Financial Management Flashcards
This document provides information about the organization’s cash position, borrowing and repayment capabilities, and capital acquisition.
Its goal is to provide stakeholders and leaders with knowledge needed to assess the organization’s performance and make decisions based on pertinent, accurate information.
Financial statements
Focuses on the flow of cash into and out of the organization. Revenues are recognized when cash is received, and expenses are recognized when cash is paid out.
More intuitive and used by physician practices and smaller businesses
Cash basis of accounting
Focuses on the organization’s overall value. Recognizes revenues when they are earned and expenses when they are incurred, regardless of when cash actually flows in or out. Allows an organization to better track the resources used in generating revenues.
Used by most organizations.
Accrual basis accounting
A snapshot of the orgs financial position, usually on the last day of an accounting period. Provides info about the liquidity as well as the net value of its assets.
Balance sheet
These components make up a balance sheet:
Assets, liabilities, and net assets (or owner’s equity)
Resources the organization owns, recorded at original cost, not current value.
Assets
These assets will be consumed and used in less than one year.
Cash and cash equivalents
Patient accounts receivable
Short-term investments
Supplies used to provide services
Current Assets
The organization’s financial obligation.
Liabilities
These liabilities must be paid in less than one year.
Accounts payable and accrued expenses.
Current portion of long-term debt.
Estimated third-party payer settlements.
Deferred revenue.
Current liabilities
These expenses are the cost of resources used to provide healthcare services. The major category used in healthcare orgs are salaries and benefits, supplies, depreciation and amortization, interest, bad debt, and other expenses.
Operating expenses
Operating Revenues - Operating Expenses
Operating Income = Operating Revenue - Operating Expense
OI = OR - OE
The orgs financial condition is assessed by comparing two data elements from its financial statements. Used in healthcare internally to analyze performance and develop action plans, as well as by external entities, such as bond raters, to assess the org’s performance on a quarterly or annual basis.
Financial Ratio
Operating Income / Operating Revenue
Operating Margin Ratio =
Operating Income/Operating Rev
or
Operating Rev-Operating Expense /
Operating Rev
Calculate the Operation margin given that an organization’s total operating revenue is $5000 and the total operating expense is $4000.
operating revenue is $5000 and the total operating expense is $4000.
$5000-$4000
_____________ = 0.2 or 20%
$5000
Indicates the financial productivity of a company’s equity financing by measuring the dollars of earnings for each dollar of equity investment.
Return on Equity Ratio (ROE)
ROE = Net income / total equity
Indicates the percentage of net patient service revenue that the organization will not collect. A lower number indicates successful collection of patient service revenue.
Bad Debt Ratio
= Provision for Bad debt/ net patient service revenue
A ratio that measures the efficiency of the organization’s collection function. A lower number is better, as it indicates more income and less money tied up in accounts receivable.
Account Receivable (days)
Formula for days in AR
Days in AR =
Net Pt Receivables x 365
__________________
Net Pt Rev
A ratio that assess how well the org manages short-term obligations and working capital. Explains how well the organization can meet its current obligations
Liquidity Ratio
Used to assess an organization’s ability to meet its short-term obligations. Measures the number of dollars of current assets available to pay each dollar of current liabilities.
Current Ratio
Current Ratio = Current Assets / Current Liabilities
CR = CA / CL
The proportion of cash, net accounts receivable, and marketable securities to current liabilities.
Quick Ratio
Shows how many days of expenses an organization can cover with cash. A higher-than-average ratio indicates better ability to cover expenses. A very high ratio indicates poor asset management.
Days Cash on Hand Ratio
This ratio measures the average time it takes an organization to pay its obligations.
Days in Accounts Payable Ratio
This analysis can be useful to see how an organization is performing relative to the performance of the industry as a whole.
Comparative Analysis
Looks at the trend of a single ratio over time.
Trend Analysis
Medicare designated the International Classification of Disease, 9th revision, Clinical Modification (ICD-9-CM) as the official system for reporting diagnoses, signs, or symptoms to payors in:
A. 1980
B. 1988
C. 1998
D. 2005
B. 1988
Historical information describing the evolution of payment systems may be found in current and previous copies of the _____ _____.
Federal Register.
In general, Diagnostic testing, including diagnostic X-ray imaging, is covered by Medicare only when there is medical necessity and when it is ordered by treating physician. The one exception to this guideline relates to ____ & ____.
Mammography services & Hospital diagnostic studies
(Hospital diagnostic studies are governed by two separate provisions, and in those regulations there is no statement restricting ordering authority to the treating physician. Hospital OP diagnostic studies are governed by 42 CFR 410.28, and rules for hospital inpatient testing are found in 42 CFR 409.16.)
Provide guidelines for ordering imaging services & states that services must be provided only on the order of practitioners with clinical privileges, consistent with state law, and of other practitioners who are authorized by the medical staff and governing body to order services.
Medicare Conditions of Participation (COP).
This act indicated that the ordering physician must include the reason for the diagnostic test on written order at the time the item or service is ordered by the physician or practitioner.
Balanced Budget Act of 1997
A radiologist may cancel, without notifying the treating physician or practitioner, an order because the beneficiary’s physical condition at the time of diagnostic testing will not permit performance of the test.
A. True
B. False
A. True
barium enema cannot be performed because of residual stool in the colon detected during scout X-Ray of the kidneys, ureters, bladder.
“Medically Necessary” services mus be:
- Consistent with symptoms or diagnosis of disease or injury.
- Necessary and consistent with generally accepted professional medical standards
- Furnished at the most appropriate level that can be provided safely and effectively.
Two common situations in which ABN is appropriate are
- Exams for medical indications that are not included in the payer’s local coverage determinations
- Screening mammograms performed more frequently than allowed by Medicare.
This modifier is appended to any charge lines for which the patient has signed an ABN to indicate that the beneficiary knows of his/her liability with respect to this charge:
A. GA
B. GX
C. GY
D. GZ
A. GA
This modifier is used to report that a voluntary ABN was issued:
A. GA
B. GX
C. GY
D. GZ
B. GX
This modifier is used to report that ABN was not issues and was not required according to policy.
A. GA
B. GX
C. GY
D. GZ
C. GY
This modifier is used to report that an ABN was not used although the service is expected to be denied as not reasonable and necessary.
A. GA
B. GX
C. GY
D. GZ
D. GZ
___ refers to intentional or unintentional billing of multiple procedure codes for a group of procedures that are covered by a single comprehensive code.
Unbundling
This initiative began on January 1, 1996, with a goal of controlling improper coding practices that lead to inappropriate increased payment for service submitted for reimbursement. It is the ensure that physicians and healthcare facilities follow Medicare’s resource-based value relative value scale.
Correct Coding Initiative (CCI)
These are placed at the end of a CPT or HCPCS code to identify a modification to the service or procedure performed. Consist of 2 numbers, 2 letters, or one number and one letter and can be attached to a level I or level II code.
Modifiers
These codes were created in 1983 by an amendment to the Social Security Act to bring under control the rising cost to Medicare of hospital inpatient care. The rationale was that diseases with the same use of hospital resources could be grouped together and billed under the same payment group.
DRG
This is a type of workload unit factors associated with the CDM, can be used as a means to capture labor and statistical information.
RVU
This type of code has been developed to allow facilities to report separately paid drugs used during imaging procedures.
Level II HCPCS.
Hospitals usually submit the following claim/bill:
A. 1500
B. CMS-1450/UB-04
B. CMS-1450/UB-04
Hospitals can submit a 1500 claim form only when they are billing on behalf of the Radiologist.
A. True
B. False
A. True
Inpatient claims for Medicare Part A do not require the reporting of CPT or HCPCS codes. However, charges should be entered consistently regardless of the patient status.
A. True
B. False
A. True
In 2001, HCFA became ____, who administers teh national Medicare program and works with states to administer Medicaid.
Center for Medicare and Medicaid Services, CMS
Part ___ of Medicare is free to those who qualify and helps cover expenses involved in hospital stays and, occasionally, in hospice care.
A. A
B. B
C. C
D. D
A. A
Part ___ of Medicare includes physician visits and outpatient care, requires payment of a monthly fee. This part is also called Supplementary Medical Insurance, and provides benefits for non-institutional healthcare providers.
A. A
B. B
C. C
D. D
B. B
This term means that the provider knows in advance the payment or allowable rate for each procedure or product.
