358 exam 3

indemnity insurance trend

going away, going more toward value based care

cost sharing

splits costs to reduce risk

3 types: copayment, deductibles, coinsurance

copayment

fixed amount for a covered service payed by patient to provider

deductible

amount you pay before insurance starts to pay

coinsurance

portion of costs you pay after you’ve paid deductible

type of insurance that accounts for over half of all healthcare spending

medicare

gdp of healthcare

projected 17%-20% 2026

who bears cost of providing care to uninsured

everyone

is medicare state or federal

federal

is medicaid state or federal

both

who is covered w medicare

elderly (65+)

disabled

end-of-life diseases

who is covered w medicaid

low income

indigent

did ACA affect medicare or medicaid

medicaid

how did ACA impact # of uninsured individuals

increased # of uninsured

did all states expand medicaid under ACA

no

who provides majority of health coverage in US

private insurance/employer sponsored

risk

money that might be lost due to insuring those who use healthcare

social security act 1965 (SSA)

established medicare and medicaid

tax equity/fiscal responsibility act 1982 (TEFRA)

established medicare cost controls

balanced budget act 1997

cost controls

medicare part c

medicare and modernization act 2003

created medicare part d

affordable care act 2010

mandated health insurance

types of private health insurance

medigap

employer sponsored

commercial

do private health insurances use one or multiple methods of payment

multiple

types of public health insurance

CHIP

medicare

medicaid

tricare (military)

trend in health care insurance

moving toward value based reimbursement

how does CMS reimburse physicians

resource based relative value scale (RBRVS)

what does cms stand for

centers for medicare and medicaid services

accountable care organizations

groups of providers that come together to take care of a defined population

moral hazard

people who have insurance are more likely to participate in risky behavior

pre-existing condition

conditions had before being covered by insurance

makes person a bigger risk

uncompensated care

bad debt

charity care

what expenditures account for a majority of healthcare spending

hospitals

medicare part a

hospitals

medicare part b

physicians

medicare part c

medigap

medicare advantage plans

medicare part d

drugs

medigap

private insurance you can buy that covers any cost sharing of medicare

CHIP

low income families that do not qualify for medicaid

managed care plans

hmo

ppo

pos

indemnity

fee for service w/o control

for profit firms

can participate in politics

not tax exempt

can’t fundraise

not for profit firms

can’t participate in politics

tax exempt

fundraise

ar

accounts receivable

matters b/c the longer money sits there the less likely you are to receive it

average time it takes for payments to be made to hospitals and providers

30-40 days

capitation

fixed amount per enrollee “member” per month (paid per person)

puts risk on provider rather than insurance

managerial accounting

internal accounting

financial accounting

external accounting

how are costs classified

behavior

traceability

decision-making capability

fixed costs

salary workers

variable costs

hourly workers

supply costs

cost allocation

determining total costs of producing a service

purpose of cost allocation

ensure proper allocation of costs to departments

allocate non-revenue producing costs to revenue-producing

set accurate pricing for services

chargemaster

list of services with 1 price for each

working capital

current assets - current liabilities

short term assets used in day to day operations

sources of working capital

permanent: what is always in account

net income: what is coming in

temporary

purpose of working capital

increase revenues and reduce expenses

self-pay patients: pay full or discount

pay full

primary goal of managing ar

reduce the collection period

supply chain

delivery of appropriate patient care supplies

provision of cost control

find best prices and reduce over-utilization

master budget

all financial info for organization

combo of operating & capital

operating budget

annual budget

capital budget

expenditures for long-term assets whose useful life is more than 1 year

retrospective payments

determined after services

charges, charges minus contracted rate, cost, reimbursement modified

prospective payments

determined before services

per day, per diagnosis, capitation

contribution margin

revenue contributed to an org after variable costs are subtracted

primary function of board/governing body

ensure proper use of resources