Does MIRR lead to the same accept/reject decision for this project as the NPV method?
The managers disagree about whether the tractor would last 5 years. A list of medical services covered by an insurance policy. Implement - implement processes that are patient-centric and efficient, especially in the areas of registration, admitting, and financial counseling, The customer's passing on information about negative experience to potential patients or through social media, Common Healthcare Revenue Cycle Software Applications, Collaboration between Finance and Revenue Cycle, Decision support and cost reporting department is usually responsible for compliance with state and federal reimbursement reporting requirements, Collaboration between Health Plan Contracting and Revenue Cycle, - Each contract must be reviewed to accurately load contract terms into the patient accounting system, Collaboration between Clinical Services and Revenue Cycle, Make sure registration is completed smoothly, insurance is collected, co-pay is collected, Way of coordinating and linking healthcare resources to avoid duplication, thus facilitating a seamless movement among care settings, Scheduling appointment, obtaining pre-authorizations, writing the appointment order, timeliness of all reporting, Must be physically separated from the rest of the hospital, Must provide one or more of the following, A home providing care for the sick, especially the terminally ill, Compliance guidance documents cover certain risk areas, Fraud Enforcement and Recovery Act of 2009 (FERA), - Expands both the potential for liability under the False Claims Act (FCA) and the government's investigative powers, Essential Elements in a Corporate Compliance Program, 16 Essential Elements of a Effective Corporate Compliance Program, 1. Plot the projects NPV profile. 1.Patients name. What is the fifth step In The billing revenue cycle? At WACC=20%? Insurance information obtained by the medical office specialist: Nick's life policy lapsed, which Nonforfeiture option would allow the insurer to use the cash value to buy a whole life policy. Why do U.S. corporations build manufacturing plants abroad when they can build them at home? b. Explain your reasoning. Assuming each of the indicated lives has the same probability of occurring probability =1/3), what is the tractor's expected NPV? How will the company respond? Briefly explain what is meant by the term efficiency continuum. What is the eighth step in the revenue cycle?
a list of the medical services covered by an insurance policy, payment method based on provider's charges, the percentage of each claim that an insured person must pay, recognition of a superior level of skill by an official organization, an amount that an insured person pays at the time of a visit to a provider. a managed care network of providers under contract to provide services at discounted fees, health plan that protects beneficiaries against losses, actions that are performed to satisfy official requirements, type of medical insurance combining a high-deductible health plan and a medical savings plan, a method by which organizations pay for health insurance directly and set up a fund from which to pay. \text{Year} & \text{EPS} & \text{Year} & \text{EPS}\\ Which website is likely to provide accurate and thorough information. If interest rates rise after a bond issue, what will happen to the bonds price and YTM? Jane bought a life insurance policy and concealed that she had stage four breast cancer on the application. Nurses must be able to discriminate websites as relevant and current. A clearinghouse is a company that helps medical offices and health plans exchange?
The major government-sponsored health programs are ____, When a patient has insurance coverage for which the practice will create a claim, the patient bill is usually done _______, after the encounter and after the payer's payment is posted. Indicate whether each of the following actions will increase or decrease a bonds yield to maturity: a. The DINK method of determining life insurance needs recommends adding an additional insurance cushion if your spouse is. The service manager then states that some last for as long as 8 years. a self-insured health plan may use its own _____. \begin{matrix} The following table gives Foust Companys earnings per share for the last 10 years. The major government-sponsored health programs are: TRICARE, CHAMPVA, Medicare, and Medicaid. Cash inflows of$13 million would occur at the end of Year 1. Which sections of the insured's policy will pay? \text{2009} & \text{4.55} & \text{2014} & \text{6.38}\\
The process or cycle of managing claims,payment, and revenue.
process of converting electronic info into an unreadable format before it is distributed, under the HIPAA Privacy Rule, impermissible use or disclosure that compromises the security or privacy of PHI that could pose a significant risk of financial, reputational, or other harm to the affected person, document used by a covered entity to notify individuals of breach in their PHI required under the new HITECH breach notification rules, HIPAA Electronic Health Care Transaction and Code Set (TCS), the HIPAA rule governing the electronic exchange of health info, updated electronic data standard for transmitting HIPAA X12 documents, such as the HIPAA claim (X12 837), that replaces ASC X12 Version 4010 beginning in Jan. 2012, alphabetic and/or numeric representations for data; a medical code set is a system of medical terms required for HIPAA transactions, HIPAA mandated identification systems for employers, health care providers, health plans, and patients; national provider system and employer system are in place; health plan and patient systems have not been created, are numbers of predetermined length and structure such as social security numbers, under HIPAA system for identifying all health care providers using unique ten-digit identifiers, Health Care Fraud and Abuse Control Program, government program to uncover misuse of funds in federal health care programs run by the Office of the Inspector General, intentional act of deception to take financial advantage of another person, actions that improperly use another person's resources, practice management application within Medisoft Clinical, electronic health record application within Medisoft Clinical, name that an individual uses for identification purposes when logging onto a computer or an application, security option that determines the areas of the program a user can access, and whether the user has rights to enter or edit data, privacy and security feature in MCPR that allows a user to leave a workstation for a brief time without having to exit the program, feature of MNP that automatically logs a user out of the program after a period of inactivity, folder that contains all records pertaining to a patient, panel in MCPR that offers providers a convenient view of important info, patient's description of the symptoms or reasons for seeking medical care, list all services