Healthcare Finance Exam 2 Study Guide questions & answers rated A+, Exams of Nursing

Download Healthcare Finance Exam 2 Study Guide questions & answers rated A+ and more Exams Nursing in PDF only on Docsity! Healthcare Finance Exam 2 Study Guide Why do we have health insurance? - correct answer ✔✔To set aside money for a large unexpected expenditure, pool money to spread out risk Who are the parties involved in health insurance? - correct answer ✔✔i. Patient ii. Providers iii. Payers- insurance information asymmetry - correct answer ✔✔Provider know more about what service you need than you do moral hazard - correct answer ✔✔Ability to decide if you need something is skewed because you don't have to pay full price for it adverse selection - correct answer ✔✔The unhealthy people are more likely to sign up for health insurance than healthy because it is of more value to them benficiary - correct answer ✔✔1. Person who is benefiting from insurance policy, policy holder deductible - correct answer ✔✔1. The amount you pay for covered health care service before your insurance starts to pay co-payment - correct answer ✔✔1. Amount you pay for specific services when you go to get it. premium - correct answer ✔✔1. Monthly fee you pay for health insurance coverage what do premiums have to cover? - correct answer ✔✔a. Profit and the cost of service, running business of insurance company co-insurance - correct answer ✔✔1. Your portion of medical cost you pay after deductible has been met Out of pocket maximum - correct answer ✔✔1. The max amount you can pay out of pocket for benefit period What is the most common type of health insurance? - correct answer ✔✔Employer-based, indemnity What are the public insurance programs? - correct answer ✔✔i. Medicare, Medicaid, CHIP, Tricare, veterans affairs What is meant by performance-based pay? - correct answer ✔✔Reimbursement to provider that is based on the quality of care they are providing, based on quality, patient safety, and patient satisfaction When were Medicare and Medicaid signed into law? - correct answer ✔✔1965 Who funds Medicare? - correct answer ✔✔federal government Who has authority over the administration of the Medicare program? - correct answer ✔✔federal level Who does Medicare cover? - correct answer ✔✔- 65 years and older - Permanent disability - End stage renal disease - ALS What does Part A of Medicare cover? - correct answer ✔✔1. Hospital insurance a. Inpatient care b. Rehabilitations c. Hospice d. Home health care e. Skilled nursing facilities What does the ACA address? - correct answer ✔✔Health insurance coverage, healthcare cost, preventative care, establish medicare and Medicaid innovation center, elder justice act Why did we specifically talk about the ACA in class? - correct answer ✔✔Single biggest effort to improve healthcare for the uninsured since Medicare What is the "marketplace"? - correct answer ✔✔Website where health insurance affordability plans can be compared What are the ten essential components that every healthcare plan must cover because of the ACA? - correct answer ✔✔i. Prescription drugs ii. Ambulatory patient service care iii. Emergency services iv. Hospital v. Laboratory vi. Maternity/newborn vii. Mental health substance abuse* viii. Preventative ix. Rehab x. pediatrics What are the criticisms of the ACA from both sides? - correct answer ✔✔i. Lefts side- not far enough, didn't cover everyone, approach was fundamentally flawed ii. Right side- increase government debt, inefficient, makes healthcare more expensive, narrow networks, more gov. regulation What are the 7 broad categories of issues in healthcare that we discussed? - correct answer ✔✔i. Quality of healthcare ii. Access to healthcare iii. Affordability iv. Disparities in care v. Opioid addiction vi. Never deaths - deaths of despair vii. Health of Americans What is the definition according to the IOM of quality in healthcare? - correct answer ✔✔the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Why is quality in healthcare important? - correct answer ✔✔i. Lives are at stake ii. Want people to be satisfied and return iii. Avoiding bad outcomes What is an adverse event in healthcare? - correct answer ✔✔Any event during medical care or hospital stay that can cause the patient harm What is medical error? - correct answer ✔✔Preventable adverse event that happens during delivery of care What does patient safety focus on? - correct answer ✔✔Preventing avoidable errors and patient harm What is the top contributing cause of errors in healthcare? - correct answer ✔✔i. Human error 1. Lack of training 2. Fatigue 3. Inattention to detail What is a health care associated infection? - correct answer ✔✔Infection obtained at the hospital What is another contributing factor to errors in healthcare? - correct answer ✔✔lack of