)

 

 

 

Example: Budget/Subclass Object of 71-95

 

Clinical Practice: Patient care services to individual patients normally eligible to be billed to Medicare, commercial insurance or the patient. Represents the “fee for service” generating activity — time spent on activities that focus on directly identifiable patient care services for which a professional fee to a patient can be generated. Includes:

 

  • Inpatient, outpatient, procedural, surgical, laboratory-based, or outreach activity for which a bill could be generated for Medicare Part B or covered under commercial insurance as physician services.
  • Follow-up and documentation time required supporting direct patient care.
  • Training or professional development activities which are intended to improve clinical skills
  • Clinical marketing activities
  • Patient care services performed by fellows that are not in an ACGME accredited program
  • Support staff and personnel performing clinical administrative functions. These include:
    • Billing
    • Collections
    • Labs used specifically for patient care
    • Scheduling/Registration
    • Other Administrative Activities

Excludes:

  • Time instructing residents or fellows in an ACGME accredited program
  • Activities associated with the management of hospital services or administration of hospital activities
  • Patient care activities which are associated with research projects
  • Credentialing and Enrollment staff
Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
15 01 15 95

 

Graduate Medical Education:  Supervision/instruction of persons enrolled in accredited ACGME intern, residency and fellow programs, direction/coordination of ACGME programs as well as patient care effort of ACGME fellows/residents. Includes:

Residency/Fellowship Directors, program coordinators’ time overseeing, managing and administering the program.

Other support activities associated with the program such as recruiting and scheduling rotations.

Additional time spent delivering patient care due to the presence and supervision of residents.

Teaching clinical procedures and preparing for and leading grand rounds.

ACGME fellows performing patient care.

 

Hospitals with Object Code:

Barnes Jewish Hospital (16)

St. Louis Children’s Hospital (19)

Barnes Jewish West County Hospital (18)

Orthopedic Center in Chesterfield (18)

Children’s Specialty Care Center Chesterfield (19)

Siteman Cancer Center South County (formerly referred to as Phase I) (18)

Center for Advanced Medicine South County (formerly referred to as Phase II) (18)

Non-Affiliated Hospitals (17)

 

General Guidance: Adhere to the ACGME requirements

Excludes:

Time instructing residents or fellows in a non ACGME accredited program (see 13-Instruction).

Patient care services performed by fellows that are not in an ACGME accredited program (see 15-Patient Care).

 

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
16,17,18,19 01 18 95

 

 

Affiliated Services:  Includes all services, general clinical support activities and contractual agreements that benefit the defined Affiliated Hospitals listed below, and do not generate an RVU or fee for service revenue for WUSM.  Examples include:

General oversight of clinical activities in the hospitals and hospital-based clinics

Service on Hospital Committees (including administrative and leadership committees)

Administrative and general patient care services (reimbursable as Medicare Part A services)

Patient safety and quality assurance activities

Staff/Physician credentialing

Contracts for specific medical direction services and/or clinical mission support agreements

Medical management of hospital based clinical service lines programs such as anesthesiology, radiology, emergency medicine, infection control, and laboratory/pathology.

Affiliated Hospitals include any hospital that we currently do have a profit sharing arrangement. Our current list includes:

 

Object Code:

Barnes Jewish Hospital (56)

St. Louis Children’s Hospital (59)

Barnes Jewish West County Hospital (58)

Orthopedic Center in Chesterfield (58)

Children’s Specialty Care Center Chesterfield (59)

Siteman Cancer Center South County (formerly referred to as Phase I) (58)

Center for Advanced Medicine South County (formerly referred to as Phase II) (58)

 

Excludes:

Supervision of residents, Contracts with MO Baptist and Shriners

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
56, 58, 59 01 58 95

 

 

 

Non-Affiliated Services: Includes all services, general clinical support activities and contractual agreements that benefit a non-Affiliated Hospital defined below, and do not generate an RVU or fee for service revenue for WUSM. Agreements can include “Flat Fee” or Bundled Payment contracts where there is direct patient care and no WUSM RVU’s or fee for service revenues generated.  Examples include:

General oversight of clinical activities in the hospitals and hospital-based clinics

Service on Hospital Committees (including administrative and leadership committees)

Administrative and general patient care services (reimbursable as Medicare Part A services)

Patient safety and quality assurance activities

Staff/Physician credentialing

Contracts for specific medical direction services and/or clinical mission support agreements

Medical management of hospital based clinical service lines programs such as anesthesiology, radiology, emergency medicine, infection control, and laboratory/pathology.