performed, along with the charges for each service, the amount paid by the health plan and the remaining balance that is the responsibility of the patient, plan for resuming normal operations after a disaster such as a fire or a computer malfunction, making a copy of data files at a specific point in time that can be used to restore data, process of retrieving data from a backup storage device, a collection of up-to-date technical info. Does the time to maturity affect the extent to which interest rate changes affect the bonds price? What information should be recorded for the patient's history? The common stock, 7.8 million shares outstanding, is now (1/1/17) selling for $65.00 per share. What is the third step in the billing revenue cycle? \text{2008} & \text{4.21} & \text{2013} & \text{6.19}\\ law that requires covered entities to establish administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of health info, electronic protected health information (ePHI), PHI that is created, received, maintained, or transmitted in electronic form, the administrative actions that a covered entity must perform, or train staff to do, to carry out security requirements; include implementing office policies and procedures to prevent, detect, contain, and correct security violations, mechanisms to protect electronic systems, equipment, and data from threats, environmental hazards, and unauthorized intrusion; reinforced doors, locks;, and identification badge readers, the technology and related polices and procedures used to protect electronic data and control access to it; firewalls, intrusion detection systems, access control, and antivirus software. 2.encounter date and reason. These models may lead to higher quality and more coordinated care at a lower cost, - The episode of care is defined as the inpatient stay in the acute care hospital, - Involved a retrospective bundling payment arrangements were actual expenditures are reconciled against a target price for an episode of care, - Involves a retrospective bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care, - CMS makes a single, prospectively determined bundled payment to the hospital that provides all services, which lasts the entire inpatient stay, - Aims to support better and more efficient care for those undergoing hip and knee replacements (lower extremity joint replacement or LEJR), Ambulatory care measures have also been developed by CMS working in an extensive process with the American Medical Association's Physician Consortium for Performance Improvement and the National Committee for Quality Assurance to measure improvements in care, - The Securities and Exchange Commission (SEC), To present information that may be useful in determining the financial status of an organization, A financial statement that ties directly to the balance sheet and shows the revenue and expenses for a fiscal period, A financial statement that reports assets, liabilities, and owner's equity on a specific date, A financial statement that shows how cash was used and where it was obtained, Accounting that records revenue when it's earned, regardless of whether the transaction affected cash, Revenue and expenses are recognized at the time the business receives the cash or pays a bill, A system for recording financial statement data that categorizes accounts as restricted or unrestricted, Gross revenue is the total charges entered for all patients for the services they received, To determine net revenue, financial services must estimate the dollar amount of contractual, discount, or other allowances that will be applied against those revenues.
Given this discussion, the CFO asks you to prepare a scenario analysis to determine the importance of the tractors life on the NPV. )$ $$ records that show who has accessed a computer or a network and what operations were performed. (Note that 9 years of growth are reflected in the 10 years of data. d. The economy seems to be shifting from a boom to a recession. What is the fourth step in the billing revenue cycle? \text{2011} & \text{5.31} & \text{2016} & \text{7.80}\\ Why is it important for a company to collect both primary and secondary data when conducting marketing research? Things to consider when determining net revenue: To estimate net receivables, the following "reserves" are estimated and deducted from gross receivables, Reserve Amounts on a Provider's Financial Statement, Reserve amounts are reported on the provider's financial statement as, - Accurate calculation and reporting of contractual allowances and self-pay discounts as well as adjustments to the charity and bad debt provisions result in the accurate reporting of both net patient service revenue and net accounts receivable, - Provision for bad debt is deducted from the total accounts receivable, Deduction impacts the recoverable amount of the accounts receivable and is presented as a provision for charity services that reduces gross revenue and an allowance for charity care reduces the accounts receivable, - If insufficient amounts of A/R are reserved, then the provider can be caught off guard with expenses exceeding available funds, Ability to post adjustments at the time of billing increases the accuracy of the receivable and minimizes the need to estimate contractual reserves, KPI's set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R, HFMA MAP Keys are strategic key performance indicators that set the standard for patient-centric revenue cycle excellence in the healthcare industry, Techniques to Measure Accounts Receivable. Some ways to measure accounts receivable include: Used to measure how fast receivables are collected and is a trending indicator of overall A/R performance and revenue cycle efficiency, A/R days calculation can also be completed for specific payers to evaluate the collection efficiency and payment progress on 3rd-party health plans or self-pay patients, - Aging reports divide the accounts receivable into 30,60,90, 230 days and over categories, Failure to complete comprehensive access processing either pre-service or at the time-of-service, Techniques to Measure Accounts Receivables, The portion of accounts receivable that identifies charges for patients where services are completed but the provider has not been able to bill the claim, - The "Suspense" period in billing systems allow the completion of these activities before a claim qualifies for billing, Final Billed Not Submitted to Payer (FBNS), - Recognizes that claims may be held in a claim scrubber for additional editing prior to being released to payor, Revenue cycle cost/total patient service cash collected, - KPI also known as the net collection rate, Represents the % of patient cash collected at or up to 7 days after an occasion of service as a % of total self-pay cash collected, Less than 2% of claims should be denied on the first submission, - The dollars in credit balance at the account level divided by the 3 month daily average of total net patient service revenue, what are the key component of failure to rescue.
