HIT218 CH18
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| What did Medicare do in the mid 1960's? | It encouraged hospitals to provide services without regard to cost because most costs were reimbursed under the medicare reimbursement program.
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| HCFA | Health Care Finance Administration
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| CMS | Centers for Medicare and Medicaid Services
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| prospective payment system (PPS) | attempted to balance the payments made for the same services rendered by different providers and pay the providers on the basis of the diagnosis at a fixed rate
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| DRG's | diagnosis related groups
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| third party payer | the insurance company - pays for services provided by health care organizations or practitioners to the "insured"
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| RBRVS | resource based relative value scale
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| HMO | health maintenance organizations
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| PPO | preferred provider organizations
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| GAAP | generally accepted accounting principles
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| HCPCS | health care procedure coding system
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| participating proveder | a provider that has come to terms with a payer an dis under an approved contractual agreement
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| NCQA | national committee for quality assurance
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| CLIA | clinical laboratory improvement amendment
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| CLIA mandates what? | the completeion of a certification process before obtaining billing privileges
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| IRS | internal revenue service
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| HIPAA | health insurance portability and accountability act
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| NPI | national provider identifier
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| master charge list, charge master, charge description master (CDM) or fee schedule | this list reflects the charge for each item that may be used in the treatment of a patient and the charge for most services
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| the revenue cycle is composed of | an interwoven system with multiple participants and systems
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| PHI | personal health information
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| claim edits include | correct patient or subscriber info, CCI edits, LMRP edits...
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| EDI | electronic data interchange
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| ANSI | American National Standards Institute
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| COB | coordination of benefit
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| RA | remittance advice
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| EOB | explanation of benefits
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| ERA | electronic remittance advice
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| payments are deposited by? | hardcopy check or EFT
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| EFT | electronic funds transfer
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| DRG's are an example of? | a per case or fixed payment system
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| when a patient balance is referred to collection and written off as a bad debt what is it's status? | it is no longer an active accounts receivable.
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| A/R days | average time to receive payment
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| A/R aging | distribution of accounts receivable by aging days
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| collection rate | effectiveness of collecting
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| payer mix | distribution of revenue by payers
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| denial rate | number or dollars of denied clains
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| bad debt rate | write-offs due to bad debt
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| charity rate | write-offs due to charity
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| capitation | used in HMO's
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| case mis index for the period = | total value of service/total number of cases
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| total value of service = | case mix value x number of cases in the period
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| PCAOB | public company accounting oversight board
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| CMS | centers for medicare and medicaid services
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| medicare fraud is defined as | making false statement or representation sof material facts to obtain a benefit or payment for which no entitlement would otherwise exist. Fraud is committed knowingly
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| medicare abuse is defined as | using practices that are insonsistent with accepted medical practice and directly or indirectly result in unnecessary costs to the medicare program. it is not required that the acts were committed knowingly
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| AHIMA | American health information management association
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| HIM professionals responsibility | refuse to participate in or conceal unethical practices or procedures
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| AICPA | American institute of certified public accountants
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| ONCHIT | office of the national coordinator for health information technology
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| managerial accounting | provides economic informatiojn and an dinternal framework to enable health care leaders to make effective decisions concerning the activities and overall performance within an organization
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| mission | a statement of the organizations purpose in broad terms
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| goal | a statement of what the organization wants to do
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| objectives | are more specific statments that define the expectations of outcomes given the goal direction
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| action steps | define the dates when certain activities are to be completed, how much labor or funding will be required, how resources will be used, and the expected outcomes or results
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| budgets | detailed numerical documents that translate the goals, objectives and actions steps into forecasts of volume and monetary resources needed
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| statistics budget | the first of several budgets developed from the planning process
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| operating budgets | predict the labor, supply and other expenses required to support the work volume predicted
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| fixed expenses | those that are not related to the volume of business
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| variable expenses | those that fluctuate as a result of changes in volume