Prospective
Contractors who manage the physician fee schedule are called ____, who under the MMA have become Medicare Administrative Contractors (MACs).
Fiscal Intermediaries
_____ has required the DHHS to adopt standards for electronic transactions and national identifiers for providers, health plans, and employers.
HIPAA
Name the two pathways in which Medicare makes decisions or determinations:
NCD - National Coverage Determination
LCD - Local Coverage Determination (focus on Reasonable and Necessary information).
Of note, LCDs were formerly LMRP (local medical review policies, which ended 11/11/2003).
To ensure that Medicare payments have been made appropriately, the ____ was established. This program set up auditors to review Medicare payments and determine if they are appropriate.
Recovery Audit Contractor Program (RAC)
Physicians are paid based on this prospective payment system, based on the RBRVS.
Medicare Physician Fee Schedule (MPFS)
IDTFs are specially designated testing facilities that are independent of an attending or consulting physician’s office and independent of a hospital. They furnish diagnostic testing, but not to use the test results to treat a patient. The facilities are paid under the ____
Medicare Physician Fee Schedule (MPFS)
In 2011, HOPPS final rule for OP supervision required that diagnostic and therapeutic services meet a specific level of supervision. They are:
- General supervision
- Direct supervision
- Personal supervision
The procedure is furnished under the physician’s overall direction and control, but the physician is not required during the performance of the procedure. The physician is responsible for the training of the nonphysician personnel who actually perform the procedure.
A. General supervision
B. Direct supervision
C. Personal supervision
D. Limited supervision
A. General supervision
The physician must be present in the office suite and immediately available to provide assistance and direction throughout the performance of the procedure.
A. General supervision
B. Direct supervision
C. Personal supervision
D. Limited supervision
B. Direct supervision
The physician must be in the room during the performance of the procedure.
A. General supervision
B. Direct supervision
C. Personal supervision
D. Limited supervision
C. Personal supervision
For diagnostic services furnished in a hospital or an on-campus department of the hospital that requires _____, the physician must be immediately available to provide assistance and direction during the procedure.
A. General supervision
B. Direct supervision
C. Personal supervision
D. Limited supervision
B. Direct supervision
This legislation was responsible for ensuring that high-cost drugs, radio-pharmaceuticals and biologicals would be paid separately and in addition to the procedure payment so that Medicare beneficiaries would continue to have access to these products.
Balance Budget Refinement Act of 1999
This system was introduced by CMS, reducing the technical reimbursement for multiple procedures during the same session to 100% for the first procedure and 50% for the second procedure.
Multiple Procedure Payment Reduction (MPPR)
Covered under CMS, _____ went into effect in 1965 and is the largest source of funding for medical and health-related services for the poorest people in the United States.
Medicaid
For people who may have too much income to qualify under the mandatory or optional categorically needy groups, and option to _____ to Medicaid eligibility is done by incurring medical or remedial care expenses by offsetting their excess income.
spend-down
The goal of financial statements is to allow stakeholders and leaders to
assess the organization’s performance and make decisions based on
pertinent, accurate information.
a. True
b. False
a. True
Financial statements provide information about an organization’s:
a. Cash position
b. Borrowing and repayment
c. Capital acquisitions
d. All of the above
d. All of the above
The 3 basic financial statements of an organization are:
a. Balance sheet, income statement, and cash flow statement
b. Balance sheet, accrual log, and cash flow statement
c. Income statement, capital budget, and balance sheet
d. Balance sheet, operating budget, and cash flow statement
a. Balance sheet, income statement, and cash flow statement
The accrual concept of accounting states that:
a. All transaction records must demonstrate both a change in assets
and a change in liabilities
b. All financial transactions must be included in the records
c. Income and expenses must be recorded in the time period in which
they are realized
d. None of the above
c. Income and expenses must be recorded in the time period in which
they are realized
The balance sheet is:
a. The assets that will be used in less than 1 year
b. A snapshot of the organization’s financial position
c. A summary of the revenues and expenses incurred over a specified
time period
d. A statement of how the organization acquired and used its cash
b. A snapshot of the organization’s financial position
The balance sheet provides information
about the liquidity of an organization, as well as the net value of its assets,
which can help decision makers assess the organization’s operational capacity
Generally accepted accounting principles (GAAP):
a. Never change
b. Are the accepted set of conventions, rules, and procedures of
accounting
c. Are established by The Joint Commission
d. All of the above
b. Are the accepted set of conventions, rules, and procedures of
accounting
On the balance sheet, current assets are assets that:
a. Will be consumed in less than 1 year
b. Assets that will not be consumed in less than 1 year
c. The organization’s land, buildings, and equipment
d. The organization’s investments
a. Will be consumed in less than 1 year
Noncurrent assets: Assets that will not be used or consumed in less than one
year, such as major equipment and buildings.
The statement of operations is the same as the organization’s:
a. Balance sheet
b. Cash flow
c. Income statement
d. Total assets and liabilities
c. Income statement
Items included on the balance sheet are:
a. Current assets, non-current assets, current liabilities, and equity
b. Current assets, non-current assets, equity, and cash flow
c. Current assets, current liabilities, equity, and capital
d. Non-current assets, current liabilities, long term liabilities, and
accounts payable
a. Current assets, non-current assets, current liabilities, and equity
Items included on the income statement are:
a. Operating revenues, cash flow, total assets, and total liabilities
b. Operating revenues, operating expenses, contractual allowances,
and charity care
c. Cash flow, total assets, capital, and non-current assets
d. Cash flow, capital expenditures, total assets, and total liabilities
b. Operating revenues, operating expenses, contractual allowances,
and charity care
GAAP requires that an unaudited statement include:
a. A financial ratio analysis
b. Notes to the financial statements
c. An annual report
d. None of the above
b. Notes to the financial statements
GAAP - Generally Accepted Accounting Principles
GAAP requires that an unaudited statement include:
a. A financial ratio analysis
b. Notes to the financial statements
c. An annual report
d. None of the above
x
Current ratio is:
a. Current assets divided by current liabilities
b. Current liabilities divided by current assets
c. Total current liabilities divided by total operating expenses
d. Net receivables divided by net patient revenue
a. Current assets divided by current liabilities
The current ratio is used to assess an organization’s ability to meet its short-term
obligations. It measures the number of dollars of current assets available to pay each
dollar of current liabilities
For-profit organizations often use a financial ratio known as :
a. OBID
b. QID
c. EBITDA
d. GAAP
c. EBITDA
EBIDA stands for earnings before deductions for interest, depreciation, and amortization.
For-profit organizations often use EBITDA, or earnings before deductions
for interest, taxes, depreciation, and amortization.
The statement of cash flows provides information about:
a. The organization’s operating revenues
b. The organization’s operating expenses
c. The organization’s capital expenditures
d. How the organization acquired and used its cash resources
d. How the organization acquired and used its cash resources
The objective of financial reporting is to:
a. Allow the organization’s stakeholders to assess the financial
performance
b. Allow the organization’s leaders to make operational decisions
based on pertinent, accurate information
c. Both A and B
d. None of the above
c. Both A and B
To aid in accurate and efficient diagnosis coding as well as provide
supporting information in the event of a payor audit, each final report from
the ordering physician must include a:
a. Alternative diagnosis
b. Reason for exam or signs and symptoms
c. Date the order was written
d. Signature of ordering physician
b. Reason for exam or signs and symptoms
The key to success in the function of coding and billing for imaging
procedures is:
a. Physician involvement
b. Monitoring of physician orders
c. Education of staff and ongoing monitoring of authoritative guidance
d. The written report
c. Education of staff and ongoing monitoring of authoritative guidance
The International Classification of Diseases (ICD), which is utilized to
report diagnoses, signs, and/or symptoms to payors is officially owned by
what organization?
a. American Health Information Management Association (AHIMA)
b. Food and Drug Administration(FDA)
c. World Health Organization (WHO)
d. American Medical Association (AMA)
c. World Health Organization (WHO)
During the exam, who is responsible for reviewing the requisition or order
to determine whether the correct exam has been ordered and the clinical
information is appropriate for the scheduled exam?
a. Clerk
b. Scheduler
c. Technologist
d. Transporter
c. Technologist
The procedural and billing coding process begins when a procedure is
scheduled and ends when what is sent to the payor?
