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Acct Life Cycle & General Ledger
Medicare Pay for Performance
KPIs
Charge Master and Pricing Transparency
Outsourcing Considerations
100
These are 1. Pre-Service, 2. Time of Service, and 3. Post-service.
What are the three components of the revenue cycle?
100
These initiatives provide financial incentives for healthcare providers to improve the quality of care they provide to seniors and people with disabilities.
What are pay-for-performance initiatives?
100
These are standards for accounts receivables and provide a method of measuring the collection and control of accounts receivables. They can be compared to other organizations in the same industry by using benchmarking.
What are KPIs?
100
The components of this include: room and bed charges and ancillary charges.
What is the charge master?
100
This involves using outside resources to manage all or specific functions.
What is outsourcing?
200
This stage of the account life cycle includes the activities that occur after the patient is discharged until the account reaches a zero balance.
What is post-service?
200
This initiative focuses on an intial set of 10 quality measures by linking reporting of those measures to the payments the hospitals receive for each discharge.
What is the Hospital Quality Initiative?
200
This is the period set by facilities to allow for completion of certain activities before a claim qualifies for billing, and best practice facilities usually set this at 3 days.
What is Suspense?
200
There are three levels of these codes, which include CPT-4 codes, and modifiers are used to provide supplemental information about them.
What are HCPCS codes?
200
These may include the following: Access to qualified staff not otherwise available to the healthcare provider, access to technology, limited the need for internal hiring/training/supervising of staff, capitalization on economies of scale.
What are the potential advantages to outsourcing accounts receivable?
300
This is the total charges entered for all patients, minus the dollar amount of contractual, discount, or other allowances.
What is net revenue?
300
This demonstration is the first pay-for-performance initiative for physicians under the Medicare program.
What is the Physician Group Practice Demonstration?
300
This number describes the industry benchmark for charity and bad debt combined as a percentage of billed A/R.
What is 5-8%?
300
This level of HCPCS codes is used for supplies and non-physician charges, and each code begins with a letter and is followed by four numeric digits.
What is Level 2 of the HCPCS codes?
300
Examples of this include the following: direct control of the accounts receivable may be impacted, patient relations could be impacted, there could be increased costs, and legal considerations must be reviewed.
What are the potential disadvantages of outsourcing accounts receivable?
400
Examples of these as reported on the hospital's financial statement are Contractual Accounts, Bad Debts, and Charity Care.
What are reserve amounts?
400
This program is a case-mix adjusted payment system for an expanded bundle of end-stage renal disease (ESRD) services. A portion of the payment will be linked to ESRD-quality measures.
What is the ESRD Disease Management Demonstration?
400
It is important to complete A/R aging analysis using this date in order to understand the impact that timely billing, or lack of timely billing, has on accounts receivable.
What is the date of service?
400
There are three levels of these. When used correctly, they provide an accurate picture of services provided, and can be assigned through the charge master process or the coding process.
What are modifiers?
400
This should be sent requesting specific responses related to a provider's needs and vendor's capabilities prior to choosing an outsource company.
What is an RFP, or request for proposal?
500
They take the lead on calculating reserves, which are used to provide financial leadership with a more accurate picture with which to budget and allocate funds among services.
What are the finance department and the CFO?
500
These are a critical component of the pay-for-performance initiative and have been developed and implemented throught collaboration between CMS and several other institutions, such as The Joint Commission, Hospital associations, AHRQ, and others.
What are the standardized quality measures?
500
This percentage describes industry benchmark for the amount of accounts receivable that should be more than 1 year old.
What is less than 1%?
500
The need for this has evolved in part as a result of consumer-driven healthplans, and it involves providing information to patients to support their ability to make informed healthcare decisions.
What is pricing transparency?
500
In order to protect the health facility, these should contain the following clauses, in addition to others: An annual renewable clause, clear understanding of who owns uncollected receivables if the contract is cancelled, a trial period.
What is an outsourcing contract?