Ch.3 HC Finance Information as a Strategic Resource Flashcards
proprietary organizations, privately owned &
responsible for paying taxes
Profit Oriented organization
voluntary nonprofit organization
applied to be tax-exempt
churches, private schools/foundations
Government Non-Profits
federal, state, county, city, university teaching hospitals
HIM manager would have what kind viewpoint
process
director of nursing would have what viewpoint
clinical
Chief financial officer would have what viewpoint
financial
revenue refers to
amount money an organization earns
represents an inflow
contractual allowances
refer to the difference between the full rate charged and the contractual rate MCO will pay
contractual allowance is considered a
deduction from revenue
grouped revenue by the unit that brings in revenue
revenue center
grouping revenue by different location care is provided
care setting
grouping revenue by similar services
service line
exchange goods/services for payment
financial transaction
1. service provided
2. transaction recorded
3. compensation exchanged
clinical services
provide actual patient care, and doing documentation/records
responsible for input billing information in the charge description master
Health Information Management dept
assigns correct code which drive reimburse
collect and maintain records
Patient accounts dept
depend on clinical service, the HIM department to input reliable info so they can bill the payer
financial dept
analyze the data to track reimbursement, control cost, forecast future activity, manage paying employment, equipment, etc
represents the outflow of money
expenses
charges equals
revenue
costs equals
expenses
Assets
resources the organization owns or due to receive
-cash
-inventory
-AR
-equipement
Liabilities
debts or what the organization owes for g/s they have received
-accounts payable
-loans payable
net worth
owners’ equity or what the organization is worth after liabilities subtracted from assets
make decisions based on reports that are created to track what resources are used
managerial accounting
direct costs
cost used by specific department
i.e payroll for medical coders
indirect cost
the overall operation of the organization
i.e electricity
fixed cost
stays the same even when there is a change
i.e nurse salary
variable cost
change with volume
i.e increase treatment of patient = increased medication used by pharmacy
budgets
used to forecast revenue and expenses for a dept/organization
sets budget next year
begins with board of directors
goal for revenue is
to be met or exceeded
goal for budgets
is to be met or lowered than forecast
variance
difference between budget amount and actual
favorable variance
actual result is better than budgeted for
unfavorable variance
results are worse than what was budgeted for
Advance Beneficiary Notice (ABN)
medicare liability waiver providers have to give the patient for services not covered
Remittance Advice (RA)
sent to provider that explains the payment
Explanation of Benefits (EOB)
communicate to patient of what total is, how much they pay, etc
-medicare summary notice
remittance advice remark codes (RARCs)
bottom of a RA that go into detail of report
Price Transparency
readily available info on the price of service, help define value of those services and enable patient/care purchaser too identify, compare, choose providers that offer desired level of care
first way standard charges must be shown is Machine-readable file that list
gross charge
discounted cash price
payer-specific negotiated charge
di-identified min/max negotiated charge
2nd way standard charges must be presented
consumer-friendly display
challenge of implementation
publish standard charges of all service/item on a prominently or publicly available website
-price estimator tool