Non-Affiliated Hospitals include any hospital that we currently do not have a profit sharing arrangement.  Current examples include MO Baptist and Shriners.

 

Excludes:

Supervision of residents, Contracts with Affiliated Hospitals

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
57 01 57 95

 

 

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Research Mission

 

 

Organized Research: All research development activities of an institution that are separately budgeted and accounted for on a project by project basis. This term includes activities involving the training of individuals in research techniques (commonly called research training) where such activities utilize the same facilities as other research and development activities.

 

Included are:

(a) Organized research projects including sponsored and internally funded research projects that are separately and budgeted for on a project by project basis. These projects have all the following:

a defined scope of work

a work plan (including scientific methodology)

a time frame (a recognizable beginning and end)

reporting requirements to the sponsor (external or internal)

a separate account within the University accounting system

 

(b) Research projects funded from internal sources (University, School or Department funds) that meet the conditions listed above. This includes work funded by internal allocations of institutional funds (often endowments) and reviewed by faculty committees.

 

(c) Salaries and benefits of faculty and staff working on organized research projects and who are funded by those projects. These staff personnel have their salary coded as organized research (Note: Object Code 20 is the only code permitted on organized research projects, i.e. where 424 code = 02).

 

(d) Faculty and staff not funded by the project but who are assigned to work on organized research projects. The effort for these personnel is coded as organized research and identified as cost sharing.

 

(e) Trainees and Fellows stipends paid from training grants where the training grant is coded as organized research. Space in which research training occurs should be coded as organized research.

 

 

Excluded are:

(a) Any research activity that does not meet the above mentioned criteria. This activity is considered departmental research (Object Code 14).

 

(b) Staff providing routine department administrative support.

 

(c) Costs incurred in grant writing and solicitation are not included. This activity is included in Department Administration (Object Code 40).

 

(d) WU space in which non-WU research (such as Howard Hughes Medical Institute sponsored research) takes place should be coded as Independent Operations/External – IDC Code 92.

 

(e) Space used for both WU and non-WU activities must be split proportionately. For example, a room used 40% for WU organized research and 60% for BJH research would be coded 40% IDC Code 82 and 60% IDC Code 92.

 

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
20 02 Blank 82

 

 

 

 

Department Research: Research development and scholarly activities that are not organized research.

 

Included are:

General research support, including start-up funding and bridge funding for investigator and research track faculty that is not project oriented. The School of Medicine does account for the overall costs of Departmental Research in each department. Typically, Departmental Research support is paid from a pool and is not identified by project. Use of general support funds identified by faculty member (such as the endowment spending distribution for an endowed chair) or by institutional function (endowment spending distribution restricted to research in a particular field or department) will typically fall into this category. This also includes staff paid from these funds. A significant factor in determining the difference between departmental research (Object Code 14) and other activities is intent. If the major purpose is investigative but the support does not meet the criteria for Organized Research, the account function is departmental research (424 code = 01 and 450 code = 14) and the labor is coded departmental research (object code 14).

 

Other types of expenses that should be coded as Department Research are cost sharing allocation charges (budget 50 debits) related to research-oriented sponsored projects, and institutionally funded expenses for support of post-doctoral research trainees and research fellows (stipends, fees, trainee tuition, health fees).

 

Excluded are:

(a) Writing the application for an organized research grant. (This activity is department administration (Object Code 40)).

 

(b) Using this activity as a “catch all” for unspecified time.

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
14 01 14 97

 

 

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Instruction Mission

 

 

 

 

 

 

 

 

 

 

Instruction: Teaching and training activities (lecturing, tutoring, supervising both independent study or laboratory course work, grading papers, etc.) limited to the following students:

  • Medical students
  • Pre-doctoral students
  • Post-doctoral students not in an ACGME accredited approved program
  • Post-doctoral students not supported from a Federally sponsored training grant

 

Excludes:

  • Supervision of residents enrolled in an ACGME accredited program (see Graduate Medical Education category below).
  • Institutionally funded expenses for support of postdoctoral research trainees and research fellows (stipends, fees, trainee tuition, and health fees) should be classified as Department Research.

 

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
13 01 13 96

 

 

 

Student Services: Activities for the administration of student affairs and for services to students, including the expenses of such activities as dean of students, admissions, registrar, counseling and placement services, student advisors, student health and infirmary services, catalogs, and commencements and convocations.