communication 1. Hand offs b. What is a never event in healthcare? - correct answer ✔✔errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility. Who creates the National Patient Safety Goals and why? - correct answer ✔✔Joint commission to learn from past mistakes and prevent them in the future What is economics? - correct answer ✔✔science that studies the production, distribution, and consumption of goods and services What is meant by the economy? - correct answer ✔✔How money is made and spent for a defined area a. How do we know if we have a good economy? - correct answer ✔✔people have more money than they need What is meant by the "American Dream"? - correct answer ✔✔Anybody of any background can achieve dream through hard work What is inflation? - correct answer ✔✔Increase in cost of material over a period of years What are interest rates? - correct answer ✔✔amount of money paid to bank to borrow money Who sets interest rates? - correct answer ✔✔Federal Reserve a. What is the Federal Reserve? - correct answer ✔✔set the interest rates and make other decisions on how to influence the economy a. What is supply and demand? - correct answer ✔✔Basic economic principle of what is available vs what is needed What percent of the gross domestic product is healthcare? - correct answer ✔✔19.7% What is price setting? - correct answer ✔✔i. The process of establishing a price or cost for a particular service Who are the price setters? - correct answer ✔✔Medicare, Medicaid, insurance, provider What is meant by price takers in healthcare? - correct answer ✔✔i. Many providers in the market that offer the same service, same quality ii. Can't determine the price, it is determined by the market supply and demand 1. Must take the price set by market 2. Price that the insurance company has negotiated 3. The government has set, Medicare and Medicaid Can decide not to offer the service or adjust how you offer the service What is price shifting? - correct answer ✔✔i. Cost for some patients is set higher for the same service ii. Done to offset the price or loss for patients who are charged less or can't pay What is a profit and loss statement? - correct answer ✔✔i. Lists the revenue, expenses, and profits What is the break even analysis? - correct answer ✔✔At what volume of the service will we breakeven What is budgeting - correct answer ✔✔i. Budgeting is creating and using financial forecasts to plan and control a business's operations ii. Contains the financial information needed to manage the finances at the current time and in the future iii. Helps managers assure the financial performance of their unit is meeting the organizational goals What is a strategic plan - correct answer ✔✔A statement about where an organization is currently. What it wants to look like in the future, and then how it plans to get there 1. New one created every 3-5 years mission - correct answer ✔✔defines the purpose of the organization vision - correct answer ✔✔- describes where the organization would like to be in the future values - correct answer ✔✔represents the core beliefs that define the organization and that make up the culture of the organization organizational goals- - correct answer ✔✔specifically defined goals that the organization is trying to achieve, including financial What is an expense budget - correct answer ✔✔· Given the forecasted volume, what do we expect out expenses to be What is a revenue budget - correct answer ✔✔· Start by forecasting what the revenue for the next year will be What is a operating budget - correct answer ✔✔· The revenue and expense budget combines · What the manager uses on a daily, weekly, and monthly basis to manage the financial resources of the unit What is the revenue cycle - correct answer ✔✔i. The process of billing for services provided and collecting the revenue in a timely fashion ii. Getting money for services provided as quickly as possible iii. Consists of gathering patient financial information, billing for services provided, and collecting payment on those bills What are accounts receivable - correct answer ✔✔i. Money due to the organization from patient's and 3rd parties for care already provided ii. Is largest current asset, in most healthcare organizations What is the goal of the revenue cycle - correct answer ✔✔i. Reduce the amount in accounts receivable ii. Objective of revenue cycle management is to reduce the collection period, or the number of days between the time of services and the time the bill is paid What are the parts of the revenue cycle - correct answer ✔✔i. Production cycle: patient seeks care, care is provided ii. Payment cycle: bill is prepared, sent and paid Why is the medical record important to the revenue cycle? - correct answer ✔✔i. All treatments needed to be recorded accurately so that patient gets correct billing