(Thus, annual cash flows would be$12,000 before taxes plus the tax savings that result from $7,200 of depreciation.) How does increased levels of CO2 dissolving into the ocean affect animals that have shells made from calcium carbonate. \text{2010} & \text{4.91} & \text{2015} & \text{7.22}\\ A computerized lifelong heath care record for an individual that incorporates data from all sources that provide treatment for individual. In an HMO with a gatekeeper system, a(n) _________ coordinates the patient's care and provides referrals. $$ d. What is the projects MIRR at WACC=10%? An organization that contracts with a network of providers for the delivery of health care for a prepaid premium. What is the sixth step in the billing revenue cycle? A self-insured health plan may use its own_____. includes all of the major processing steps required to process a patient account from the request of service through closing the account with a zero balance and purging it from the system, Scheduling and pre-access processing set the stage for effective patient communication and data collection, For scheduled patients, a final account review is completed prior to the patient's arrival, Post-Service includes account activities that occur after the patient is discharged until the account reaches a zero balance, When and Where to Have a Patient Financial Discussion, For routine scenarios, such as patients with insurance coverage or known ability to pay, financial discussion should take place between the patient or guarantor and properly trained provider representatives, For non-routine or complex scenarios, such as uninsured or underinsured patients, a financial counselor or supervisor should be involved, - Patients should be told with the type of service providers who typically participate in a service, - Provider organization should have clear policies about prior balances, and should make those policies available to the public, - When patient that prior balance is, discussions should focus on steps toward amicable resolution, - Price transparency has evolved based on providers need to easily provide pricing information to patients, The problem is that the charge Master list the total charge, not net charges after the provider adjustment, Price transparency is taking the charge for service based on the CPT/hcpcs or ms-drg code in a hospital contract terms and the patients benefit plan to the charges to determine and accurate patient liability, 1. The land must be returned to its natural state at a cost of $12 million, payable at the end of Year 2. a. Unlike an HMO, a PPO permits its members to use ______ providers, but at a higher cost.
Educate - educate patients and follow best practices for communication, - Be consistent in key aspects of account resolution, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), - CMS implemented value-based purchasing program that has increasingly highlighted a focus on core measures, 1. How much has earth warmed since the industrial era began? Which of the following combines a health plan that has a high deductible and low premiums with a special "saving account" that is used to pay medical bills before the deductible has been met? Prescription Opioid Drug Abuse and Misuse Prevention - Prescription Drug Monitoring Programs, Health Insurance Portability and Accountability Act (HIPAA), - Expand health coverage by improving the portability and continuity of health insurance coverage in group and individual markets, HIPAA Standard Unique Employer Identifier, - A unique employer identifier is required under HIPAA, The National Provider Identifier (NPI) is a HIPAA Administrative Simplification Standard, - Develop written policies and procedures including a description of staff who have access to protected info, how it'll be used, when it may be disclosed, Health Information Technology for Economic and Clinical Health (HITECH) Act, Enacted as a part of the American Recovery Act of 2009 and was signed into law on February 17, 2009 to promote the adaption and meaningful use of health information technology, Electronic Protected Health Information (ePHI), PHI that is created, received, maintained or transmitted in electronic form, All diagnostic services provided to a Medicare beneficiary by a hospital on the date of the beneficiary's inpatient admission or during the 3 calendar days (in the case of non-IPPS, 1 day) immediately preceding the date of admission are required to be included on the bill for the inpatient stay, unless no Part A coverage, This statute clarifies that all outpatient services that aren't diagnostic service provided to a Medicare beneficiary by a hospital, "Related" outpatient services include all non diagnostic services unless the hospital attests that the services are clinically unrelated to the later inpatient stay, Payment delays occur when the required bundling of services isn't done and individual claims are submitted to the Medicare Administrative Contractor (MAC), -- Medicare only pays for medically necessary services so providers are expected to screen outpatient services for compliance with Medicare coverage rules, - Must inform beneficiary ASAP that he/she will have to cover the payment if Medicare won't pay, - Traditionally, providers decide to admit a patient as inpatient, - Traditionally, certain payers have always been liable for payments of claims so Medicare does not make a secondary payment, If the patient is 65 or older and employed and has coverage through workplace, Medicare is secondary, Medicare Secondary Payer - Accident or Other Liability, - When a patient needs medical care as the result of an accident, a liability health plan may be responsible for payment, Patient is eligible for Medicare due to a disability, is under the age of 65, and has group health insurance through a large group health plan (LGHP), Medicare Secondary Payer - End-Age Renal Disease (ESRD), Patient has permanent kidney failure, is covered by a GHP, and has not completed the 30-month coordination period, - Purpose of the CCI is to ensure that the most comprehensive groups of codes, rather than the component parts, are billed, - Using a modifier allows a hospital to indicate a specific circumstance that has affected a procedure or service without changing its definition or code, Modifiers may be used to indicate to the recipient of a claim that a service or procedure, Providers don't use modifiers if the narrative definition of a code indicates multiple occurrences, Modifiers used for Outpatient Prospective Payment System, Modifiers used for OPPS have different levels, they are, - Usually provide information about performance of a procedure, although there are exceptions, - Provide additional detail about an anatomical location or about a procedure or service, Revenue Cycle Staff and Leadership Must Ensure in regards to Ethics, - Adherence to an organization's mission statement, ethical standards and values statement, Employees of providers are required to learn and apply proper procedures to ensure protected health information is secure, - The Patient Protection and Affordable Care Act or ACA, was signed into law in 2010, Reformation of the healthcare delivery system includes, Center for Medicare and Medicaid Innovation, - Charged with the ongoing development of new models for delivery and payment of services, An ACO is a delivery system of physicians, hospitals, and other healthcare providers, who work collaboratively to manage and coordinate the care of patient population, Other Non-demonstration Pay-for-Performance Programs, 1. b. Because investors expect past trends to continue, g may be based on the historical earnings growth rate. for a patient exam, gathers info-patients current medications and allergies and reason for visit, patients vitals signs (blood pressure, temp, oxygen level and pulse) and weight and height and records it all, reviews records, enters room, discussed reason for visit, and completes a physical exam, care to keep diseases from occurring or to enable early detection and treatment (routine annual physical exam, immunizations, screening tests, and behavioral counseling), provided for illnesses with a sudden onset that are time limited not expected to continue more than a few days or weeks (recovery from a broken bone); provided in a hospital, treated over the long term (heart disease, diabetes asthma, and AIDS), organizing a patient's health record in chronological order, using a systematic, logical, and consistent method; the record created when a physician provides treatment to a patient, a chronological health care record that includes info that the patient provides, such as medical history, as well as the physician's assessment, diagnosis, and treatment plan, a patient expected to require an overnight stay in a hospital, refers to treatment that is provided without admission to a hospital in settings such as physician practices, hospital emergency rooms, and clinics for outpatients, eight data points included in an ambulatory care medical records.
