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NE-BC > NE BC > Flashcards

NE BC Flashcards

1
Q

What is a not-for-profit hospital?

A

A Tax-Exempt organization considered a charity by the IRS

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2
Q

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

A

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

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3
Q

What is a for profit hospital?

A

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)

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4
Q

What is the Medicare System

A

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

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5
Q

How is Medicare funded and who is eligible

A

-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.

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6
Q

What does Medicare Part A Cover

A

Hospital Insurance/inpatient hospital care

Some hospice/HH

No monthly premium

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7
Q

What does medicare Part B cover

A

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

PT/OT

Monthly premium

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8
Q

What does Medicare Part C cover

A

Medicare Advantage Plan

Similar to HMO or PPO
Includes part A and B

May offer Dental/Vision/Wellness

Most include part D

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9
Q

What does Medicare Part D Cover

A

Prescription Drug Plan

Available to everyone

Must join a Medicare Plan that includes part D

Monthly Premium

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10
Q

What is Medicaid

A

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

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11
Q

What are the requirement for receiving Medicaid

A

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

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12
Q

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

A

The Patient Protection and Affordable Care Act

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13
Q

What is a Health Maintenance Organization (HMO)

A

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

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14
Q

What is a Preferred Provider Organization?

A

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.

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15
Q

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

A

Diagnosis related groups (DRGs)

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16
Q

How is the reimbursement rate of a DRG calculated?

A

Based on the average cost of services

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17
Q

How many DRGs exist?

A

> 400

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18
Q

Define prospective payments.

A

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

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19
Q

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

A

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

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20
Q

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

A

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

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21
Q

What is Value Based Purchasing?

A

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

Pay is yearly based on total performance score (TPS)

22
Q

What is budget?

A

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

23
Q

What is the purpose of a budget?

A

To manage the business’s finances in an organized way

24
Q

What are the components of a budget cycle?

A

Development
Monitoring
Reporting
Justifying
Variance Allowance

25
Q

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

A

Revenue
Expense
Capital
Operational

26
Q

Define Revenue

A

Anticipated amount of income during a budget period

27
Q

Define Expense

A

Salary
Non-Salary
Fixed
Variable

28
Q

What are fixed expenses?

A

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

29
Q

What are variable expenses?

A

Vary based on the census or acuity level

30
Q

Define Capital budget

A

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

Equipment
Renovation Costs

31
Q

What Factors should be addressed in a capital budget?

A

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

32
Q

Define amortization

A

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

33
Q

What is depreciation?

A

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

34
Q

Explain an operating budget

A

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

35
Q

What are the steps in developing an operating budget?

A

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

36
Q

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

A

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

37
Q

How are patient days calculated?

A

ADCx365

38
Q

What is average daily census (ADC)?

A

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.

39
Q

How is the ADC calculated?

A

Total Patient days/365

40
Q

Define full time equivalent (FTE)

A

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

41
Q

How are FTEs calculated?

A

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

42
Q

Why are full time equivalents (FTE) important?

A

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

43
Q

Calculate Hours per patient day (HPPD)

A

Productive hours / ADC

44
Q

Define Productive time.

A

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

45
Q

Why is calculating Productive Time important for the budget?

A

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

46
Q

How do you calculate productive time?

A

2080 hours - benefit time

47
Q

Define non-productive time

A

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

48
Q

What is benefit time?

A

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

49
Q

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

A

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

50
Q

What is the purpose of EEOC?

A

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

NE-BC (5 decks)

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