a. Charges
b. Claim form
c. Bill
d. Radiology report
b. Claim form
A chart audit is considered useless without:
a. Trending
b. Monitoring
c. Action taken on the findings
d. Data to support the findings
c. Action taken on the findings
A written notice provided to a Medicare beneficiary before services are
furnished stating the service may not be covered by Medicare is an:
a. Informed consent
b. Advance beneficiary notice (ABN)
c. Physician order
d. Outpatient code editor
b. Advance beneficiary notice (ABN)
Many radiology departments can fall short on reimbursements because of
which missed codes associated with the procedure?
a. Imaging
b. Surgical
c. Physician
d. RVU
b. Surgical
Hospital billing departments will process electronic claims through
software programs to review for billing errors prior to submitting claims to
payors.
a. True
b. False
a. True
HCPCS codes are used in radiology to code:
a. Radiology interventional procedures
b. Radiopharmaceuticals
c. Surgical procedures associated with radiology procedures
d. Modifiers
b. Radiopharmaceuticals
The facility’s financial billing system, administrative organization, reporting
structures, and which of the following all contribute to the existing charge
capture process?
a. RIS and/or CDM
b. Patients
c. Quality department
d. Safety committee
a. RIS and/or CDM
Outpatient hospital bills or forms require the following information except:
a. Revenue code
b. Attending physician’s name
c. Primary and secondary diagnosis and condition codes
d. Number of views or images taken
d. Number of views or images taken
■■ Patient demographics
■■ Responsible party payor information, including identification numbers
■■ Line item date of service per revenue code line item
■■ Revenue code
■■ HCPCS/CPT codes (such as imaging procedure revenue code lines)
■■ Modifiers (for Medicare or Medicaid claims)
■■ Primary and secondary diagnosis and condition codes
■■ Attending physician’s name
■■ Provider number and address
The following coding system is utilized to report services, procedures, and supplies not listed in level 1 codes: a. ICD b. AMA c. HCPCS d. CPT
c. HCPCS
The section of the CPT manual specifying radiology procedures includes the: a. 19000 – 39999 b. 80000 – 89999 c. 70010 – 79999 d. 30100 – 38999
c. 70010 – 79999
Modifiers may be used to indicate the following except when:
a. A service or procedure has both a professional and a technical
component
b. A bilateral procedure was performed
c. Only part of a service was performed
d. A contrast study was performed
d. A contrast study was performed
A classification system that groups patients according to diagnosis, type
of treatment, age, and other relevant criteria is known as:
a. CPT
b. DRG
c. ICD
d. HCPCS
b. DRG
The chargemaster has the following components:
a. Revenue code
b. Department identification number(s)
c. Chargemaster description
d. All of the above
d. All of the above
Radiology administrators may use the chargemaster as a tool for
capturing RVUs for purposes of productivity measurement.
a. True
b. False
a. True
For most facilities, all CPT and HCPCS procedures and supply codes are \_\_\_\_\_\_\_\_ into the chargemaster. a. Loaded b. Hard-coded c. Captured d. Selected
b. Hard-coded
Which of the following supplies are billable?
a. Alcohol wipes
b. Gauze sponges
c. Bedpan
d. Stents
d. Stents
HCPCS was developed in:
a. 1983
b. 1984
c. 1985
d. 1986
1978
Healthcare Common Procedure Coding System (HCPCS)
When billing for supplies, whether an HCPCS code is assigned or not,
which appropriate code for the supply type must be assigned?
a. Revenue
b. APC
c. DRG
d. CPT
a. Revenue
Dictated by the interpreting radiologist, what serves to support the radiology exam performed? a. Procedure b. Findings c. Radiology report d. Diagnosis
c. Radiology report
The imaging report, dictated by the performing or
interpreting radiologist, serves to support the examination performed and the
clinical findings of the examination for both the technical (hospital/facility) and
professional (physician) components.
In the hospital setting, when the physician bills for the professional
component of CPT, the radiology department will bill for the:
a. Technical component
b. Modifier component
c. ABN component
d. Global component
a. Technical component
Authoritative coding guidance is provided by:
a. American Medical Association
b. American Hospital Association
c. Centers for Medicare & Medicaid Services
d. All of the above
a. American Medical Association
When conducting a coding and documentation review, all of the following should be reviewed except: a. Radiology reports b. Physician orders c. Claims forms/detailed bills d. PACS images
d. PACS images
the number and type of
encounters for review must be selected. Once this information has been determined,
the imaging reports, the physician’s order, copies of the detailed bills, and
any internal charge documents should be gathered.
Key components in the imaging coding process are the CPT and modifiers, HCPCS, DRGs, APCs, and: a. ICD b. ABN c. CMS d. CCI
a. ICD
The federal government is the authoritative source on:
a. American Medical Association (AMA)
b. Medicare (CMS)
c. American College of Radiology (ACR)
d. Private payors
b. Medicare (CMS)
Revenue codes consist of 4 numeric digits and are used to note types of
services submitted by hospitals on the hospital provider uniform billing
electronic claim forms.
a. True
b. False
a. True
also known as a CMS-1450 or UB-04 claim form
The absence of accurate diagnosis information creates a concern for both
the radiologist and the hospital and could result in the performance of an
incorrect radiology exam, thus delaying patient:
a. Exams and preparations
b. Billing and payment
c. Scheduling and consent
d. Diagnosis and treatment
d. Diagnosis and treatment
How often does the DHHS Secretary provide an estimate of the SGR and CF to MedPAC? a. Annually b. Bi-annually c. Monthly d. Quarterly
a. Annually
The
use of SGR began in 1997 as part of the BBA and is intended to control the growth
in aggregate Medicare expenditures for physicians’ services
How do IDTFs differ from physician offices and hospital outpatient
departments?
a. They are restricted to the technical component
b. They have lighter rules and requirements
c. They are subject to unannounced inspections
d. None of the above
c. They are subject to unannounced inspections
The Medicare Modernization Act makes clear that radiopharmaceuticals
are not considered covered outpatient drugs.
a. True
b. False
b. False
The MMA mandated that the MPFS increase payments by at least 1.5% in 2004
and again in 2005. The MMA makes clear that radiopharmaceuticals are considered
covered outpatient drugs. CMS determined that reimbursement for drugs that
cost less than $50 could be bundled into the cost of the procedure or service, and
that only drugs costing more than $50 would be considered separately payable.
The portion of the Medicaid program that is paid by the federal
government is known as the:
a. Federal Health Insurance Percentage (FHIP)
b. Medicaid Assistance Percentage Protocol (MAPP)
c. National Medicaid Assistance Protocol (NMAP)
d. Federal Medical Assistance Percentage (FMAP)
d. Federal Medical Assistance Percentage (FMAP)
The FMAP is
determined annually for each state by a formula that compares the state’s average
per capita income level with the national average. Wealthier states have a smaller
share of their costs reimbursed.
A commonly covered optional service under the Medicaid program is:
a. Prescribed drugs
b. Diagnostic services
c. Prosthetic devices
d. All of the above
d. All of the above
CMS reduced the technical reimbursement for multiple procedures
performed during the same session to ____ for the first procedure and
____ for the second.
a. 100%; 0%
b. 100%; 50%
c. 50%; 50%
d. 100%; 75%
b. 100%; 50%
The Part A portion of Medicare is also called:
a. Hospital insurance
b. Supplementary medical insurance
c. Prescription drug benefits
d. None of the above
a. Hospital insurance
What level of government administers the Medicaid program?
a. Federal
b. State
c. Local
d. County
a. Federal
Medicaid is a federally funded and state-funded medical assistance program
administered individually by each state.10 In general, it provides health benefits for
eligible persons and families with low incomes and limited resources. The
Medicaid program, like Medicare, is administered by CMS. (page 109).
