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CRHCP Course & Test > Admin & Finance - Section 6: Cost Reporting > Flashcards

Admin & Finance - Section 6: Cost Reporting Flashcards

1
Q

True or False:

A cost report is required because Medicare will cut off payments to the clinic for an unfiled cost report

A

True

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2
Q

True or False:

A cost report is required because Medicare will cut off payments to the clinic for an unfiled cost report, but thy will not request all payments made to the provider be repaid to the program

A

False; Medicare will cut off payments to the clinic for an unfiled cost report and will ultimately request all payments made to the provider be repaid to the program.

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3
Q

Cost reports are due ____ calendar months from the clinic’s year end.

A

5 calendar months

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4
Q

Cost reports are due 5 calendar month for the clinic’s ____ ____

A

Year end

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5
Q

How must cost reports be submitted?

A

In electronic format (ECR) file on CMS approved vendor software via mailed CD or electronically through CMS portal

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6
Q

If a cost report is filed via CD, what must also be submitted?

A

A signed hard copy and an electronic “fingerprint” matching the electronic cost report

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7
Q

RHC rate is synonomous with what?

A

RHC cost per visit

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8
Q

How do you calculate the RHC cost per visit?

A

Allowable RHC costs / RHC visits

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9
Q

Allowable RHC costs / RHC visits = ____ ____

A

RHC cost per visit or RHC rate

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10
Q

True or False:

The RHC rate cannot exceed the maximum allowable reimbursement rate for the current period

A

True

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11
Q

True or False:

Independent RHCs or clinics attached to a hospital with greater than 100 beds have a capped RHC rate

A

False; 50 beds

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12
Q

True or False:

The cost report is where you get paid for pneumococcal and influenza vaccine costs and Medicare bad debt

A

True

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13
Q

The cost report determines future interim ____ rates

A

Payment

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14
Q

What does the cost report reconcile?

A

Medicare’s payment method to actual cost per visit

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15
Q

What is reported on Worksheet S?

A

Statistics

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16
Q

Worksheet S is for ____

Worksheet S-8 is for ____

A

S - independent

S-8 - provider based

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17
Q

What 3 statistics should be reported on Worksheet S?

A

Facility name, entity status, hours of operation

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18
Q

Clinic hours of operation should reflect what?

A

The hours practitioners are available to see patients

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19
Q

True or False:

Clinic hours should be broken down between hours operating as RHC and non-RHC

A

True

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20
Q

What format should clinic hours of operation be reported in?

A

Military

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21
Q

If filing for no utilization on Worksheet S, what do you put on line 4?

A

N

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22
Q

If filing a low utilization on Worksheet S, what do you put on the cost report?

A

L

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23
Q

Low utilization on the cost report is normally for payments made by the program for less than $____.

A

$50,000

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24
Q

Worksheet S-2 is for ____ RHCs

A

Independent

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25
Q

What does Worksheet S-2 replace?

A

CMS 339 questionnaire for independent RHCs

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26
Q

Worksheet S-3 is for ____ RHCs

A

Independent

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27
Q

What 2 things do visits need to be broken down by within Worksheet S-3?

A

Visit type and program/payer

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28
Q

True or False:

When breaking down visits by program/payer type for Worksheet S-3, you should include regular Medicare and Medicare Advantage

A

False; do not include Medicare Advantage

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29
Q

What is reported with Worksheet A?

A

Expenses

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30
Q

Worksheet ____ reports expenses for independent RHCs and Worksheet ____ reports expenses for provider based RHCs

A

A, M-1

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31
Q

What expense reporting documents should be used with Worksheet A, M-1?

A

Balance sheet, P&L, trial balance

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32
Q

Financial statements must match the ____ reporting period

A

Cost

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33
Q

What is the most frequent cost reporting period? What do other clinics sometimes use?

A

1/1/xx - 12/31/xx

7/1/xx - 6/30/xx

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34
Q

For new clinics, financial statements must reflect costs for what time period?

A

From the date of the clinic’s certification to the end of their first fiscal year

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35
Q

All costs from the financial statements must be reflected in columns ____ and ____ of Worksheet A for independent and Worksheet M-1 for provider based

A

1 and 2

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36
Q

Expenses should be ____ enough to properly classify within cost report categories (i.e., supplies should be broken up into medical supplies, office supplies, etc.)

A

Detailed

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37
Q

Miscellaneous/non-patient care revenue must be reviewed for possible ____

A

Offsets

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38
Q

Non-allowable expenses must be reviewed for ____ or classification in a non-reimbursable cost center

A

Offset

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39
Q

What are the 3 cost report categories?

