Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CRHCP Course & Test > Admin & Finance - Section 5: Benchmarking > Flashcards

Admin & Finance - Section 5: Benchmarking Flashcards

1
Q

A term used to describe a rule or guideline by which others can be measured or judged

A

Bechmarking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Used as a point of reference from which an evaluation can be made

A

Benchmarking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Comparing one’s processes and performance metrics to the best performance and practices in the industry

A

Benchmarking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can benchmarks be evaluated in health care?

A

Set internally or obtained from clinical data registeries, payers (such as CMS MIPS quality benchmark) and accreditors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The purpose or benchmarking in healthcare is to improve what 4 things all except which of the following:

Efficiency
Quality of care
Volume of patients
Patient safety
Patient satisfaction
Reimbursement from payers
A

Volume of patients and reimbursement from payers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is important when new practices are implemented to ensure their success?

A

Finding a way to measure progress to determine if the benchmark is being achieved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What 3 things make a good benchmarking measure?

A

Importance, measurability, feasibility (achievability)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What benchmarking measure is described below?

The extent to which the measure is evidence based, has substantial potential for improvement through intervention, is prevalent and significant enough in the population to justify efforts, and has a substantial impact on patient and/or community health or value

A

Importance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which benchmarking measure is described below?

The extent to which the measure produces consistent (reliable) and credible (valid) results. The measure should be precisely defined and specified, easily interpreted, and risk-adjusted as appropraite

A

Measurability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which benchmarking measure is described below?

The extent to which data required is readily available or could be captured without undue burden and at a reasonable cost, and the measure implemented for improvement in the setting at which it is being applied

A

Feasibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of benchmarking is described below?

A measure that assesses infrastructure, characteristics, or capacity to provide health care, such as equipment, personnel, or policies

A

Structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What examples of benchmarking types are provided below?

Staff-to-patient ratio
Percent of diabetic patients tracked in a registry

A

Structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of benchmarking is described below?

A measure that focuses on steps that should be followed to provide good care. There should be a scientific basis for believing the process, when executed well, will increase the probability of a desired outcome

A

Process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What examples of benchmarking types are provided below?

Colorectal cancer screening
Medication reconciliation

A

Process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of benchmarking is described below?

A measure that assesses the results of health care, such as clinical events, recovery, and health status

A

Outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What examples of benchmarking types are provided below?

Diabetes long-term complications admission rate
Controlling high blood pressure

A

Outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What type of benchmarking is described below?

Takes place between departments, divisions, or offices within the same hospital or clinic.

A

Internal benchmarking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What examples of benchmarking types are provided below?

Patient satisfaction per location
No shows

A

Internal benchmarking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What type of benchmarking is described below?

Occurs when an organization analyzes another organization process or similar service and compares that organization’s goals or outcomes against their own.

A

Competitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Centers for Medicare and Medicaid Services, National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), National Association of RHCs, Medical Group Management Association, American Academy of Family Physicians, educational institutions, and non-profit organizations are ____ measure sources

A

Performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are 5 common financial benchmarks?

A 
Gross collection percentage
Adjusted collection percentage
Financial summary dashboard
Days in accounts receivable
Aged accounts receivable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does the gross collection percentage measure?

A

The ratio of payments to charges, without consideration of contractual adjustments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

The gross collection percentage measures the ratio of payments to charges, with consideration of ____ ____.

A

Contractural adjustments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Calculate the gross collection percentage using the following information:

Total monthly payments: $60,000

Total monthly charges:
$100,000

A

Divide $60,000 (payments) by $100,000 (charges) = .60

Multiply by 100 to get a gross collection percentage of 60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

True or False:

The fee schedule, payer contracts, and payer mix do not affect the gross collection percentage

A

False; The fee schedule, payer contracts, and payer mix directly affect the percentage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If the clinic fee schedule is based on 200% of the Medicare Allowable, you can automatically expect the gross collection percentage to approximate ____%

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

True or False:

The gross collection percentage takes contractual adjustments into account

A

False; the gross collection percentage does not take contractual adjustments into account

28
Q

This metric shows how much revenue is lost due to factors in the revenue cycle such as uncollectible bad debt, untimely filing, and other noncontractual adjustments

A

Adjusted collection percentage

29
Q

The adjusted collection rate should be ____% at minimum

A

95%

30
Q

The average collection rate is ____% -____%.

A

95%-99%

31
Q

The highest performers achieve a minimum adjusted collection rate of ____%

A

99%

32
Q

The adjusted collection percentage should be used to quantify if inappropriate or excessive ____ are being applied.

A

Write-offs

33
Q

Adjusted collection percentage measures ____ revenue

A

Collectible

34
Q

Why does adjusted collection percentage subtract write-offs from charges?