What is appended to the CPT code and billed on the 1500 claim form for
the physician work to interpret the procedure?
a. Ambulatory payment classification
b. Technical component modifier
c. Professional component modifier
d. None of the above
c. Professional component modifier
UB04 is the hospital claim form
1500 claim form is for Professional services
Medicare-insured patients typically make up what portion of those seen in imaging? a. Minimal b. Comparable c. Insignificant d. Large
d. Large
_________ reimbursements for physicians cannot exceed the
reimbursement rates for _________, but most states have set them lower.
a. Medicare; Medicaid
b. Medicaid; Medicare
c. Medicaid; FMAP
d. MCOs; Medicare
b. Medicaid; Medicare
The key term for determining Medicare coverage is:
a. Cost
b. Location
c. Medical necessity
d. Both A & B
c. Medical necessity
A service is generally considered
medically necessary if it is
■■ Appropriate and consistent with the diagnosis and could not have been omitted
without adversely affecting the patient’s condition or the quality of medical care
rendered
■■ Compatible with the standards of acceptable medical practice in the United
States
■■ Provided not solely for a member’s convenience or the convenience of the physician
or hospital
■■ Not primarily custodial care
■■ The least costly level of service that can be safely provided (eg, a hospital stay is
necessary when treatment cannot be safely provided on an outpatient basis)
LMRPs were phased out to make way for:
a. NCSs
b. LCDs
c. Both A and B
d. None of the above
b. LCDs
LCDs focus on “reasonable and necessary” information, whereas the former LMRPs
included benefit category and statutory exclusion provisions. LMRPs also contained
a host of other coding information not directly related to medical necessity
Which is a daily publication that provides updates on the most recent
rules, proposed rules, and notices of federal agencies and organizations?
a. Journal of Roentgenology
b. New England Journal of Medicine
c. Federal Register
d. Daily Planet
c. Federal Register
The Federal Register also
relays information about executive orders and presidential papers. The public can
access these documents through the Federal Register Web site.
Medicaid eligibility is determined by:
a. Income
b. Assets
c. Resources
d. All of the above
d. All of the above
Income is only one method for determining
Medicaid eligibility; assets and resources are also tested against established state
thresholds (page 98).
When national MPFS payment rates are referenced, usually only
____________ are listed.
a. “Participating”
b. “Participating” and “nonparticipating”
c. “Nonparticipating”
d. None of the above
a. “Participating”
Medicare Part B coverage pertains to:
a. Supplemental medical insurance
b. Hospital coverage
c. The patient’s tax bracket
d. None of the above
a. Supplemental medical insurance
Medicare coverage is split between Medicare Part A, which is hospital coverage, and
Medicare Part B, which is supplemental medical insurance. Medicare Part A is free
to those who qualify and helps cover expenses involved in hospital stays and, occasionally,
in hospice care. Coverage under Medicare Part B, which includes physician
visits and outpatient care, requires payment of a monthly fee.
The portion of the Medicaid program that is paid by the federal
government is known as the:
a. Federal Market Share Ratio
b. National Health Percentage
c. Federal Medical Assistance Percentage
d. Federal Medicaid Assistance Percentage
c. Federal Medical Assistance Percentage
The FMAP is
determined annually for each state by a formula that compares the state’s average
per capita income level with the national average. Wealthier states have a smaller
share of their costs reimbursed
NCDs are influenced by this group who offers advice to CMS on which
medical items and services are reasonable and necessary?
a. Medicare Coverage Advisory Committee (MCAC)
b. American College of Radiology (ACR)
c. American Medical Association (AMA)
d. Medicare Payment Advisory Commission (MedPAC)
a. Medicare Coverage Advisory Committee (MCAC)
The MCAC offers advice to the CMS on which medical items and services
are reasonable and necessary under Medicare law; the CMS then makes the
final decision. The MCAC meets in an open and public forum, providing careful
review and discussion of specific clinical and scientific issues to ensure an unbiased
and contemporary consideration of state-of-the-art technology and science.
The Medicare Recovery Audit Contractor Program was established to
ensure that Medicare payments have been made appropriately.
a. True
b. False
a. True
The contractors review the last three years of provider claims for inpatients,
outpatients, skilled nursing facilities, physicians, ambulance services, laboratory
services, and durable medical equipment (DME) to identify overpayments or
underpayments.
Most _______ do not cover care provided by physicians outside of their
set network, but federal regulations require this type of MCO to guarantee
that members are able to receive care.
a. POSs
b. TPAs
c. PPOs
d. HMOs
d. HMOs
The passing of the Medicare Modernization Act of 2003 prompted a shift
in the way PPOs do business.
a. True
b. False
a. True
Medicare began providing
members with regional PPO coverage, allowing them to see any in-network physician.
The legislation dictates that to participate in Medicare, a health plan must bid
on not one or part of a state but a group of states.
With a _______, if the member’s in-network primary care physician refers
the member to an out-of-network practitioner, in-network reimbursements
still apply.
a. POS
b. TPA
c. PPO
d. HMO
a. POS
a point of service (POS) plan works from an
HMO platform and is subject to the same fee schedules, copayments, and utilization
management restrictions as an HMO. A POS plan is a sort of HMO-PPO hybrid.
Under this program, the payor must be notified by telephone in the case of
specific procedures and hospital stays and be made aware of the
upcomign expense.
a. Managed care
b. Notification
c. POS
d. Self-insurance
a. Managed care
Under a __________ program, the employer shoulders all the financial
risk involved in the care of its employees, up to the amount of the stoploss
coverage.
a. Managed care
b. Notification
c. POS
d. Self-insurance
d. Self-insurance
Members of a typical ________ have the freedom to visit any in-network
specialist with or without a referral and still receive in-network benefits.
a. HMO
b. PPO
c. POS
d. MCO
b. PPO
POS plan still requires the member to obtain a referral for the out-of-network physician if they want to keep “in network” benefits.
Most businesses use _________ that serve many companies because
they can benefit from the resulting efficiencies.
a. HMOs
b. PPOs
c. MCOs
d. TPAs
d. TPAs (third party administrator)
TPAs are state licensed to administer health benefit plans for self-insured employers.
Very large self-insured employers, such as Disney and Ford Motor Company,
own their TPAs
Through utilization management, payors minimize expenses due to which
of the following by controlling member access to medical services?
a. Unnecessary medical procedures
b. Extended hospital stays
c. Inadequate care
d. All of the above
d. All of the above
By requiring physicians to discuss patient care choices, they will continue
to be reminded of payor guidelines. This is known as the:
a. Confer effect
b. Guard duty
c. Sentinel effect
d. None of the above
c. Sentinel effect
research has continually proven, any management program that requires physicians
to contact the payor and explain that they have ordered a certain procedure or hospitalization
prevents unnecessary care. This is known as the sentinel effect—by
requiring physicians to discuss or explain their patient care choices, they will continue
to be reminded of the payor’s guidelines.
According to 2011 national managed care entrollment data, how many were enrolled in a PPO? a. 108.3 million b. 68.1 million c. 24.1 million d. 9.5 million
a. 108.3 million
Contracts should ensure that if “clean” claims are not paid within the
prescribed period of time:
a. The contract is terminated
b. The provider is paid interest on the claim
c. The provider is responsible for penalizing the payor however the
provider deems fit
d. All of the above
b. The provider is paid interest on the claim
In terms of performance measures stated in a contract, the imaging
administrator:
a. Should allow the facility some flexibility
b. Should never agree to absolute terms
c. Should feel confident in the facility’s performance to agree to
absolute terms
d. Both A & B
c. Should feel confident in the facility’s performance to agree to
absolute terms
What kind of revenue is usually based on a predictable fee schedule?
a. Technical
b. Professional
c. Both A & B
d. None of the above
b. Professional
Contract reciprocity is sometimes referred to as:
a. Shadow EPO
b. Shadow PPO
c. Shady PPO
d. Stalker PPO
b. Shadow PPO
Such
agreements may result in providing services under a contract to an organization
with which one would never have done business or on terms one would not have
offered.
Contract negotiation preparation does not require a thorough knowledge of the following: a. The facility b. The opposition c. The staff d. The competition
c. The staff
Some of the more popular methods for determining costs are to calculate costs as a function of: a. Medicare b. RVUs c. Visits d. All of the above
d. All of the above
Regardless of which contract payment method is used, rates are usually:
a. Non-negotiable
b. Negotiable
c. High
d. Low
b. Negotiable
Negotiations should be looked upon as a contest, and the
person who leads the negotiations should be the most competitive person on the
team—one who clearly does not like to lose. However, that person must also understand
the need for building long-term relationships.
The person who leads negotiations should:
a. Be competitive
b. Build long-term relationships
c. Downplay their facility’s weaknesses
d. All of the above
d. All of the above
Healthcare providers typically charge ________ times the rate set by the
federal government’s Medicare program but actually collect a fraction of
the charge.
a. 5 to 10
b. 10 to 20
c. 3 to 4
d. None of the above
c. 3 to 4
What duration is usually the goal of a services contract?
a. 6 months to 1 year
b. 5 to 10 years
c. 3 to 5 years
d. 1 to 2 years
c. 3 to 5 years
longer duration may
become problematic for the imaging provider as the landscape changes. A duration
of three to five years allows the imaging provider enough time to recoup any additional
investments made to fulfill the contract obligations.