A

Healthcare costs, overhead, non-RHC costs

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40
Q

Compensation for providers, nurses, and other healthcare staff/compensation for physician supervision would be classified in which cost report category?

A

Healthcare costs

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41
Q

Cost of services and supplies incident to services of physicians (including drugs and biologicals incident to RHC service) would be classified in which cost report category?

A

Healthcare costs

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42
Q

Cost related to the maintenance of licenses and malpractice insurance for medical professionals would be classified in which cost report category?

A

Healthcare costs

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43
Q

Malpractice insurance (premium cannot exceed amount of aggregate coverage), depreciation, and transportation of healthcare personnel between clinics or other healthcare locations only would be classified in which cost report category?

A

Healthcare costs

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44
Q

True or False:

A car paid for by the clinic and provided to a doctor for personal use qualifies as a healthcare cost

A

False

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45
Q

How is overhead allocated?

A

On ratio of healthcare costs to non-RHC costs

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46
Q

What are the 2 types of overhead?

A

Facility and administrative

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47
Q

Rent, insurance, interest on morgage or loans, other building expenses are examples of what type of overhead?

A

Facility

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48
Q

Office salaries, office supplies, legal/account, contract labor (i.e., housekeeping) are examples of what type of overhead?

A

Administrative

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49
Q

The RHC rate is calculated by dividing RHC costs by RHC visits. Anything paid outside of this rate will be put where?

A

In non-RHC costs

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50
Q

What Medicare Part is lab, x-ray, and technical components billed to for independent RHCs?

A

Medicare Part B

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51
Q

For provider based RHCs, lab, x-ray, and technical components are billed as an ____ service under the parent hospital’s Medicare number

A

Outpatient

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52
Q

True or False:

Dental, physical, and retail pharmacy are paid through the RHC rate

A

False; these items and services are not covered by the program

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53
Q

True or False:

CCM and telemedicine services are paid through the all-inclusive rate

A

False; CCM and telemedicine services are paid outside of the all-inclusive rate

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54
Q

True or False:

Membership costs that are for professional, technical, or buisness-related organizations are allowable

A

True

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55
Q

True or False:

Social and fraternal memberships are allowable

A

False; not allowable

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56
Q

True or False:

Research costs are not allowable

A

True

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57
Q

True or False:

Translation service costs are not allowable

A

False; are allowable

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58
Q

What is the general rule of thumb in relation to advertising costs?

A

If it helps patients find you or if it helps you recruit staff, those are allowable. If you advertise to increase patient loads, it is not allowable.

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59
Q

Is staff recruitment advertising an allowable cost?

A

Yes

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60
Q

Is yellow pages advertising an allowable cost?

A

Yes

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61
Q

Is advertising to increase patient volume an allowable cost?

A

No

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62
Q

Is fundraising advertising an allowable cost?

A

No

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63
Q

Are taxes levied by state and local governments an allowable cost?

A

Yes, if exemption is not allowed

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64
Q

Are fines and penalties an allowable cost?

A

No

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65
Q

Is the professional privilege tax an allowable cost?

A

Yes

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66
Q

Is income tax an allowable cost?

A

No

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67
Q

Interest expense has to be ____ and ____ interest on current capital indebtedness to be an allowable cost

A

Necessary and proper

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68
Q

Cost incurred for the use of borrowed funds

A

Interest

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69
Q

____ interest is incurred on a loan made to satisfy a financial need of a provider

A

Necessary

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70
Q

For interest to be considered necessary, it must be incurrent on a loan for purpose reasonably related to ____ care

A

Patient

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71
Q

Is an appropriate allowance for depreciation on buildings and equipment used in provision of patient care an allowable cost?

A

Yes

72
Q

To be an allowable cost, depreciation must be:

Identified and ____ in accounting records

Based on ____ cost of asset or fair market value of donated assets

Prorated over the estimated useful ____ of the asset

A

Recorded
Historical
Life

73
Q

With few exceptions, what method of depreciation is the only method that is acceptable?

A

Straight line

74
Q

Is depreciation on assets purchased with federal funds an allowable cost?

A

Yes

75
Q

Is depreciation on donated assets an allowable cost?

A

Yes

76
Q

True or False:

Fully depreciated assets still in use cannot have a revised life assigned when enrolling as an RHC

A

False; can have a revise life assigned

77
Q

What is Worksheet A-6 / A-8 used for?

