Week 3: Finance/Insurance/Coding

Question 1

What is the focus of finance?

Answer 1

1. anticipating needs for funds
2. allocation of funds
3. acquisition of funds

Question 2

What is ROI equation?

Answer 2

(gain from investment-cost of investment)/cost of investment

Question 3

What is revenue equation?

Answer 3

volume x price per unit sold

Question 4

What is net revenue?

Answer 4

what payers actually pay you

outpatient -per visit or unit of service
inpatient-per day per discharge

Question 5

What is contractual allowance?

Answer 5

gross revenue (what you charge)- net revenue (what you are paid)

Question 6

Why is healthcare not a normal market?

Answer 6

clinicians are not interchangable and most parts of business are complex and ambigous

Question 7

What are 2 different types of expenses?

Answer 7

capital

operating

Question 8

What are capital expenses?

Answer 8

large sums of money needed to start business

Question 9

What are operating expenses?

Answer 9

ongoing expenses once business up and running

labor is largest operating expense in service industry

Question 10

What is a direct cost?

Answer 10

what is needed to treat the patient ex: labor, supplies

Question 11

What are indirect costs?

Answer 11

overhead expenses necessary to maintain patient care

insurance, rent, marketing

Question 12

What are fixed expenses?

Answer 12

(revenue per unit of service- variable cost per unit of service)

Question 13

What are three types of financial statements?

Answer 13

income statement (yearly profit and loss), balance sheet (quarterly), cash flow statement

Question 14

What is included in a balance sheet?

Answer 14

assets and liabilities, equity

Question 15

What two insurances must a business offer employees?

Answer 15

unemployment and workers compensation

Question 16

What does workers compensation cover?

Answer 16

50% of wages for 26 weeks

Question 17

What is health care option for those who are unemployed?

Answer 17

COBRA, allows employees to pay for continued coverage for up to 18 months

Question 18

How much did MSD account for overall injuries and illnesses?

Answer 18

33%

Question 19

For PT’s what are the most common MSD?

Answer 19

1. LBP/spine

2. upper limb disorders

Question 20

What does no fault status mean?

Answer 20

workers comp will cover anything regardless of who’s fault it is

Question 21

What else does workers comp cover?

Answer 21

survivors death benefits

Question 22

What are 3 ways workers comp is funded?

Answer 22

1. private
2. self
3. state( most common in Mass)

Question 23

How much does a pt pay during workers comp?

Answer 23

nothing, no co pay

Question 24

What is the impact act?

Answer 24

that standardized functional data be submitted for all post acute settings in 2016 to track who has better outcomes

Question 25

What kind of system is medicare part A?

Answer 25

PPS-prospective payment system

reimbursement based on time, frequency of visits and types of codes

Question 26

What kind of codes are needed for medicare A?

Answer 26

EXACT minutes for CPT codes

recognizes group treatments of 4 patients performing the same of similar activities

Question 27

How are HMO and Medicaid reimbursed?

Answer 27

fee for service and value of CPT codes provided

Question 28

What is Medicare Part B?

Answer 28

fee for service, reimbursed based on value of CPT codes utilized

15 mins= treatment

Question 29

What is the rounding rule?

Answer 29

8 minute rule, take total time treating patient and divided by 15 if remainder is over 8 you can round up

Question 30

What are two different types of codes used?

Answer 30

untimed(eval) and timed (therex etc.)

Question 31

What size of group does Medicare B recognize?

Answer 31

2

Question 32

What type of insurance requires G codes?

Answer 32

Medicare part B, for “functional reporting”

Question 33

What are 5 most common G codes?

Answer 33

mobility, changing/maintaining body position, carrying/moving objects,

Question 34

What is lowest level G code?

Answer 34

CH= 0 % limited
CN= 100% limited 

goes up from 0 in 19% intervals and up alphabetically

Question 35

What are three types of CPT codes?

Answer 35

1. evaluations
2. modalities
3. therapeutic procdures

Question 36

How many times per session can an unattended modality be preformed?

Answer 36

only billed once per day

attended can be billed more than once if MD orders were obtained

Question 37

What kind of code would bed mobility be?

Answer 37

therapuetic activity

Question 38

What does code 97110 stand for?

Answer 38

unskilled service or therex