All of the following questions should be asked before negotiating a
contract, except:
a. Who provides the professional services?
b. Does the payor need or require after-hours, weekend, or holiday
coverage?
c. Does the payor require submission of electronic reports from an
EMR?
d. None of the above
c. Does the payor require submission of electronic reports from an
EMR?
What duration is usually the goal of a services contract?
a. 6 months to 1 year
b. 5 to 10 years
c. 3 to 5 years
d. 1 to 2 years
x
In contract negotiation, it is appropriate to agree on confidentiality of:
a. Financial information
b. Patient information
c. All of the above
d. None of the above
c. All of the above
Most acute care providers in the healthcare industry use:
a. Cost-based pricing
b. Market-based pricing
c. Fixed pricing
d. None of the above
a. Cost-based pricing
Cost accounting categorizes costs and allocates them to units of service based
on specific assumptions. A unit of service may be an RVU, a particular procedure,
or in the case of an imaging department, an X-ray examination, MRI, or CT
Many payors include a clause in contracts that late claims:
a. Are ineligible for payment
b. Are eligible for payment, but at a reduced rate
c. Are eligible for payment
d. Will result in the termination of the contract
a. Are ineligible for payment (usually 60-90 days after the date the service was provided)
To set prices effectively, a facility needs:
a. Accurate cost of information
b. An accurate number of RVUs
c. Levels of reimbursement by payor
d. All of the above
d. All of the above
_______ are Medicare’s inpatient counterpart to __________.
a. DRGs; APCs
b. APCs; DRGs
c. DRGs; RVUs
d. RVUs; APCs
a. DRGs; APCs
Which contract term is referred to in the event that the payor merges with or is bought by another company? a. Reciprocity b. Term and termination c. Assignment d. Arbitration
c. Assignment
A well-negotiated contract may represent a short-lived victory without the automatic
assignment of the contract to a successor organization. That is, the contract should
remain in effect even if a payor merges with, or is bought by, another company.
In cost accounting, costs can be:
a. Fixed
b. Variable
c. Both A and B
d. None of the above
c. Both A and B
Costs can be
fixed, variable, or a combination of the two and can be direct or indirect. The allocation
of costs is used as the foundation for pricing.
Many facilities lack the resources to ensure that cost data are consistent
with reality.
a. True
b. False
a. True
The most common approach to medical services pricing is:
a. RVU based
b. Market-based
c. Cost-based
d. All of the above
d. All of the above
Cost-based pricing seeks to cover
costs,
market-based pricing aims to set prices based on market rates and
then ensure that costs remain at a level that will result in a profit or margin
RVUs take into account a number of variables, including intensity of resources,
level of training and skill necessary for the provider to deliver the service, and the
time and stress involved in service delivery
Patient flow is inseparable and intertwined with:
a. Patient contact
b. Patient billing
c. Hospital or imaging center workflow
d. Staffing levels
b. Patient billing
The revenue cycle encompasses all aspects of the patient billing process and, consequently,
shows patient flow through a healthcare institution from initial registration
to final payment. As shown in Figure 6.1, patient flow and patient billing are
inseparable and intertwined
Sched/reg, Billable services provided, Billing process, Reimbursement
The evaluation of a revenue cycle and management of that cycle is perhaps the best mean of improving: a. Patient satisfaction b. Employee turnover c. Revenue d. Volume
c. Revenue
Key indicators and measures of effectiveness are universal for all
individual practices.
a. True
b. False
b. False
Approximately what percentage of claims are lost, not considered, misfiled, or mishandled? a. 5% b. 10% c. 15% d. 20%
c. 15%
The Fair Debt Collection Practices Act protects:
a. The provider from the patient
b. The patient from the credit bureaus
c. The patient from the provider
d. Consumers from abusive debt collectors
d. Consumers from abusive debt collectors
To combat decreasing managed care reimbursement, many providers are
now pursuing:
a. Prepaid or contract accounts
b. Patient cash payments
c. Attorney or Letter of Protection payments
d. Medicare/Medicaid accounts
a. Prepaid or contract accounts
In light of decreasing managed care reimbursements, many providers have looked
to direct provider-to-provider contracts to bridge the gap between managed care
payments and private pay accounts
Which would give a collector the best handle on actual money outstanding? a. Explanation of Benefits b. Tracking claims c. Tracking no shows d. None of the above
b. Tracking claims
According to the Fair Debt Collection Practices Act, which one of these is
considered a violation when collecting a debt?
a. Acceptance of a check postdated more than 5 days
b. Charges to a patient for collect phone calls or telegrams when the
communications conceal the true attempt of the contact
c. Collection of charges or interest that were not specifically
addressed in the document creating the debt
d. All of the above
d. All of the above
To combat decreasing managed care reimbursement, many providers are
now pursuing:
a. Prepaid or contract accounts
b. Patient cash payments
c. Attorney or Letter of Protection payments
d. Medicare/Medicaid accounts
x
Which of the following is not a part of the revenue cycle?
a. Patient intake
b. Billable service provided
c. Patient satisfaction questionnaire
d. Billing of service
c. Patient satisfaction questionnaire
The revenue cycle generally consists of how many major components?
a. Two
b. Four
c. Three
d. Ten
b. Four
Patient Intake
Billable Service Provided
Billing of Service
Reimbursement
The yearly budgeting process, or financial planning process, is closely aligned
with another key business planning process. That key business planning
process aligned with the financial planning process is the:
a. Statistical planning process
b. Strategic planning process
c. Resource allocation process
d. Capital bond planning process
b. Strategic planning process
Strategic planning and the budgeting process are closely aligned, as a budget should
be created to fund the operations that appear in the strategic plan. In some organizations,
the strategic planning process is integrated with the budget process, and the
only written communication of the strategic plan may be the budgets created by the
facility or its departments.
Understanding of the total cost of ownership in a capital acquisition requires
analysis of the impact of the capital acquisition on the cost of the equipment
and the cost of:
a. Warranties and service
b. Certifications and inspections
c. IT related changes and costs
d. All of the above
x
On some time schedule, daily, weekly, monthly, quarterly, yearly, variance
reporting provides detailed analysis to the radiology administrator about the
success of the financial plan.
a. True
b. False
a. True
The acronym FTE represents:
a. Full time equivalent
b. Full time employee
c. Flexible time equivalent
d. Flexible time employee
b. Full time employee
Define seasonality.
a. How the budget process changes throughout the year
b. A process throughout the year that drives the part of the budget being
worked on at any given time.
c. The variation in budgets throughout the year.
d. A way to describe periods during which volumes go up or down in a
predictable way throughout the year.
d. A way to describe periods during which volumes go up or down in a
predictable way throughout the year.
Compensation, in total, is defined as:
a. Salary
b. Hourly wages
c. Salary and fringe benefits
d. Employee assistance programs
c. Salary and fringe benefits
Some examples of fringe benefits are:
a. Vacation time
b. Health insurance
c. Disability programs
d. All of the above
d. All of the above
In the budgeting process, SI stands for:
a. Significant indicator
b. Surplus indicator
c. Statistical indicator
d. Special indicator
c. Statistical indicator
Volume is counted by use of a statistical indicator (SI), which is any
measure chosen to represent volume. For most imaging departments the SI is procedures,
although it could be Current Procedural Terminology (CPT) codes, relative
value units (RVUs), or patients. RVUs correlate closely with procedure volumes.
Expenses that change with changes in volume are called:
a. Flexible expenses
b. Variable expenses
c. Fixed expenses
d. Clinical expenses
b. Variable expenses
Direct variable expenses are expenses that change with changes in volume
(eg, the cost of contrast media injected during CT scanning).