A

Adjustments to cost

78
Q

Worksheet A-6 is used for what purpose?

A

To reclassify costs to appropriate cost centers

79
Q

What are some examples of items or services that would be reclassified to appropriate cost centers on worksheet A-6?

A

Lab, x-ray, EKG

80
Q

What are the 2 methods that can be used for reclassifying costs for services performed by staff?

A

Time staff takes to perform services (lab, x-ray, EKG)

Time studies for each specific test

81
Q

How is the method of time staff takes to perform services (ex: lab, x-ray, EKG) calculated?

A

Allocate % of time for non-RHC carve out vs. RHC duties (if staff member takes 20% of their time for non-RHC, pull 20% into non-reimbursable cost center)

82
Q

How is the method of time studies calculated for reclassifying cost?

A

Calculate time per test, multiply by number of tests performed, then by average hourly wage

83
Q

Where should non-RHC wages be reclassified to?

A

Non-reimbursable cost center

84
Q

Worksheet A-8 is used for what purpose?

A

To include additional or exclude non-allowable costs

85
Q

Entertainment, gifts, charitable contributions, automobile expense (when not related to patient care), and personal expenses paid out of clinic funds are examples of what?

A

Non-allowable costs that should be excluded on worksheet A-8

86
Q

Cost of providing telehalth services must be classified in the non-RHC section on line ____ for independent and line ____ for provider based

A

79

25.01

87
Q

CCM must be classified on line ____ for independent and line ____ for provider based

A

80

25.02

88
Q

True or False:

Telehealth visits should be included in RHC visit reporting

A

False; do not include

89
Q

True or False:

Telehealth time should not be included in FTE calculations

A

True

90
Q

True or False:

Telehealth and CCM are paid outside of the RHC rate

A

True

91
Q

Do you exclude or reclassify telehealth and CCM?

Ask yourself - does it use overhead (space, staff, etc)? If yes, you should ____

A

Reclassify into non-RHC space

92
Q

Do you exclude or reclassify telehealth and CCM?

Ask yourself - Is it a non-allowable expense that doesn’t use overhead? If yes, you should use A-8 to ____

A

Exclude

93
Q

If telehealth visits are performed by the provider from their home (and this is the only time they do telehealth), an ____ with limited overhead components may be appropriate.

A

Exclusion

94
Q

When reclassifying, only allocate ____ costs (i.e., practitioner wages, clinic support wages). Overhead will allocate itself through the cost report.

A

Direct

95
Q

For telehealth direct expense calculation, what are the 2 methods that can be use?

A

Actual time spent

Average time based on partial studies or EMR records (if available)

96
Q

What is the most common related party transaction (e.g., building is owned by doctors, who also own the clinic. Clinic pays “rent” to doctors.)?

A

Party building ownership

97
Q

Mortgage interest, property taxes, building depreciation, property insurance, repairs and maintenance are paid by building owners, and lawn service are examples of what?

A

Related party building ownership cost items for reporting

98
Q

Face-to-face encounter with qualified provider during which covered services are performed

A

RHC visit

99
Q

What should RHC visits be broken down by?

A

Provider type (MD, PA, NP)

100
Q

True or False:

Only face-to-face encounters should be counted as RHC visits

A

True

101
Q

True or False:

Visits for hospital, telehealth, non-covered services, non-qualified providers, or injections can be included as RHC visits

A

False; these should not be included

102
Q

True or False:

All clinicians working on a regular basis should be included in visits subject to the productivity standard

A

True

103
Q

True or False:

If 3 people make up 40 hours in a week, that equals 3 FTEs

A

False; if 3 people make up 40 hours in a week, that equals 1 FTE

104
Q

When calculating FTE, practitioners’ work should be categorized into which 3 sections?

A

Administrative
Patient care
Inpatient care hours

105
Q

How are FTEs calculated?

A

Based upon how many hours the practitioner is available to provide patient care

106
Q

FTE is calculated by ____ type

A

Practitioner

107
Q

True or False

Medicare will charge the clinic with a minimum number of visits per FTE, whether performed or not

A

True

108
Q

Medicare Productivity Standard

____ visits per employed or independent contractor physician FTE

____ visits per midlevel FTE

A

4,200

2,100

109
Q

True or False:

Physician services under agreement are not subject to productivity standards, but there is a limited application to this

A

True

110
Q

True or False:

Paying a provider through 1099 automatically means they are not subject to productivity standards

A

False; does not mean

111
Q

Medicare Productivity Standards are applied in ____

A

Aggregate

112
Q

For the Medicare Productivity Standard, what are total visits compared to?