A mining company is deciding whether to open a strip mine, which costs $2 million.
What happens to the overall annual premium cost once a term rider expires? The treasurer agrees with the controller, but he argues that most tractors do give 5 years of service. \end{matrix} If a patient's payment is later than permitted under the financial policy of the practice, the ____ may be started. Should the project be accepted if WACC=10%? Does the MIRR method always lead to the same accept/reject decision as NPV? The bond is downgraded by the rating agencies. Chick Fil A targets families who eat out at least once a week and are frequently exposed to Chick Fil A's advertising strategies. What is the most commonly used drug among teenagers. A method by which organizations pay for health insurance directly and set up a fund from which to pay. In an HMO, securing _________ may be required before services are provided. List at least four important skills of medical insurance specialists. Self-reporting of adverse administrative events and recommendations regarding corrective action may preempt or mitigate the need for sanctions, - The establishment of compliance standards and procedures is best accomplished by an organization's code of conduct, Code of conduct can help reduce weaknesses by helping employees and agents understand their roles and responsibilities while fostering an environment where concerns and questions are raised without fear of retaliation or retribution, The Chief Compliance Officer (CCO) oversees the Code of Conduct, Created to protect the integrity of the Health and Human Services Department programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste, and abuse, - Identify opportunities to improve program economy, efficiency, and effectiveness, OIG publishes an annual statement of work for the upcoming year and updates it, as needed, on a monthly basis, 1. What is the ninth step in the billing revenue cycle? The son has medical expenses and there is damage to the skateboard. a computerized lifelong healthcare record for an individual that incorporates data from all sources that provide treatment for the individual. Your firm, Agrico Products, is considering a tractor that would have a cost of $36,000, would increase pretax operating cash flows before taking account of depreciation by$12,000 per year, and would be depreciated on a straight-line basis to zero over 5 years at the rate of $7,200 per year beginning the first year. Health plan that protects beneficiaries against losses. coordination of care received by a patient over time and across multiple health care providers, the provision of medical services at a less than acceptable level of professional skill that results in injury or harm to a patient, provision of financial incentives to physicians who provide evidence-based treatments to their patients, may be used as evidence in a legal matter involving a patient or provider, individuals and institutions in the health care field must regularly evaluate the adequacy and appropriateness of the care they deliver, info collected during a patient visit is used by medical researchers to develop new methods of treatment and to compare the effectiveness of existing treatments, case studies are used to train a wide range of health professionals are developed with info from patient encounters, determine the incidence of disease and in developing methods to improve the health of the population, physician practices are businesses as well as centers for patient care, computerized record of one physician's encounters with a patient over time, private, secure electronic health care files that are created, maintained, and owned by the patient; include current medications and dosages, health insurance info, immunization records, allergies, medical test results, past surgeries, family medical history, function and uses electronic health records (EHR), 1.Health info and date elements 2.results management 3.order management 4.decision support 5.electonic communication and connectivity 6.patient support 7.administrative processes 8.reporting and population management, Advantages of electronic health records (EHR), implementation issues for electronic health records (EHR), cost, lack of standards, training and workflow issues, privacy and security risks, follow up on the status of claims being adjusted, the movement of monies into and out of a business, a ten-step process that results in timely payment for medical services, 1.preregister patient 2.establish financial responsibility for visit 3.check in patients 4.review coding compliance 5.review billing compliance 6.check out patients 7.prepare and transmit claims 8.monitor payer adjudication 9.generate patient statements 10.follow up payments and collections, a code that represents the physician's determination of a patient's primary illness, a code that represents the particular service, treatment, or test provided by a physician, treatment that is in accordance with generally accepted medical practice, management of the activities associated with a patient encounter to ensure that the provider receives full payment for services, a collection of data that includes all areas of an organization's operations, the process of analyzing large amounts of data to discover patterns or knowledge, a plan for the management of records that lists types of records and indicates how long they should be kept, staff members who provide treatment to patients include: physicians, physician assistants, nurses, medical assistants, staff members who manage the business aspects of health care include: medical billers and coders, receptionist, practice managers, compliance officers, and anyone else who works behind the scenes in a medical office, do not provide medical treatment or testing, health care professional who performs both administrative and clinical tasks in physician offices, health care professional who performs administrative tasks throughout the medical billing cycle, medical office staff member who specialized training who handles the diagnostic and procedural coding of medical records, nationally recognized designation that acknowledges that an individual has mastered a standard body of knowledge and meets certain competencies, sessions are assigned course credits by the credentialing organizations, and satisfactory completion of a test on the material is often required, state-specified performance measures for the delivery of health care by medical professionals, if either patient or physician ends the relationship, the physician must still maintain, Centers for Medicare and Medicaid Services (CMS), federal agency in the Department of Health and Human Service that runs Medicare, Medicaid, clinical labs, and other government health programs; responsible for enforcing all HIPAA standards other than the privacy and security standards, health care providers are liable (legally responsible) for providing medical standards of care to their patients, computer-to-computer exchange of routine business info using publicly available electronic standards, Health Information Technology for Economic and Clinical Health (HITECH) Act, provisions in the American Recovery and Reinvestment Act (ARRA) of 2009 that extend and reinforce HIPPA and contain new breach notification requirements for covered entities and business associates, guidance on ways to encrypt or destroy PHI to prevent a breach, requirements for informing individuals when a breach occurs, higher monetary penalties for HIPAA violations, and stronger enforcement of the Privacy and Security Rules, 1.
The managers disagree about whether the tractor would last 5 years. A list of medical services covered by an insurance policy. Implement - implement processes that are patient-centric and efficient, especially in the areas of registration, admitting, and financial counseling, The customer's passing on information about negative experience to potential patients or through social media, Common Healthcare Revenue Cycle Software Applications, Collaboration between Finance and Revenue Cycle, Decision support and cost reporting department is usually responsible for compliance with state and federal reimbursement reporting requirements, Collaboration between Health Plan Contracting and Revenue Cycle, - Each contract must be reviewed to accurately load contract terms into the patient accounting system, Collaboration between Clinical Services and Revenue Cycle, Make sure registration is completed smoothly, insurance is collected, co-pay is collected, Way of coordinating and linking healthcare resources to avoid duplication, thus facilitating a seamless movement among care settings, Scheduling appointment, obtaining pre-authorizations, writing the appointment order, timeliness of all reporting, Must be physically separated from the rest of the hospital, Must provide one or more of the following, A home providing care for the sick, especially the terminally ill, Compliance guidance documents cover certain risk areas, Fraud Enforcement and Recovery Act of 2009 (FERA), - Expands both the potential for liability under the False Claims Act (FCA) and the government's investigative powers, Essential Elements in a Corporate Compliance Program, 16 Essential Elements of a Effective Corporate Compliance Program, 1. Plot the projects NPV profile. 1.Patients name. What is the fifth step In The billing revenue cycle? At WACC=20%? Insurance information obtained by the medical office specialist: Nick's life policy lapsed, which Nonforfeiture option would allow the insurer to use the cash value to buy a whole life policy. Why do U.S. corporations build manufacturing plants abroad when they can build them at home? b. Explain your reasoning. Assuming each of the indicated lives has the same probability of occurring probability =1/3), what is the tractor's expected NPV? How will the company respond? Briefly explain what is meant by the term efficiency continuum. What is the eighth step in the revenue cycle?
a list of the medical services covered by an insurance policy, payment method based on provider's charges, the percentage of each claim that an insured person must pay, recognition of a superior level of skill by an official organization, an amount that an insured person pays at the time of a visit to a provider. a managed care network of providers under contract to provide services at discounted fees, health plan that protects beneficiaries against losses, actions that are performed to satisfy official requirements, type of medical insurance combining a high-deductible health plan and a medical savings plan, a method by which organizations pay for health insurance directly and set up a fund from which to pay. \text{Year} & \text{EPS} & \text{Year} & \text{EPS}\\ Which website is likely to provide accurate and thorough information. If interest rates rise after a bond issue, what will happen to the bonds price and YTM? Jane bought a life insurance policy and concealed that she had stage four breast cancer on the application. Nurses must be able to discriminate websites as relevant and current. A clearinghouse is a company that helps medical offices and health plans exchange?
The major government-sponsored health programs are ____, When a patient has insurance coverage for which the practice will create a claim, the patient bill is usually done _______, after the encounter and after the payer's payment is posted. Indicate whether each of the following actions will increase or decrease a bonds yield to maturity: a. The DINK method of determining life insurance needs recommends adding an additional insurance cushion if your spouse is. The service manager then states that some last for as long as 8 years. a self-insured health plan may use its own _____. \begin{matrix} The following table gives Foust Companys earnings per share for the last 10 years. The major government-sponsored health programs are: TRICARE, CHAMPVA, Medicare, and Medicaid. Cash inflows of$13 million would occur at the end of Year 1. Which sections of the insured's policy will pay? \text{2009} & \text{4.55} & \text{2014} & \text{6.38}\\
The process or cycle of managing claims,payment, and revenue.
process of converting electronic info into an unreadable format before it is distributed, under the HIPAA Privacy Rule, impermissible use or disclosure that compromises the security or privacy of PHI that could pose a significant risk of financial, reputational, or other harm to the affected person, document used by a covered entity to notify individuals of breach in their PHI required under the new HITECH breach notification rules, HIPAA Electronic Health Care Transaction and Code Set (TCS), the HIPAA rule governing the electronic exchange of health info, updated electronic data standard for transmitting HIPAA X12 documents, such as the HIPAA claim (X12 837), that replaces ASC X12 Version 4010 beginning in Jan. 2012, alphabetic and/or numeric representations for data; a medical code set is a system of medical terms required for HIPAA transactions, HIPAA mandated identification systems for employers, health care providers, health plans, and patients; national provider system and employer system are in place; health plan and patient systems have not been created, are numbers of predetermined length and structure such as social security numbers, under HIPAA system for identifying all health care providers using unique ten-digit identifiers, Health Care Fraud and Abuse Control Program, government program to uncover misuse of funds in federal health care programs run by the Office of the Inspector General, intentional act of deception to take financial advantage of another person, actions that improperly use another person's resources, practice management application within Medisoft Clinical, electronic health record application within Medisoft Clinical, name that an individual uses for identification purposes when logging onto a computer or an application, security option that determines the areas of the program a user can access, and whether the user has rights to enter or edit data, privacy and security feature in MCPR that allows a user to leave a workstation for a brief time without having to exit the program, feature of MNP that automatically logs a user out of the program after a period of inactivity, folder that contains all records pertaining to a patient, panel in MCPR that offers providers a convenient view of important info, patient's description of the symptoms or reasons for seeking medical care, list all services performed, along with the charges for each