Expenses that do not change with changes in volume are called:
a. Fixed expenses
b. Clinical expenses
c. Flexible expenses
d. Variable expenses
a. Fixed expenses
Direct fixed expenses
are expenses that do not change with volume (eg, the cost of on-call beepers for CT technologists)
When an imaging administrator engages in an examination of all operational
expenses and builds a budget that is based on the predicted cost activities of
each sub account, this exercise is called:
a. A living nightmare
b. Yearly Medicare cost accounting
c. Zero based budgeting
d. Perpetual inventory control
c. Zero based budgeting
Budgets that allow for adjustment when actual volume/revenue drivers
change significantly from predicted levels are called:
a. Flexible budgets
b. Clinical budgets
c. Fixed budgets
d. Statistical budgets
a. Flexible budgets
The budget is created at the beginning of the budget year and
then each month; as volume rises above or falls below predicted levels, revenue and
expenses are changed accordingly.1
Flexible budgeting is a sound method, especially if overall budgeting occurs within
specific cost centers. Managers used to be taught to budget higher than needed and
spend less than budgeted.
At the time of budget preparation, much thought goes into why specific
financial predictions are made. In financial jargon, the process of
documenting the thoughts behind why these predictions are made is called
documenting:
a. Strategic planning
b. Justifications
c. Budget audit preparation
d. Budget assumptions
d. Budget assumptions
Applying projected growth rates to the historical volumes by month preserves
detail about busy or slow times of the department’s history. Engaging in this
methodology would be creating a(n):
a. Seasonal index
b. Budget history
c. Way to measure success
d. None of the above
a. Seasonal index
With respect to financial planning, the acronym CON represents:
a. Chief of nursing
b. Certification of non-compete
c. Certificate of need
d. Chief on nights
c. Certificate of need
State certifications, inspections, and CON costs are all part of the calculation
for total cost of ownership.
a. True
b. False
a. True
- Warranties, service contracts, and maintenance
- State certifications, inspections, and CONs
- The accreditation process and phantoms
- Work flow costs or changes
- Facility and renovation costs
- Ancillary equipment
In the radiology budgeting process, statistical indicators are used to measure:
a. Revenue
b. Volume
c. Profit dollars
d. Incentive and quality measures
b. Volume
Volume is counted by use of a statistical indicator (SI), which is any
measure chosen to represent volume. For most imaging departments the SI is procedures,
although it could be Current Procedural Terminology (CPT) codes, relative
value units (RVUs), or patients. RVUs correlate closely with procedure volumes.
The difference between a budgeted amount and the amount of actual
revenue or expense for a period is called a(n):
a. Error
b. Variance
c. Mistake
d. Report
b. Variance
It is fairly common practice in variance reporting to include:
a. Assumptions not met
b. Percentages of variance
c. Actual variance values and percentage of variance
d. Non-performance of the strategic plan
b. Percentages of variance
The most common type of variance report is the actual-to-budget variance report.
The actual-to-budget variance is often calculated by the finance department and
noted in a separate column in the budget reports as either a number or a percentage.
To calculate a number variance, subtract the budget number from the actual number.
Which of the following is not a kind of budget that would be used by an imaging administrator? a. Staffing budgets b. Operating budgets c. Research budgets d. None of the above
d. None of the above
FTE stands for:
a. Full time employee
b. Full time equivalent
c. Full time equal
d. Full time entity
b. Full time equivalent
The abbreviation for RVU as it relates to productivity standards is:
a. Real-time value unit
b. Run time value unit
c. Relative value unit
d. Risk value unit
c. Relative value unit
Expenses that increase and or decrease with an increase and or decrease in volume are called: a. Fixed b. Variable c. Everyday d. Routine
b. Variable expenses
Choose two main categories of employee time:
a. Worked time and productive time
b. Productive time and lunch time
c. Lunch time and vacation time
d. Vacation time and worked time
a. Worked time and productive time
Productive hours ÷ Worked hours = Productivity percentage
The time a staff member spends on the job is:
a. Paid time
b. Play time
c. Worked time
d. Non-productive time
c. Worked time
Four main categories of employee time:
- Worked time: The time staff members spend on the job.
- Productive time: The time staff members spend on their daily duties
- Nonproductive time: The time between tasks
- Paid time: All paid time, PTO, SICK, Bereavement, holidays
Expenses which include equipment and facilities are defined as:
a. Variable
b. Fixed
c. Expensive
d. Budgeted
b. Fixed
Four main categories of employee time:
- Worked time: The time staff members spend on the job.
- Productive time: The time staff members spend on their daily duties
- Nonproductive time: The time between tasks
- Paid time: All paid time, PTO, SICK, Bereavement, holidays
The time staff members spend on the job.
A. Worked Time
B. Productive Time
C. Nonproductive time
D. Paid Time
A. Worked time
The time between tasks
A. Worked Time
B. Productive Time
C. Nonproductive time
D. Paid Time
C. Nonproductive time
All paid time (eg paid time off [PTO] for illness, vacation, bereavement and holiday
A. Worked Time
B. Productive Time
C. Nonproductive time
D. Paid Time
D. Paid time
Expenses for patient-related supplies include drugs, hospital instruction, liquid
helium, and office products.
A. Variable
B. Fixed
C. Expensive
D. None
A. Variable
Expenses related to tangible fixed assets—generally
equipment and associated maintenance contracts and lease payments:
A. Variable
B. Fixed
C. Expensive
D. None
B. Fixed
A graphical reporting tool that can capture data from different systems and represent them summarized in real time for easy reading.
A. Dashboard
B. QI
C. Proforma
D. Business Plan
A. Dashboard
The average amount of staff time required per patient, procedure, or task is known as: a. Worked time b. Productive time c. Labor standards d. Variable expenses
c. Labor standards
What is an educated guess of how a new business venture will perform over a certain period of time? a. Balance sheet b. Transaction summary c. Pro forma d. Summary statement
c. Pro forma
a pro forma is a presentation of business data, including assumptions,
forecasted financial positions, and operating indicators based on the assumptions
integrated with the organization’s financial and other objectives for a new or
existing business activity
The author of a pro forma is always the actual manager responsible for
the business or service line being evaluated.
a. True
b. False
b. False
The pro forma requires research to deteremine the applicable:
a. Metrics, indicators, and costs
b. Laws, regulations, and costs
c. Policies and procedures
d. Metics, regulations, and costs
a. Metrics, indicators, and costs
…(both direct and indirect) to ensure that the
assumptions used will be accurate and inclusive and will properly present the
anticipated impact on the organization
What is the typical time frame in which a business change is evaluated?
a. Six months
b. One year
c. Three years
d. Five years
d. Five years
The time frame is typically
five years based on organizational goals, standards, and rationale assumptions;
it should be used as a common time frame in all aspects of the pro forma process
What kind of needs should be assessed during the initial stages of pro forma development? a. Clinical b. Strategic c. Financial d. All of the above
d. All of the above
What does a SWOT analysis stand for?
a. Strengths, weaknesses, opportunities, threats
b. Strengths, worries, opposition, take-aways
c. Stamina, weaknesses, options, timetable
d. Stance, wins, opportunites, threats
a. Strengths, weaknesses, opportunities, threats
If an organization does not already have a standard pro forma, which
department needs to approve one before the process begins?
a. Legal
b. Finance
c. Nursing
d. Administration
b. Finance
In the example scenario, what was John’s first step
a. Analyze the impact of extended hours, additional staff, and new
services
b. Figure out time requirements per procedure
c. Conduct a market review and SWOT analysis
d. review of reimbursement demo
c. Conduct a market review and SWOT analysis
What is/are the critical basis of any accurate, useful pro forma?
a. Data collection
b. Assumptions
c. Integration
d. All of the above
d. All of the above
A basic pro forma should include:
a. Cost assumptions
b. Revenue assumptions
c. Both of the above
d. None of the above
c. Both of the above
Formula for Percent Variance is:
(Actual - Budget)/Budget x 100 = % Variance
Expenses related to tangible fixed assets—generally
equipment and associated maintenance contracts and lease payments:
A. Variable
B. Fixed
C. Expensive
D. None
B. Fixed
The average amount of staff time required per patient, procedure, or task is known as: a. Worked time b. Productive time c. Labor standards d. Variable expenses
c. Labor standards
Productivity that is too high:
a. Reduces the ability to accept unscheduled patients
b. Can lead to fatigue errors
c. Creates job dissatisfaction and poor customer service
d. All of the above
d. All of the above
Productivity that is too high:
a. Reduces the ability to accept unscheduled patients
b. Can lead to fatigue errors
c. Creates job dissatisfaction and poor customer service
d. All of the above
d. All of the above
When using productivity benchmarks it is best to use:
a. Facilities that are similar in bed size, exam volumes and modalities
to your own.
b. Facilities that are a Level I trauma center
c. Facilities that do not routinely collect and report their data.
d. Facilities that only report exam volume data.
d. Facilities that only report exam volume data.