A

Total minimum productivity standard

113
Q

True or False:

A productie midlevel with visits in excess of their productivity standard can be used to offset a physician shortfall or vice versa

A

True

114
Q

True or False:

Seasonal influenza and pneumovax reimbursement is done outside of the RHC rate

A

True

115
Q

True or False:

You do not have to take vaccines out of net costs

A

False

116
Q

True or False:

You only have to include the vaccines that are given to Medicare patients

A

False; you must report vaccines given to all insurance types

117
Q

Where should the cost of vaccines be classified? If you don’t do that, where can they be reclassified?

A

In their specific cost centers on worksheet A

Reclassify on worksheet A-6

118
Q

For vaccine reporting, total clinical staff hours worked per year becomes the ____ in the vaccine ratio

A

Denominator

119
Q

Why are all clinical staff hours included when reporting vaccine administration?

A

Because all clinical salaries are used in the cost report calculation

120
Q

____ minutes is the accepted time for vaccine administration

A

10 minutes

121
Q

There are some exceptions with MACs limiting vaccine administration to ____ minutes

A

5 minutes

122
Q

How do you calculate vaccine administration time?

A

Total vaccines x 10 minutes (accepted time for vax admin) / 60 minutes

123
Q

How do you calculate staff time ratio for vaccine reporting?

A

Divide total vaccine administration hours by total clinical hours worked

124
Q

True or False:

Clinic must maintain logs of influenza vaccines administered

A

False; must maintain logs of influenza AND pneumococcal

125
Q

How should a vaccine log be submitted?

A

Electronically

126
Q

Worksheet C, C-1 is for ____ RHCs to report settlement data

A

Independent

127
Q

Worksheet M-3, M-5 is for ____ RHCs to report settlement data

A

Provider based

128
Q

Why is it important to compare our provider statistical and reimbursement system report (PS&R) to our Medicare visit count?

A

We want to ensure that we do not overcount our visits because that will eat into our rate (cost/visits = rate)

129
Q

Deductibles and coinsurance amounts uncollectible from Medicare beneficiaries after reasonable collection efforts

A

Medicare bad debt

130
Q

Is uncollected deductibles/coinsurance from private pay patients (or other non-Medicare beneficiaries), Medicare Advantage or Part B, or non-RHC services considered to be Medicare bad debt?

A

No

131
Q

Is charity, courtesy, or third-party payer allowances considered to be Medicare bad debt?

A

No

132
Q

Is uncollected amounts due from other payers considered to be Medicare bad debt?

A

No

133
Q

Are undisputed Medicare claims considered to be Medicare bad debt?

A

No

134
Q

For debt to be considered an allowable Medicare bad debt, it must be related to ____ services and derived from ____ and ____ amounts

A

Covered

Deductible and coinsurance

135
Q

For debt to be considered an allowable Medicare bad debt, the provider must establish that ____ collection efforts were made

A

Reasonable

136
Q

For debt to be considered an allowable Medicare bad debt, the debt must actually be ____ when claimed to be worthless

A

Uncollectible

137
Q

For debt to be considered an allowable Medicare bad debt, sound business judgment must establish that is no ____ of recovering the debt at any time in the future

A

Likelihood

138
Q

It is required that the uncollectible Medicare deductible and coinsurance be charged off as ____ ____ in the accounting period when the bad debt is determined to be worthless

A

Bad debt

139
Q

It is required that the uncollectible Medicare deductible and coinsurance be charged off as bad debs in the accounting period when what else happens?

A

The bad debt is determined to be worthless

140
Q

A bad debt log is used for Medicare deductibles and coinsurance deemed ____ and written off the clinic’s books during the cost reporting period

A

Uncollectible

141
Q

True or False:

A bad debt log will not contain dates of service that are prior to the current cost reporting period

A

False; it can, and most often does, contain dates of service prior to the current cost reporting period

142
Q

True or False:

Medicare bad debts are based on the date of service, NOT the write off date.

A

False; based on write off date, not date of service

143
Q

What are the two types of Medicare bad debt?