 

Included are:

(a) Activities categorized as student administration and services may include, but are not limited to:

 

Student placement and infirmary services

Administration staff such as dean of students

Admissions

Registrar

Counseling

Student advisors

Student health staff

Catalogs, commencements and miscellaneous meetings or gatherings

 

 

Excluded:

(a) When the administrative activity benefits not only student affairs but also other functions (research, clinical, etc.) then the activity is coded as Departmental Administration.

 

(b) At the Medical Campus, Student Administration and Services are primarily found within the Dean’s Office, in the Division of Biology & Biomedical Sciences, and in Allied Health Programs (Physical Therapy and Occupational Therapy). In other departments, the decentralized student administration activities should be coded as Instruction.

 

 

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
00 05 00 91

 

 

 

Other Activities

 

 

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Other Sponsored Activities (30):  Programs and projects sponsored by Federal and non-Federal agencies and organizations which involve the performance of work other than instruction and organized research. Examples of such programs and projects are health service projects, federally funded clinical trials that occur in patient care space, and community service programs.

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
30 03 00 83

 

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Research Studies:  These are non-federally funded clinical trials that do not involve human subjects.

 

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
14 01 D4 97

 

 

Non-Federal Clinical Trials (00):  These are non-federally funded clinical trials that do involve human subjects.

 

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
00 01 D5 95

 

 

 

Department Administration (40):  Administrative and supporting services that benefit common or joint departmental activities. Departmental administration costs must benefit two or more departmental activities or objectives.  Includes activities such as:

  • Department Chair and Division Chief /effort appropriate for the size and complexity of the Department or section.
  • Preparation of competitive grant proposals.
  • Participation in school/division/department committees
  • Review of department accounts and financial statements.
  • Selection/training of general staff
  • Selection/recruitment of faculty
  • Planning for building projects or renovations
  • Administrative and clerical titles that are typically included are administrative assistants, accountants, office managers, Executive Directors
  • Research or grant administrators benefiting both organized and departmental research.

 

Excludes: Supervision of residents or administration of a single function.  For example coders, medical assistants, billing staff should be classified as clinical (15) while credentialing and enrollment staff should either be affiliated hospital or Non-affiliated hospital (56, 57, 58, 59).

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
40 01 40 89

 

 

 

Academic Support: “includes expenditures for activities specifically designed and carried out to provide administrative and management support to the academic programs… It includes the expenditures of  academic deans … but does not include the expenditures of department chairmen (which are included in the appropriate primary function categories).”

 

Included:

Activities categorized as Academic Support include but are not limited to:

Administrative activities with a School-wide scope, usually reporting to a Dean, that support multiple missions, and

Recharge centers, whether in central administration or in departments, unless the mission of the center benefits only particular functions (see exclusion in (c) below).

 

Excluded:

(a) Administrative activities within academic departments that support multiple missions should be coded as Departmental Administration.  Note that Recharge Centers are the only activity within academic departments that should be coded as Academic Support.

 

(b) Departmental libraries (i.e. libraries maintained at a level below the School-wide level) should be coded as Departmental Administration.

 

(c) Recharge centers that provide services or materials that benefit only selected functions should be coded as the function(s) that benefit, not academic support.  For example, the Center for Clinical Studies benefits only clinical trials and research studies.

 

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
00 04 00 89

 

 

 

Operations and Maintenance of Physical Plant: Expenses that have been incurred by a central service organization or at the departmental level for the administration, supervision, operation, maintenance, preservation, and protection of the institution’s physical plant. They include expenses normally incurred for such items as janitorial and utility services, repairs and ordinary or normal alterations of buildings, furniture and equipment; care of grounds, maintenance and operations of buildings and other plant facilities; security; earthquake and disaster preparedness; environmental safety; hazardous waste disposal; property, liability, and all other insurance relating to property; space and capital leasing; facility planning and management; and, central receiving.

 

 

Included are:

(a) Operation and Maintenance of Physical Plant expenses are those costs that have been incurred by a department for the continual operation and maintenance of the University’s physical plant.

 

 

(b) The salary and other associated costs of custodians, security forces, machinists and electricians etc.

 

 

Payroll Object Code FIS A-21 Category Code
(424 Code)
FIS Function Code
(450 Code)
Space Indirect Cost
(IDC) Code
00 07 00 86

 

 

 

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