When using productivity benchmarks it is best to use:
a. Facilities that are similar in bed size, exam volumes and modalities
to your own.
b. Facilities that are a Level I trauma center
c. Facilities that do not routinely collect and report their data.
d. Facilities that only report exam volume data.
d. Facilities that only report exam volume data.
The standards generated using the activity based costing (ABC) approach
are _________ and __________ to develop and maintain.
a. More accurate, less expensive
b. More accurate, more expensive
c. Less accurate, less expensive
d. Less accurate, more expensive
b. More accurate, more expensive
The standards generated using the activity based costing (ABC) approach
are _________ and __________ to develop and maintain.
a. More accurate, less expensive
b. More accurate, more expensive
c. Less accurate, less expensive
d. Less accurate, more expensive
b. More accurate, more expensive
The standards generated using the activity based costing (ABC) approach
are _________ and __________ to develop and maintain.
a. More accurate, less expensive
b. More accurate, more expensive
c. Less accurate, less expensive
d. Less accurate, more expensive
b. More accurate, more expensive
A business plan:
a. Describes all aspects of a proposed venture and a realization of an
organization’s expectations and goals
b. Should make a convincing case that a market exists
c. Should provide objectives for short and long term
d. All of the above
a. Describes all aspects of a proposed venture and a realization of an
organization’s expectations and goals
A company description within a business plan is important to:
a. Outside investors only
b. Internal audience only
c. Both outside investors and internal audience
d. None of the above
c. Both outside investors and internal audience
A formal business plan does not:
a. Guarantee that a business will be successful
b. Provide an objective way to make decisions about an opportunity
and avoids mistakes
c. Serve as the basis for acquiring capital funds
d. None of the above
a. Guarantee that a business will be successful
It is important to make sure a business plan:
a. Deemphasizes investor needs
b. Deemphasizes market needs
c. Demonstrates that there is market interest and documents it
d. Both a and b
c. Demonstrates that there is market interest and documents it
A business plan should include an exit strategy.
a. True
b. False
a. True
An imaging administrator can use the following technique(s) before writing a business plan: a. SWOT analysis b. Force field analysis c. Both a and b d. Neither a nor b
c. Both a and b
The main difference between a SWOT analysis and a TOWS analysis is
that TOWS:
a. Is more complicated
b. Does not examine weaknesses and strengths
c. Examines threats and opportunities first
d. Focuses on the internal environment
c. Examines threats and opportunities first
The executive summary of a business plan:
a. Is usually written first, but read last
b. Is usually written last, but read first
c. Is two to five paragraphs
d. Always contains graphs and charts
b. Is usually written last, but read first
A business plan’s comprehensive executive summary may include:
a. The qualifications of the organization’s management team
b. A synopsis of the competition’s revenue
c. Examples of the organization’s previous failures
d. None of the above
a. The qualifications of the organization’s management team
■■ A synopsis of the company’s general strategy for success in business ventures
■■ Examples of previous successes, especially similar plans or projects that reached
successful outcomes
■■ The qualifications of the company’s management team
■■ A concise statement describing where the proposed business activity fits into the
competitive market
■■ Annual revenue for the past five years and projected revenue for the coming five
years
The “Company Description, Strategy, and Management Team” section of a
business
plan:
a. Includes the reason for establishing a new business
b. Contains the organization of the business plan document
c. Always reveals the compensation of the management team
d. Reveals past instances of corporate scandal and SEC investigations
b. Contains the organization of the business plan document
The executive summary of a business plan:
a. Is usually written first, but read last
b. Is usually written last, but read first
c. Is two to five paragraphs
d. Always contains graphs and charts
b. Is usually written last, but read first
The
executive summary gives a synopsis of the business plan’s most important components.
In creating the summary, ask what an executive would be likely to want to
know if given only two to five minutes to present the entire proposal. Questions
would probably include the following
A business plan’s comprehensive executive summary may include:
a. The qualifications of the organization’s management team
b. A synopsis of the competition’s revenue
c. Examples of the organization’s previous failures
d. None of the above
a. The qualifications of the organization’s management team
- previous successes
- synopsis of general strategy for success
- business activity fits into the competitive market
- annual revenue for past 5-years
The “Company Description, Strategy, and Management Team” section of a
business
plan:
a. Includes the reason for establishing a new business
b. Contains the organization of the business plan document
c. Always reveals the compensation of the management team
d. Reveals past instances of corporate scandal and SEC investigations
b. Contains the organization of the business plan document
The “Company Description, Strategy, and Management Team” section of a
business
plan:
a. Includes the reason for establishing a new business
b. Contains the organization of the business plan document
c. Always reveals the compensation of the management team
d. Reveals past instances of corporate scandal and SEC investigations
b. Contains the organization of the business plan document
When assessing the market and competitors, a business plan should:
a. Quantify as much as possible the competitors’ market share
b. Identify the organization’s service area and customer base
c. Identify potential customers and what they want
d. All of the above
d. All of the above
Qualitative research to assess the market:
a. Is statistical research about a business or service
b. Includes focus groups and one-on-one interviews
c. Both a and b
d. None of the above
b. Includes focus groups and one-on-one interviews
Quantitative research to assess the market does not include:
a. Customer satisfaction surveys
b. Demand and market share estimation
c. Segmentation research
d. Focus groups and interviews
d. Focus groups and interviews
When assessing the market and competitive environment, the business plan
addresses how likely the new service will succeed in the face of competition.
a. True
b. False
a. True
Force field analysis involves:
a. Describing past situations
b. Unstructured brainstorming
c. Analyzing two opposing forces acting on a situation
d. None of the above
c. Analyzing two opposing forces acting on a situation
In force field analysis, it is determined:
a. Which factors reduce the impact of opposition
b. Which factors are inconsequential
c. What the competition’s strengths are
d. What the competition’s weaknesses are
a. Which factors reduce the impact of opposition
can help identify all the factors supporting a
decision and reduce the impact of opposition to the decision
The “Financial Information and Analyses” section of a business plan:
a. Will often be the most important section
b. Quantifies forecasts and estimates
c. Both a and b
d. None of the above
c. Both a and b
The “Financial Information and Analyses” section of a business plan should
include at least:
a. Net present value (NPV), return on investment (ROI), request for proposal
(RFP)
b. Volume and operating statistic analysis, net present value (NPV), return
on investment (ROI)
c. Volume and operating statistic analysis, certificate of need (CON), return
on investment (ROI)
d. None of the above
b. Volume and operating statistic analysis, net present value (NPV), return on investment (ROI)
It is common for imaging to consume how much of an organization’s entire capital budget? a. One tenth b. One quarter c. One half d. One third
d. One third
When presenting a business plan in a meeting:
a. Answer these questions: What is the plan, its goals, how much it will cost,
and why it’s recommended
b. Provide a concise review in a document not longer than four pages when
presenting the plan
c. Not have a document since executives do not read it
d. None of the above
a. Answer these questions: What is the plan, its goals, how much it will cost,
and why it’s recommended
The OIG’s Compliance Program Guidances lists the minimum seven
elements that should be included in every Compliance Program. The list
includes:
a. The designation of a chief compliance officer and other appropriate
bodies
b. The development and implementation of regular, effective
education and training programs for all affected employees
c. The use of audits and/or other evaluation techniques to monitor
compliance and assist in the reduction of identified problem areas
d. All of the above
d. All of the above
-development and distribution of written standards of conduct
-designation of a chief compliance officer and other appropriate bodies
-development and implementation of regular, —effective education and training
maintenance of a process, such as a hotline, to receive complaints
elopment of a system to respond to allegations of improper/illegal activities
dits and/or other evaluation techniques to monitor compliance
investigation and remediation of identified systemic problems.
Medicare covers more than how many Americans?
a. 6 million
b. 10 million
c. 50 million
d. 100 million
c. 50 million
Policies and procedures should be reviewed:
a. Monthly
b. Semi- annually
c. Annually
d. Every five years
c. Annually
How many people should be assigned oversight responsibility for the
compliance program?
a. One
b. Two
c. A committee of no less than five people
d. None of the above
a. One
The U.S. Sentencing
Commissions Guidelines state, “Specific individual(s) within high-level personnel of
the organization must have been assigned overall responsibility to oversee compliance
with [compliance] standards and procedures.”