A

Indigent or medical indigent patients (patients that cannot pay)

Patients not deemed to be indigent (patients that could pay but won’t)

144
Q

True or False:

An automatic indigence determination is made for Medicare/Medicaid dual-eligible beneficiaries

A

True

145
Q

For indigent patients, you must bill ____ for proof of eligibility and apply any ____ payments, if applicable

A

Medicaid

146
Q

True or False:

You do not need to have a processed state Medicaid remittance advice before allowing dual eligible bad debts

A

False; Must have a processed state Medicaid remittance advice before allowing dual eligible bad debts

147
Q

True or False:

Indigence can be determined by the patient (i.e., is does not need to be determined by the provider)

A

False; indigence must be determined by the provider, not the patient. A patient’s signed declaration of his/her inability to pay his/her medical bills cannot be considered proof of indigence.

148
Q

For indigent patients not eligible for Medicaid, you should take into account a patient’s total ____ which would include, but are not limited to, an analysis of assets (only those convertible to cash and unnecessary for the patient’s daily living), liabilities, and income and expenses.

A

Resources

149
Q

True or False:

The same collection effort needs to be applied to any bill

A

True

150
Q

What are some examples of reasonable collection efforts?

A

Collection letters, phone calls, collection agency, if also used for non-Medicare patients

151
Q

If after reasonable and customary attempts to collect a bill, the debt remains unpaid more than ____ days from the date the first bill is mailed to the beneficiary, the debt may be billed uncollectible

A

120

152
Q

If after reasonable and customary attempts to collect a bill, the debt remains unpaid more than 120 days from date the ____ is mailed to the beneficiary, the debt may be deemed uncollectible

A

First bill is mailed

153
Q

What is the minimum number of days that can be used for the presumption of non-collectability?

A

120 days

154
Q

True or False:

Medicare collections must follow the same timelines as all other payers

A

True

155
Q

True or False:

Any payments received from the beneficiary doesn’t restart the 120 collectability timeframe.

A

False; any payments received from the beneficiary restarts the 120 collectability timeframe

156
Q

The collection policy must be consistent among ____

A

All payer types

157
Q

The collection policy must involve the first bill being issued within ____-____ days of the date of service

A

30-90

158
Q

If you do not send a bill to a patient with 30-90 days of the date of service, what must you have?

A

A documented reason for not timely billing a patient

159
Q

The collection policy must include ____, rather than a token, collection effort

A

Genuine

160
Q

In addition to issuing a bill after a date of service, the collection policy should include efforts such as ____ billings, collection ____, telephone calls, or ____ contacts with this party

A

Subsequent, letters, personal

161
Q

True or False:

If you use a collection agency, you should refer all uncollected patient charges of like amounts regardless of class of patient

A

True

162
Q

True or False:

If you use a collection agency and it collects from the beneficiary, the full amount collected doesn’t need to be applied to the Medicare bad debt

A

False; if the collection agency collects from the beneficiary, the FULL AMOUNT collected must be applied to the Medicare bad debt

163
Q

True or False:

Collection agency fees applicable to the collection of the debt can be recorded as an administrative expense on the clinic’s financial statements

A

True

164
Q

Should you have a Medicare collection policy section within your collection policy?

A

No

165
Q

Why shouldn’t you have a Medicare collection policy section within your collection policy?

A

This will indicate different treatment/procedures for the collection of Medicare bad debts and cause your bad debts to be disallowed at audit

166
Q

Within the section of the collection policy that outlines the procedure for Medicare bad debt write off (consistent among all patient classes), include a section that exmaple how to complete the Medicare ____ ____ ____

A

Bad debt log

167
Q

For indigent patients that are Medicaid daul-eligible, ____ remittance advice indicating payment or denial of payment should be retained as audit documentation

A

Medicaid

168
Q

For indigent patients that are not Medicaid eligible, what is required as audit documentation?

A

Documentation of the method by which indigence was determined in addition to all backup information to substantiate the determination

169
Q

For non-indigent patients, ____ efforts must be documented in the patient’s file (including copies of bills, documentation of phone calls/personal contact, and follow up letters) for audit documentation

A

Collection

170
Q

Unrestricted grants and gifts ARE or ARE NOT deducted from operating costs

A

Are

171
Q

Post October 1983, restricted grants are also not deducted from ____ costs

A

Operating

172
Q

Are donated supplies or space an allowable cost?

A

No

173
Q

To maximize revenue, you should update fee schedule on a ____ basis

A

Annual

174
Q

To maximize revenue, ____ non-reimbursable costs

A

Minimize

175
Q

To maximize revenue, reduce overhead attributable to ____ costs

A

Non-reimbursable

CRHCP Course & Test (14 decks)

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