service, the amount paid by the health plan and the remaining balance that is the responsibility of the patient, plan for resuming normal operations after a disaster such as a fire or a computer malfunction, making a copy of data files at a specific point in time that can be used to restore data, process of retrieving data from a backup storage device, a collection of up-to-date technical info. Does the time to maturity affect the extent to which interest rate changes affect the bonds price? What information should be recorded for the patient's history? The common stock, 7.8 million shares outstanding, is now (1/1/17) selling for $65.00 per share. What is the third step in the billing revenue cycle? \text{2008} & \text{4.21} & \text{2013} & \text{6.19}\\ law that requires covered entities to establish administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of health info, electronic protected health information (ePHI), PHI that is created, received, maintained, or transmitted in electronic form, the administrative actions that a covered entity must perform, or train staff to do, to carry out security requirements; include implementing office policies and procedures to prevent, detect, contain, and correct security violations, mechanisms to protect electronic systems, equipment, and data from threats, environmental hazards, and unauthorized intrusion; reinforced doors, locks;, and identification badge readers, the technology and related polices and procedures used to protect electronic data and control access to it; firewalls, intrusion detection systems, access control, and antivirus software. 2.encounter date and reason. These models may lead to higher quality and more coordinated care at a lower cost, - The episode of care is defined as the inpatient stay in the acute care hospital, - Involved a retrospective bundling payment arrangements were actual expenditures are reconciled against a target price for an episode of care, - Involves a retrospective bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care, - CMS makes a single, prospectively determined bundled payment to the hospital that provides all services, which lasts the entire inpatient stay, - Aims to support better and more efficient care for those undergoing hip and knee replacements (lower extremity joint replacement or LEJR), Ambulatory care measures have also been developed by CMS working in an extensive process with the American Medical Association's Physician Consortium for Performance Improvement and the National Committee for Quality Assurance to measure improvements in care, - The Securities and Exchange Commission (SEC), To present information that may be useful in determining the financial status of an organization, A financial statement that ties directly to the balance sheet and shows the revenue and expenses for a fiscal period, A financial statement that reports assets, liabilities, and owner's equity on a specific date, A financial statement that shows how cash was used and where it was obtained, Accounting that records revenue when it's earned, regardless of whether the transaction affected cash, Revenue and expenses are recognized at the time the business receives the cash or pays a bill, A system for recording financial statement data that categorizes accounts as restricted or unrestricted, Gross revenue is the total charges entered for all patients for the services they received, To determine net revenue, financial services must estimate the dollar amount of contractual, discount, or other allowances that will be applied against those revenues.
Given this discussion, the CFO asks you to prepare a scenario analysis to determine the importance of the tractors life on the NPV. )$ $$ records that show who has accessed a computer or a network and what operations were performed. (Note that 9 years of growth are reflected in the 10 years of data. d. The economy seems to be shifting from a boom to a recession. What is the fourth step in the billing revenue cycle? \text{2011} & \text{5.31} & \text{2016} & \text{7.80}\\ Why is it important for a company to collect both primary and secondary data when conducting marketing research? Things to consider when determining net revenue: To estimate net receivables, the following "reserves" are estimated and deducted from gross receivables, Reserve Amounts on a Provider's Financial Statement, Reserve amounts are reported on the provider's financial statement as, - Accurate calculation and reporting of contractual allowances and self-pay discounts as well as adjustments to the charity and bad debt provisions result in the accurate reporting of both net patient service revenue and net accounts receivable, - Provision for bad debt is deducted from the total accounts receivable, Deduction impacts the recoverable amount of the accounts receivable and is presented as a provision for charity services that reduces gross revenue and an allowance for charity care reduces the accounts receivable, - If insufficient amounts of A/R are reserved, then the provider can be caught off guard with expenses exceeding available funds, Ability to post adjustments at the time of billing increases the accuracy of the receivable and minimizes the need to estimate contractual reserves, KPI's set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R, HFMA MAP Keys are strategic key performance indicators that set the standard for patient-centric revenue cycle excellence in the healthcare industry, Techniques to Measure Accounts Receivable. Some ways to measure accounts receivable include: Used to measure how fast receivables are collected and is a trending indicator of overall A/R performance and revenue cycle efficiency, A/R days calculation can also be completed for specific payers to evaluate the collection efficiency and payment progress on 3rd-party health plans or self-pay patients, - Aging reports divide the accounts receivable into 30,60,90, 230 days and over categories, Failure to complete comprehensive access processing either pre-service or at the time-of-service, Techniques to Measure Accounts Receivables, The portion of accounts receivable that identifies charges for patients where services are completed but the provider has not been able to bill the claim, - The "Suspense" period in billing systems allow the completion of these activities before a claim qualifies for billing, Final Billed Not Submitted to Payer (FBNS), - Recognizes that claims may be held in a claim scrubber for additional editing prior to being released to payor, Revenue cycle cost/total patient service cash collected, - KPI also known as the net collection rate, Represents the % of patient cash collected at or up to 7 days after an occasion of service as a % of total self-pay cash collected, Less than 2% of claims should be denied on the first submission, - The dollars in credit balance at the account level divided by the 3 month daily average of total net patient service revenue, what are the key component of failure to rescue.