A

To calculate a more accurate collection percentage than gross collection percentage

35
Q

True or False:

Payments, charges, and adjustment figures used in the adjusted collection percentage don’t need to be from the same period

A

False; payments, charges, and adjustment figures used in the calculation should all be from the same period

36
Q

True or False:

Given RHC reimbursement mechanisms, it is not uncommon for RHCs to have an adjusted collection percentage above 100%

A

True

37
Q

High performing RHCs may have an adjusted collection percentage of ____% or greater

A

105%

38
Q

Calculate the adjusted collection percentage using the information provided below:

Monthy payments: $60,000
Monthly adjustments: $35,000
Monthly charges: $100,000

A

$60,000 (payments) + $35,000 (adjustments) = $95,000

$95,000 / $100,000 (charges) = .95 x 100 = 95%

39
Q

This indicator calculates how many days of charges are represented in total AR

A

Days in AR or AR Days

40
Q

What does days in accounts receivable measure?

A

How long it takes a practice to collect payments due

41
Q

Calculate the days in AR using the information provided below:

Total receivables: $70,000
Credit balance: $5,000
Average daily gross charge amount/365: $600,000

A

$70,000 (total receivables) - $5,000 (credit balance) = $65,000

$600,000 (charges) / 365 = $1,643.83

$65,000 / $1,643.83 = 39.54

42
Q

Fill in the blank:

AR days less than 30 = \_\_\_\_ performance
AR days less than 40 = \_\_\_\_ performers
AR Days 40-60 = \_\_\_\_ performers
AR Days 60-90 = \_\_\_\_ performers
AR Days more than 90 = indicates \_\_\_\_
A 
Wow
Best
Moderate
Poor
Problems
43
Q

Represents the percentage of claims denied by payers during a given period relative to total charges

A

Denial rate

44
Q

How do you calculate denial rate?

A

Add the total dollar amount of claims denied by payers within a given period and divide by the total dollar amount (total charges) of claims submitted within the same period

45
Q

Denial rates should not exceed ____%

A

5%

46
Q

Calculate the denial rate using the below information:

Total claims denied - $20,000
Total claims submitted - $300,000
Time frame: 90 days

A

$20,000 (total claims denied) / $300,000 (total claims submitted) = 0.666

0.666 x 100 = 6.6%

47
Q

Fill in the blank:

Denial rate less than 2% = ____ performers
Denial rate 2-5% = ____ performers
Denial rate 5-10% = ____ performers
Denial rate more than 10% = ____

A

Highest
Better
Moderate
Poor

48
Q

Fill in the blank:

AR Days less than ____ = Wow!
AR Days less than ____ = Best performers
AR Days ____ - ____ = Moderate performers
AR Days ____ - ____ = Poor performers
AR Days more than ____ = Indicates problems

A 
30
40
40-60
60-90
90
49
Q

Fill in the blank:

Denial rate less than ____% = Highest performers
Denial rate ____-____% = Better performers
Denial rate ____ - ____% = Moderate performers
Denial rate more than ____% = Poor performers

A

2
2-5
5-10
10

50
Q

All aging accounts receivable buckets should be monitored at what frequency?

A

Monthly

51
Q

True or False:

All aging accounts receivable buckets should be monitored quarterly

A

False; monthly

52
Q

The 0-30 category should have ____% or greater of AR

A

50%

53
Q

120+ days of AR should represent less than ____%

A

12%

54
Q

Significant AR over 120 days indiciates significant problems such as:
Large ____ balances
____ submission issues
____ contracting problems

A

Patient, claim, payer

55
Q

Fill in the blank:

Less than 12% of total AR is over 120 days old = ____ performers
12%-25% of total AR is over 120 days old = ____ / ____ performers
More than 25% of total AR is over 120 days old = indicates ____

A

High
Best/moderate
Problems

56
Q

Fill in the blank:

Less than ____% of total AR is over 120 days old = High performers
____-____% of total AR is over 120 days old = Best/moderate performers
More than ____% of total AR is over 120 days old = Indicates problems

A

12%
12-25%
25%

57
Q

What is the most critical decision in benchmarking?

A

Selecting the performance measures to track

58
Q

Performance measures must be ____ to the practice and must have ____ readily available.

A

Relevant, data

59
Q

Why is it essential that reports are compared with prior periods?

A

To determine trends

60
Q

How should management communicate practice benchmarks?

A

To assigned teams

61
Q

What do benchmarks identify?

A

Problems

62
Q

For monthly reporting, develop a clinic dashboard of relevant performance measures and include monthly ____, ____, and ____.

A

Charges, payments, and adjustments

63
Q

What is the benchmark for the adjusted collections metric (%)?

A

98% or greater

64
Q

What is the benchmark for AR Days?

A

Less than 45 days

65
Q

What is the benchmark for denial rates?

A

Less than 2%

66
Q

What is the benchmark for AR greater than 120 days?

A

Less than 12%

CRHCP Course & Test (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions