Week 3: Finance/Insurance/Coding Flashcards
What is the focus of finance?
- anticipating needs for funds
- allocation of funds
- acquisition of funds
What is ROI equation?
(gain from investment-cost of investment)/cost of investment
What is revenue equation?
volume x price per unit sold
What is net revenue?
what payers actually pay you
outpatient -per visit or unit of service
inpatient-per day per discharge
What is contractual allowance?
gross revenue (what you charge)- net revenue (what you are paid)
Why is healthcare not a normal market?
clinicians are not interchangable and most parts of business are complex and ambigous
What are 2 different types of expenses?
capital
operating
What are capital expenses?
large sums of money needed to start business
What are operating expenses?
ongoing expenses once business up and running
labor is largest operating expense in service industry
What is a direct cost?
what is needed to treat the patient ex: labor, supplies
What are indirect costs?
overhead expenses necessary to maintain patient care
insurance, rent, marketing
What are fixed expenses?
(revenue per unit of service- variable cost per unit of service)
What are three types of financial statements?
income statement (yearly profit and loss), balance sheet (quarterly), cash flow statement
What is included in a balance sheet?
assets and liabilities, equity
What two insurances must a business offer employees?
unemployment and workers compensation
What does workers compensation cover?
50% of wages for 26 weeks
What is health care option for those who are unemployed?
COBRA, allows employees to pay for continued coverage for up to 18 months
How much did MSD account for overall injuries and illnesses?
33%
For PT’s what are the most common MSD?
- LBP/spine
2. upper limb disorders
What does no fault status mean?
workers comp will cover anything regardless of who’s fault it is
What else does workers comp cover?
survivors death benefits
What are 3 ways workers comp is funded?
- private
- self
- state( most common in Mass)
How much does a pt pay during workers comp?
nothing, no co pay
What is the impact act?
that standardized functional data be submitted for all post acute settings in 2016 to track who has better outcomes
What kind of system is medicare part A?
PPS-prospective payment system
reimbursement based on time, frequency of visits and types of codes
What kind of codes are needed for medicare A?
EXACT minutes for CPT codes
recognizes group treatments of 4 patients performing the same of similar activities
How are HMO and Medicaid reimbursed?
fee for service and value of CPT codes provided
What is Medicare Part B?
fee for service, reimbursed based on value of CPT codes utilized
15 mins= treatment
What is the rounding rule?
8 minute rule, take total time treating patient and divided by 15 if remainder is over 8 you can round up
What are two different types of codes used?
untimed(eval) and timed (therex etc.)
What size of group does Medicare B recognize?
2
What type of insurance requires G codes?
Medicare part B, for “functional reporting”
What are 5 most common G codes?
mobility, changing/maintaining body position, carrying/moving objects,
What is lowest level G code?
CH= 0 % limited CN= 100% limited
goes up from 0 in 19% intervals and up alphabetically
What are three types of CPT codes?
- evaluations
- modalities
- therapeutic procdures
How many times per session can an unattended modality be preformed?
only billed once per day
attended can be billed more than once if MD orders were obtained
What kind of code would bed mobility be?
therapuetic activity
What does code 97110 stand for?
unskilled service or therex