(Thus, annual cash flows would be$12,000 before taxes plus the tax savings that result from $7,200 of depreciation.) How does increased levels of CO2 dissolving into the ocean affect animals that have shells made from calcium carbonate. \text{2010} & \text{4.91} & \text{2015} & \text{7.22}\\ A computerized lifelong heath care record for an individual that incorporates data from all sources that provide treatment for individual. In an HMO with a gatekeeper system, a(n) _________ coordinates the patient's care and provides referrals. $$ d. What is the projects MIRR at WACC=10%? An organization that contracts with a network of providers for the delivery of health care for a prepaid premium. What is the sixth step in the billing revenue cycle? A self-insured health plan may use its own_____. includes all of the major processing steps required to process a patient account from the request of service through closing the account with a zero balance and purging it from the system, Scheduling and pre-access processing set the stage for effective patient communication and data collection, For scheduled patients, a final account review is completed prior to the patient's arrival, Post-Service includes account activities that occur after the patient is discharged until the account reaches a zero balance, When and Where to Have a Patient Financial Discussion, For routine scenarios, such as patients with insurance coverage or known ability to pay, financial discussion should take place between the patient or guarantor and properly trained provider representatives, For non-routine or complex scenarios, such as uninsured or underinsured patients, a financial counselor or supervisor should be involved, - Patients should be told with the type of service providers who typically participate in a service, - Provider organization should have clear policies about prior balances, and should make those policies available to the public, - When patient that prior balance is, discussions should focus on steps toward amicable resolution, - Price transparency has evolved based on providers need to easily provide pricing information to patients, The problem is that the charge Master list the total charge, not net charges after the provider adjustment, Price transparency is taking the charge for service based on the CPT/hcpcs or ms-drg code in a hospital contract terms and the patients benefit plan to the charges to determine and accurate patient liability, 1. The land must be returned to its natural state at a cost of $12 million, payable at the end of Year 2. a. Unlike an HMO, a PPO permits its members to use ______ providers, but at a higher cost.
Educate - educate patients and follow best practices for communication, - Be consistent in key aspects of account resolution, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), - CMS implemented value-based purchasing program that has increasingly highlighted a focus on core measures, 1. How much has earth warmed since the industrial era began? Which of the following combines a health plan that has a high deductible and low premiums with a special "saving account" that is used to pay medical bills before the deductible has been met? Prescription Opioid Drug Abuse and Misuse Prevention - Prescription Drug Monitoring Programs, Health Insurance Portability and Accountability Act (HIPAA), - Expand health coverage by improving the portability and continuity of health insurance coverage in group and individual markets, HIPAA Standard Unique Employer Identifier, - A unique employer identifier is required under HIPAA, The National Provider Identifier (NPI) is a HIPAA Administrative Simplification Standard, - Develop written policies and procedures including a description of staff who have access to protected info, how it'll be used, when it may be disclosed, Health Information Technology for Economic and Clinical Health (HITECH) Act, Enacted as a part of the American Recovery Act of 2009 and was signed into law on February 17, 2009 to promote the adaption and meaningful use of health information technology, Electronic Protected Health Information (ePHI), PHI that is created, received, maintained or transmitted in electronic form, All diagnostic services provided to a Medicare beneficiary by a hospital on the date of the beneficiary's inpatient admission or during the 3 calendar days (in the case of non-IPPS, 1 day) immediately preceding the date of admission are required to be included on the bill for the inpatient stay, unless no Part A coverage, This statute clarifies that all outpatient services that aren't diagnostic service provided to a Medicare beneficiary by a hospital, "Related" outpatient services include all non diagnostic services unless the hospital attests that the services are clinically unrelated to the later inpatient stay, Payment delays occur when the required bundling of services isn't done and individual claims are submitted to the Medicare Administrative Contractor (MAC), -- Medicare only pays for medically necessary services so providers are expected to screen outpatient services for compliance with Medicare coverage rules, - Must inform beneficiary ASAP that he/she will have to cover the payment if Medicare won't pay, - Traditionally, providers decide to admit a patient as inpatient, - Traditionally, certain payers have always been liable for payments of claims so Medicare does not make a secondary payment, If the patient is 65 or older and employed and has coverage through workplace, Medicare is secondary, Medicare Secondary Payer - Accident or Other Liability, - When a patient needs medical care as the result of an accident, a liability health plan may be responsible for payment, Patient is eligible for Medicare due to a disability, is under the age of 65, and has group health insurance through a large group health plan (LGHP), Medicare Secondary Payer - End-Age Renal Disease (ESRD), Patient has permanent kidney failure, is covered by a GHP, and has not completed the 30-month coordination period, - Purpose of the CCI is to ensure that the most comprehensive groups of codes, rather than the component parts, are billed, - Using a modifier allows a hospital to indicate a specific circumstance that has affected a procedure or service without changing its definition or code, Modifiers may be used to indicate to the recipient of a claim that a service or procedure, Providers don't use modifiers if the narrative definition of a code indicates multiple occurrences, Modifiers used for Outpatient Prospective Payment System, Modifiers used for OPPS have different levels, they are, - Usually provide information about performance of a procedure, although there are exceptions, - Provide additional detail about an anatomical location or about a procedure or service, Revenue Cycle Staff and Leadership Must Ensure in regards to Ethics, - Adherence to an organization's mission statement, ethical standards and values statement, Employees of providers are required to learn and apply proper procedures to ensure protected health information is secure, - The Patient Protection and Affordable Care Act or ACA, was signed into law in 2010, Reformation of the healthcare delivery system includes, Center for Medicare and Medicaid Innovation, - Charged with the ongoing development of new models for delivery and payment of services, An ACO is a delivery system of physicians, hospitals, and other healthcare providers, who work collaboratively to manage and coordinate the care of patient population, Other Non-demonstration Pay-for-Performance Programs, 1. b. Because investors expect past trends to continue, g may be based on the historical earnings growth rate. for a patient exam, gathers info-patients current medications and allergies and reason for visit, patients vitals signs (blood pressure, temp, oxygen level and pulse) and weight and height and records it all, reviews records, enters room, discussed reason for visit, and completes a physical exam, care to keep diseases from occurring or to enable early detection and treatment (routine annual physical exam, immunizations, screening tests, and behavioral counseling), provided for illnesses with a sudden onset that are time limited not expected to continue more than a few days or weeks (recovery from a broken bone); provided in a hospital, treated over the long term (heart disease, diabetes asthma, and AIDS), organizing a patient's health record in chronological order, using a systematic, logical, and consistent method; the record created when a physician provides treatment to a patient, a chronological health care record that includes info that the patient provides, such as medical history, as well as the physician's assessment, diagnosis, and treatment plan, a patient expected to require an overnight stay in a hospital, refers to treatment that is provided without admission to a hospital in settings such as physician practices, hospital emergency rooms, and clinics for outpatients, eight data points included in an ambulatory care medical records.
