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Basic Accounting
Revenue Streams
Expenses
Coding and Billing
Payment Models
100
Fiscal Year
What is a time period (typically 12 months) that represents one full budget cycle of an organization; it can be a calendar year or another predetermined cycle, such as July 1 to June 30?
100
Grant funding
What is funding that can be applied for and awarded to organizations? Grants can be available through community-based organizations (city, state, or federal gov.; research; non-profit).
100
FTE (full time equivalent)
What is the ratio of the total number of paid hours in a defined period (ex--1 week) to the number of hours defined as full-time (often 2080 hours)?
100
ICD 10 Codes (International Classification of Diseases)
What is a guideline used to code and classify data for inpatients and outpatients? Each code indicates a specific disease or impairment.
100
Prospective Payment System (PPS)
What are set payments in advance of services for a specific time period? The predetermined rates are based on average levels of resource use for certain types of health care such as per diem (per day) or per case.
200
Net Revenue and Gross Revenue
What is the total remaining revenue after any deductions or allowances are applied and what is the total revenue before any deductions or allowances are applied?
200
Medicare and Medicaid (CMS)
What are government agencies that often reimburse therapy treatments based on the units of care delivered.
200
Capital Equipment
What is a single piece of equipment that exceeds a predetermined amount (ex--$5,000) and a life span of longer than a predetermined period (ex -- 1 week)?
200
CPT codes (Current Procedural Terminology)
What is a 5 digit numeric code used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation or management services of physicians,hospitals, and other health care providers (OT). Example of a common code for OT is 97535 or self care management.
200
Bundled Payment
What is a single payment for a group of services related to a treatment or condition that may involve multiple providers in multiple settings (ex--total joint payment)?
300
Net profit or operating margin
What is the amount of revenue that remains after deduction of all expenses, deductions, and allowances?
300
Blue Cross (Wellmark), Coventry, Principal
What are examples of private health insurers that will pay for OT services?
300
Variable costs
What are expenses that are directly influenced by changes in volume (ex -- splinting material costs, medical and office supplies)? In health care, employees can be partially fixed and partially variable.
300
8 minute rule
What is a guideline set forth by CMS for therapists to utilize when billing for services? It is based on total minutes patient was treated.
300
Fee for Service
What is a reimbursement system in which the provider bills and receives payment for each service provided (ex.--set fee for each unit of occupational therapy)?
400
Fixed costs, direct costs, and indirect costs
What are costs that do not changes with the volume of services provided (ex-building lease); expenses that can be attributable to the activities related to the direct costs of your service (OT salary); and expenses that are not attributable to the activities related to your services (HR staff)?
400
Self pay or consultation services
What is a type of fee for service where the patient or company has accepted responsibility for the bill and agrees to pay a specific amount for each service received?
400
Depreciation
What is a way of allocating the cost of a major asset such as a piece of capital equipment over its useful life for tax and accounting purposes?
400
Medical necessity and qualifying as skilled services
What are two concepts that are used to determine if services provided under Medicare are appropriate as billed services?
400
Pay for Performance
What is a funding source that includes a financial incentive for achieving defined and measurable goals related to care processes and outcomes, patient experience, or resource use?
500
Units of care
What is the basic unit of measure upon which services are billed, such as a 15 minute unit of care, a 1 hour group, a unit defined by the Centers for Medicare and Medicaid (CMS) "8 minute rule", or a day of treatment?
500
$3,700
What is the Medicare cap for outpatient OT services per year for patients? This is the same cap for outpatient PT and Speech services per year?
500
Productivity
What is a way of tracking efficiencies to reduce waste and increase revenues? It is the number of units of care billed or the percentage of time spent in billable activity during a predetermined period, often based on an 8 hour day?
500
97535 for 15 minutes 97110 for 15 minutes 97530 for 15 minutes
What is a typical OT billing for 45 minutes of treatment (self care, there exercise, ther activity)
500
Managed Care
What is a reimbursement method that involves close management of approved services by the insurer or payer as well as management of the outcomes of care through strategies to control the cost of health care while maintaining quality?