The primary responsibilities of a compliance officer should include:
a. Overseeing and monitoring the implementation of the compliance
program
b. Periodically revising the program in light of changes in the
organization’s needs
c. Reporting on a regular basis to the government on progress of the
implementation
d. Both a and b
d. Both a and b
The whistleblower statutes are also known as:
a. Habeas corpus
b. Qui tam
c. Nolo contendere
d. E pluribus unum
b. Qui tam
Examples of false claims that could be submitted in imaging include the
following:
a. Submitting a claim for tests that were not ordered
b. Submitting a claim for tests that were not performed
c. Both a and b
d. None of the above
c. Both a and b
- using the wrong ICD
- submitting a claim for test not ordered
- submitting a claim for test not performed
- submitting a claim for complete exam when limited was performed
The best defense against a False Claims Act is having an existing Qui Tam
policy.
a. True
b. False
b. False
The best defense against the FCA is having an existing corporate compliance plan
The FTC works closely with the \_\_\_\_\_\_ to investigate potential healthcare antitrust violations. a. FBI b. CIA c. DOJ d. NSA
c. DOJ
investigate potential healthcare antitrust violation:
mergers, joint ventures, provider participation in the exchange, networks
Physician self-referral laws are known as:
a. Stark I and Stark II
b. Anti-Kickback Statute
c. Lincoln Laws
d. PhRMA
a. Stark I and Stark II
prohibit a physician from referring
Medicare or Medicaid patients to an entity for designated health services if the
physician or the physician’s immediate family has a financial relationship with that
entity
HIPPA is an acronym for:
a. The Health Insurance Portability and Accountability Act
b. The Health Insurance Privacy and Accountability Act
c. The Health Initiative Portability and Acceptance Act
d. The Health Institute Privacy and Affordability Act
a. The Health Insurance Portability and Accountability Act
The Privacy Rule was established to ensure the non-disclosure of:
a. Patient Financial Information (PFI)
b. Protected Health Information (PHI)
c. Personal Physician Information (PPI)
d. Pre-existing Medical Conditions (PMC)
b. Protected Health Information (PHI)
Some common examples of fraud include:
a. Knowingly billing for a procedure that was not performed
b. Knowingly billing for services or procedures that were not medically
necessary
c. Knowingly unbundling, or billing separately for groups of tests that
are usually billed together
d. All of the above
d. All of the above
■■ Knowingly billing for a procedure that was not performed
■■ Knowingly billing for services or procedures that were not medically necessary
■■ Knowingly double-billing for services
■■ Knowingly up-coding, or assigning a higher-level code to a procedure
■■ Knowingly submitting false costs reports (eg, omitting rebates)
■■ Knowingly unbundling, or billing separately for groups of tests that are usually
billed together
The recent past has seen increased activity in relation to healthcare
compliance regulations and legislation. One of the most financially
impactful developments is the ___ Audit.
a. CMS
b. OIG
c. RAC
d. FBI
c. RAC
RACs are third-party
contractors who earn their incomes as a percentage of recovered fees. RAC auditors
have the ability to examine a healthcare provider’s billing history going back
three years from the date the claim was paid, but not prior to claims paid October
1, 2007
Which regulation imposes a financial penalty on any person or company who defrauds government programs? a. Anti-Kickback statute b. Qui Tam statute c. The False Claims Act d. Antitrust laws
c. The False Claims Act
An FCA violation involves which factors:
a. Presentation of a claim
b. A claim presented to the US government
c. A claim presented with actual knowledge that the claim is wrong,
false, or fraudulent or with reckless disregard for or deliberate
ignorance of the truth (or falsity) of the claim
d. All of the above
d. All of the above
Essential components of a culture of compliance include:
a. Policies and procedures
b. Employee education
c. Continuous monitoring
d. All of the above
d. All of the above
Regulatory compliance is expected in all provider settings: hospitals,
imaging centers, physician offices.
a. True
b. False
a. True
What is the federal agency responsible for administering Medicare,
Medicaid, and other federal health programs?
a. CMS
b. HCFA
c. HIPAA
d. FDA
a. CMS
Hospitals, healthcare providers, and others bill the _______ government
for services provided to Medicare patients and bill the ________
government for Medicaid services.
a. State, local
b. State, federal
c. Federal, state
d. County, federal
c. Federal, state
The whistleblower statutes are also known as:
a. Habeas corpus
b. Qui tam
c. Nolo contendere
d. E pluribus unum
b. Qui tam
The five elements or duties of a fiduciary relationship include:
a. Performance
b. Accounting
c. Both a and b
d. None of the above
c. Both a and b
- performance
- notification
- loyalty
- obedience
- accounting
Administrators developing pro forma financial statements should include
______ year upgrades to make administration aware that such upgrades
will be needed to keep the technology current.
a. One to three
b. Two to four
c. Three to five
d. Four to six
c. Three to five
Interventional cardiologists will often:
a. Require their own lists of supplies
b. Use different medications than which the staff is accustomed
c. Both a and b
d. None of the above
c. Both a and b
Which of the following is a basic service model for radiologists?
a. The university model used by large academic hospital systems
b. The employment model
c. The independent contractor model
d. All of the above
d. All of the above
All human research is subject to ethical review by:
a. An Institutional Review Board (IRB)
b. The National Institutes of Health (NIH)
c. The Office of the Inspector General (OIG)
d. Chief Compliance Officer (CCO)
a. An Institutional Review Board (IRB)
There is never conflict between the goals, initiatives, and operational
direction of the hospital and that of the radiology group.
a. True
b. False
b. False
Some basic issues of “turf battles” are:
a. Duplication of services
b. Most efficient use of costly equipment
c. Proper utilization of space
d. All of the above
d. All of the above
What is good for business and conveys a sincere commitment to fairness and equity? a. Medicare b. Community outreach c. Diversity d. Marketing
c. Diversity
Budgets should be submitted that meet the organization’s:
a. Mission
b. Vision
c. Both a and b
d. None of the above
c. Both a and b
The manager’s ethical responsibility is to devise a 3-5 year capital plan
that reflects the department’s needs and is sensitive to the organization’s
finances.
a. True
b. False
a. True
What will steer the industry in the direction that yields the most return on investment? a. Government reimbursement trends b. The Office of the Inspector General c. The Center for Disease Control d. Charitable donations
a. Government reimbursement trends
While conscious of revenue, an imaging administrator needs to remain
focused on:
a. The healthcare needs of the facility and its patients
b. Profitability
c. Physician requests
d. All of the above
d. All of the above
Profit will run a close
second, and physician requests will come in third. These three frontrunners all
compete for first place, however, and each facility will be different in its needs
depending on its size and the availability of funding
The financial risk for major equipment purchases usually falls on the:
a. Radiologists
b. Facility
c. Referring doctors
d. Vendors
b. Facility
The financial
risk usually falls on the facility, which in turn is dependent upon the referrals of the
requesting physicians for a successful return on investment.
Within a department, what has been frequently noted as an actual asset in many facilities? a. Registration desk b. Waiting room c. Staff lounge d. Square footage
d. Square footage
From a(n) \_\_\_\_\_\_\_ point of view, there is no right or wrong employment model for radiologists. a. Ethical b. Business c. Ideological d. Patient’s
a. Ethical
However, there are different practice patterns, financial risk and liability
issues, and political considerations unique to each model that affect the imaging
administrator.
The proper allocation of___________, varying models for radiologists, turf
battles, health disparity issues, workforce issues, and proper relationships
with vendors will dominate the healthcare landscape for years to come.
a. Technological resources
b. Department finances
c. Charitable contributions
d. Peer pressure
a. Technological resources
To provide specific guidelines regarding acceptable conduct, an organization may create a: a. Conflict of interest statement b. Fiduciary statement c. Code of ethics d. Compliance plan
c. Code of ethics
The duty of performance requires the administrator:
a. Perform duties with skill and diligence
b. Make decisions competently and in the best interest of the
organization
c. Execute the employer’s goals and objectives as long as those
initiatives are within the law
d. All of the above
d. All of the above
An example of the chain of command on an administrative level is:
a. Board of directors
b. Compliance manager
c. State Department of Health
d. ACR
a. Board of directors