A mining company is deciding whether to open a strip mine, which costs $2 million.
What happens to the overall annual premium cost once a term rider expires? The treasurer agrees with the controller, but he argues that most tractors do give 5 years of service. \end{matrix} If a patient's payment is later than permitted under the financial policy of the practice, the ____ may be started. Should the project be accepted if WACC=10%? Does the MIRR method always lead to the same accept/reject decision as NPV? The bond is downgraded by the rating agencies. Chick Fil A targets families who eat out at least once a week and are frequently exposed to Chick Fil A's advertising strategies. What is the most commonly used drug among teenagers. A method by which organizations pay for health insurance directly and set up a fund from which to pay. In an HMO, securing _________ may be required before services are provided. List at least four important skills of medical insurance specialists. Self-reporting of adverse administrative events and recommendations regarding corrective action may preempt or mitigate the need for sanctions, - The establishment of compliance standards and procedures is best accomplished by an organization's code of conduct, Code of conduct can help reduce weaknesses by helping employees and agents understand their roles and responsibilities while fostering an environment where concerns and questions are raised without fear of retaliation or retribution, The Chief Compliance Officer (CCO) oversees the Code of Conduct, Created to protect the integrity of the Health and Human Services Department programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste, and abuse, - Identify opportunities to improve program economy, efficiency, and effectiveness, OIG publishes an annual statement of work for the upcoming year and updates it, as needed, on a monthly basis, 1. What is the ninth step in the billing revenue cycle? The son has medical expenses and there is damage to the skateboard. a computerized lifelong healthcare record for an individual that incorporates data from all sources that provide treatment for the individual. Your firm, Agrico Products, is considering a tractor that would have a cost of $36,000, would increase pretax operating cash flows before taking account of depreciation by$12,000 per year, and would be depreciated on a straight-line basis to zero over 5 years at the rate of $7,200 per year beginning the first year. Health plan that protects beneficiaries against losses. coordination of care received by a patient over time and across multiple health care providers, the provision of medical services at a less than acceptable level of professional skill that results in injury or harm to a patient, provision of financial incentives to physicians who provide evidence-based treatments to their patients, may be used as evidence in a legal matter involving a patient or provider, individuals and institutions in the health care field must regularly evaluate the adequacy and appropriateness of the care they deliver, info collected during a patient visit is used by medical researchers to develop new methods of treatment and to compare the effectiveness of existing treatments, case studies are used to train a wide range of health professionals are developed with info from patient encounters, determine the incidence of disease and in developing methods to improve the health of the population, physician practices are businesses as well as centers for patient care, computerized record of one physician's encounters with a patient over time, private, secure electronic health care files that are created, maintained, and owned by the patient; include current medications and dosages, health insurance info, immunization records, allergies, medical test results, past surgeries, family medical history, function and uses electronic health records (EHR), 1.Health info and date elements 2.results management 3.order management 4.decision support 5.electonic communication and connectivity 6.patient support 7.administrative processes 8.reporting and population management, Advantages of electronic health records (EHR), implementation issues for electronic health records (EHR), cost, lack of standards, training and workflow issues, privacy and security risks, follow up on the status of claims being adjusted, the movement of monies into and out of a business, a ten-step process that results in timely payment for medical services, 1.preregister patient 2.establish financial responsibility for visit 3.check in patients 4.review coding compliance 5.review billing compliance 6.check out patients 7.prepare and transmit claims 8.monitor payer adjudication 9.generate patient statements 10.follow up payments and collections, a code that represents the physician's determination of a patient's primary illness, a code that represents the particular service, treatment, or test provided by a physician, treatment that is in accordance with generally accepted medical practice, management of the activities associated with a patient encounter to ensure that the provider receives full payment for services, a collection of data that includes all areas of an organization's operations, the process of analyzing large amounts of data to discover patterns or knowledge, a plan for the management of records that lists types of records and indicates how long they should be kept, staff members who provide treatment to patients include: physicians, physician assistants, nurses, medical assistants, staff members who manage the business aspects of health care include: medical billers and coders, receptionist, practice managers, compliance officers, and anyone else who works behind the scenes in a medical office, do not provide medical treatment or testing, health care professional who performs both administrative and clinical tasks in physician offices, health care professional who performs administrative tasks throughout the medical billing cycle, medical office staff member who specialized training who handles the diagnostic and procedural coding of medical records, nationally recognized designation that acknowledges that an individual has mastered a standard body of knowledge and meets certain competencies, sessions are assigned course credits by the credentialing organizations, and satisfactory completion of a test on the material is often required, state-specified performance measures for the delivery of health care by medical professionals, if either patient or physician ends the relationship, the physician must still maintain, Centers for Medicare and Medicaid Services (CMS), federal agency in the Department of Health and Human Service that runs Medicare, Medicaid, clinical labs, and other government health programs; responsible for enforcing all HIPAA standards other than the privacy and security standards, health care providers are liable (legally responsible) for providing medical standards of care to their patients, computer-to-computer exchange of routine business info using publicly available electronic standards, Health Information Technology for Economic and Clinical Health (HITECH) Act, provisions in the American Recovery and Reinvestment Act (ARRA) of 2009 that extend and reinforce HIPPA and contain new breach notification requirements for covered entities and business associates, guidance on ways to encrypt or destroy PHI to prevent a breach, requirements for informing individuals when a breach occurs, higher monetary penalties for HIPAA violations, and stronger enforcement of the Privacy and Security Rules, 1.