NE BC

Question 1

What is a not-for-profit hospital?

Answer 1

A Tax-Exempt organization considered a charity by the IRS

Question 2

What are not-for-profit hospitals required to do?

Answer 2

Required to treat all conditions/people regardless of insurance or ability to pay

Question 3

What is a for profit hospital?

Answer 3

An organization that is funded by investors or shareholders that can lawfully release a patient who does not have ability to pay for service (after EMTALA)

Question 4

What is the Medicare System

Answer 4

A federal insurance program developed in 1965 providing health insurance coverage for citizen 65+, or any age with end stage renal failure or disabilities.

Consists of 4 parts A,B,C,D

Question 5

How is Medicare funded and who is eligible

Answer 5

-Funded by the payroll tax

-Must be US citizen/Permanent Legal Resident 5+ years.

-Spouse or self must have paid in for at least 10 years.

Question 6

What does Medicare Part A Cover

Answer 6

Hospital Insurance/inpatient hospital care

Some hospice/HH

No monthly premium

Question 7

What does medicare Part B cover

Answer 7

Medical Insurance
Physician Fees, outpt care, labs DME, some meds

PT/OT

Monthly premium

Question 8

What does Medicare Part C cover

Answer 8

Medicare Advantage Plan

Similar to HMO or PPO
Includes part A and B

May offer Dental/Vision/Wellness

Most include part D

Question 9

What does Medicare Part D Cover

Answer 9

Prescription Drug Plan

Available to everyone

Must join a Medicare Plan that includes part D

Monthly Premium

Question 10

What is Medicaid

Answer 10

Medicaid is a 1965 Fed/state funded insurance program managed by the states govt for health insurance for low income families, children, pregnant women and elderly

Question 11

What are the requirement for receiving Medicaid

Answer 11

One must be a U.S. Citizen or permanent legal resident. Includes Low income adults children and disabled.

Question 12

What was signed into Law in 2010 with the goal of making Health insurance available to more people

Answer 12

The Patient Protection and Affordable Care Act

Question 13

What is a Health Maintenance Organization (HMO)

Answer 13

Est. in 1973 by the HMO act

Provides a predetermined set of services focused on preventative care

Paid as a set of fees or dues

Question 14

What is a Preferred Provider Organization?

Answer 14

Established in the early 1980s

Provides more options than an HMO

Participants have an option to utilize “In-network” providers at a discount with more benefits.

Question 15

What term is used to describe the phenomenon where healthcare providers receive rates of reimbursement for care?

Answer 15

Diagnosis related groups (DRGs)

Question 16

How is the reimbursement rate of a DRG calculated?

Answer 16

Based on the average cost of services

Question 17

How many DRGs exist?

Answer 17

> 400

Question 18

Define prospective payments.

Answer 18

Rates agreed upon in advance by insurance companies and the hospital based on DRGs

Question 19

Why would a hospital use a Prospective Payment System (PPS)?

Answer 19

To develop a budget based on the number of clients per DRG they serve on avg

Question 20

What are the four quality measures for pay for performance reimbursement?

Answer 20

Performance
Outcomes
Patient Satisfaction/Experience
Structures and Technologies (EHR)

Question 21

What is Value Based Purchasing?

Answer 21

CMS pay-for-performance incentive program for acute-care hospitals

Pay is yearly based on total performance score (TPS)

Question 22

What is budget?

Answer 22

A plan for how to SPEND, MONITOR, and REDISTRIBUTE available money as needed

Question 23

What is the purpose of a budget?

Answer 23

To manage the business’s finances in an organized way

Question 24

What are the components of a budget cycle?

Answer 24

Development
Monitoring
Reporting
Justifying
Variance Allowance

Question 25

What are the four types of budgets for which a nurse manager/leader may be responsible?

Answer 25

Revenue Expense Capital Operational

Question 26

Define Revenue

Answer 26

Anticipated amount of income during a budget period

Question 27

Define Expense (4)

Answer 27

Salary Non-Salary Fixed Variable

Question 28

What are fixed expenses?

Answer 28

Cost that remain the same no matter the number of patients Rental fees Printer/copy fees Contract fees

Question 29

What are variable expenses?

Answer 29

Vary based on the census or acuity level

Question 30

Define Capital budget

Answer 30

Long range planning tool for organization for items that typically have a lifespan of >1 year Equipment Renovation Costs

Question 31

What Factors should be addressed in a capital budget?

Answer 31

Why is it necessary What would we do without it What is the expected return on investment What new patient population would it draw What education/renovation/addt'l personnel is required

Question 32

Define amortization

Answer 32

assigning cost of an asset over its lifetime (must know life expectancy)

Question 33

What is depreciation?

Answer 33

The amount written off annually on a piece of equipment and buildings

Question 34

Explain an operating budget

Answer 34

Annual budget Activity of unit current year planning for next fiscal year Includes revenue and expense Closely monitored and followed by nurse mgr ensuring goals are met

Question 35

What are the steps in developing an operating budget?

Answer 35

Productivity Goals Patient days Workload (HPPD) Non-productive time Productive time/Nonproductive time over the long term Non-labor costs

Question 36

What is the primary role of the nurse manager in the budget process?

Answer 36

Monitor a unit-based budget and provide feedback to the finance dept.

Question 37

How are patient days calculated?

Answer 37

ADCx365

Question 38

What is average daily census (ADC)?

Answer 38

The avg # of pts on an inpatient unit at a certain point in time for a set period of time. almost always collected at midnight.

Question 39

How is the ADC calculated?

Answer 39

Total Patient days/365

Question 40

Define full time equivalent (FTE)

Answer 40

FTE refers to the number of hours worked that add up to one full time employee

Question 41

How are FTEs calculated?

Answer 41

Total number of nursing hours of care in a year / 2080

Question 42

Why are full time equivalents (FTE) important?

Answer 42

FTEs are a good budget tool because it factors in part-time employees, which is more reflective of the amount of work than the total number of nurses working if there are a lot of part time workers

Question 43

Calculate Hours per patient day (HPPD)

Answer 43

Productive hours / ADC

Question 44

Define Productive time.

Answer 44

The time (actual number of hours) a nurse or staff spends providing direct patient care.

Question 45

Why is calculating Productive Time important for the budget?

Answer 45

Productive time for finance purposes is the number of hours actually worked. It is calculated by taking 2080 - benefit time. This is an important figure because a nurse does not work every single day and addt'l staffing is needed for the benefit days

Question 46

How do you calculate productive time?

Answer 46

2080 hours - benefit time

Question 47

Define non-productive time

Answer 47

Time workers are paid that are not directly related to the workload (PTO, education, orientation)

Question 48

What is benefit time?

Answer 48

Benefit time is a financial term that includes the average number of vacation days, holidays, personal days, and average sick time used

Question 49

List non salary operating expenses that must be figured into the budget

Answer 49

Medical Supplies Office Supplies Pharmacy Linen Contracts Travel and Education Printing other

Question 50

What is the purpose of EEOC?

Answer 50

The Equal Emplpyment Opportunity Commission (EEOC) enforces laws regarding discrimination and harassment in the workplace