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| master budget | consolidation of all departments operating budgets, catergories of expenses and revenues
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| rolling budget method | requires management to prepare a budget for a period of time and add to the end of tha period another month when a month is consumed
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| flexible budget | predicated on volume, all supplies labor and other variable expenses are bugdgeted in proportion to the anticipated volume
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| zero based budget | management must complete a program assessment and define consequences if specific programs are terminated or reduced
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| controlling | activities that management typically pursues when what was planned does not occur financially
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| variance report | reflects the budget that was prepared and approved and shows that actual results on at least a monthly basis
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| business plan | a formal written document that evolves from the input of others, listing objectives that support the organizational goals
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| productive time | the time a worker is present and working
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| the four m's | manpower machinery materials money
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| cost allocation system | determines the approximate costs to provide services
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| step down method | a common method that is supported by Medicare in its cost reporting req's, the indirect department that receives the least amount of service from other indirect departments and provides the most service to other departments has its costs allocated first
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| double distribution method | assumes that the allocation of costs cannot be linear and the at some indirect departments need to be allocated to less commonly dispersed departments before the costs of these departments are fully allocated
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| simultaneous equations method ( aka algebraic or multiple apportionment method) | permits multiple allocation to occur through sophisticated mathematical software and teh use of simultaneous mathematical equations
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| financial accounting | recording and reporting the financial transactions of the organization for both internal management and users outside of the organization
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| FASB | financial standards accounting board
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| GASB | government accounting standards board
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| entity | the business unit or activity for which accountingrecords are maintained
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| going concern | assumes that the owners of a business entity will continue operating indefinitely to fulfill the business plans of the organization
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| stable monetary unit | in the US it is the US dollar
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| matching concept | recognizes that any associated expenses such as labor, supplies, and travel would be recorded in the same accounting period and matched with the revenue for that accounting period
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| objectivity | states that historical cost is a more objective measure than current value
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| disclosure | an entity's financial statements provide a mechanism to communicate the economic activities of an organization
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| financial accountant, managerial accountant, and managerial finance officer | all cover different aspects of financial management
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| cash basis accounting | each transaction is recorded when cash is exchanged as with one's personal finances
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| accrual basis accounting | uses the matching concept, enabling revenues to be matched with the actual expenses incurred to produce the revenue
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| profit | the amount of money actually received from the payer less the actual cost to do the service
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| AHA | American hospital association
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| balance sheet displays | the organization's assets, liabilities, and fund balance or equity at a fixed point in time
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| assets - liabilities = | fund balance (equity)
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| statement of revenues and expenses | revenue - expense = net income
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| financial analysis or ratio analysis | the management process of formulation judgements and decisions from the relation between the numbers represented on two reports: the balance sheet and the statment of revenues and expenses
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| current ratio | current assets with current liabilities
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| turnover ratio | divides patient accounts receivable by the average daily patient revenues
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| net days of revenue in patient accounts receivable = | net patient accounts receivalbe / average daily net patient service revenue
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| average net daily patient service revenue = | net patient service revenue for the period / days in the period
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| performance ratio | evaluates that use of resources to achieve a goal
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| operating margin ratio | displays the relation between the net revenues received and the expenses required to supply the revenues
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| net operating revenue | the amount of revenue expected to be received or total charges less the deductions expected by third party payers resulting in revenues net of deductions or net operating revenue
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| long term debt / total assets ratio | compares the amount of long term debt the organization has with the amount of assets it has to pay those debts
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| CFO | chief financial officer
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| capital expenditure committee | evaluates all capital requests so that cash resources are sued to purchase the high cost items that will yield the most benefit to the organization
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| opportunity costs | benefits that would be received from the next best alternative use of the investment funds
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| time value of money | a person who invests money should be entitled to a return or interest
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| depreciation | calculated by dividing the capital cost by the years of life
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| payback method | the payback period determines the number of years it will take for the cash inflows from each project to pay back the initial investment (cash outflow)
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