question

*Efficiency

answer

Process & doing things right

question

*Effectiveness

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Outcomes & doing the right thing

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Accural Accounting

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Records revenues when they are earned & expenses when they have been accrued. Provides a more accurate reflection of your current financial situation

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Cash Based Accounting

answer

Recognizes revenue only when cash is collected & expenses when cash is paid. Provides a truer reflection of actual cash on hand & requires less reconciliation

question

Chart of Accounts

answer

Lists all potential accounts for all financial information (income, expenses, assets, liabilities, equities

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Income Statement

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Records all revenues & expenses associated with the business for a specified time. Summary of a company's profit or loss during a given period

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Balance Sheet

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Snapshot of buisness' financial condition at specific time. Includes values for assets, liabilities & stockholders equity

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Cash Flow Statement

answer

Financial statement used to maintain awareness of funds (cash available) to support ongoing business operations

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Break Even Point

answer

Point where revenues for services minus all variable expenses = the fixed expenses & add'l revenue will start creating a profit for the business

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OSHA

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*Procedures for reporting a file * Evacuatin procedures during emergency *fire extinguisher locations * Emergency contacts & info * Designated meeting location * Staff assignments & responses

question

**Revenue Per Visit (RPV) Calculated

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Review payor contracts = Toal amount collected ./. total # pt visits

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**Days in A/R formula

answer

total A/R ./. (total charges ./. total days in A/R (i.e. $558039 ./. ($700,00 ./. 60)

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Medical Necessity

answer

Most important criteria for E&M

question

Days in A/R

answer

How long it takes to collect a charge. Good is less than 40 days

question

**Days in A/R forumula

answer

Total A/R ./. Total charges ./. # of days for charges

question

Assests =

answer

liabilities & equity

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Assests

answer

If assests are higher than liabilites, that's a good thing

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**Net Collection Rate

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Total Receipts - Refunds ./. Total Charges - Contractual Adj

question

Bad Deb Ratios

answer

Total bad debt for period ./. total charges for period

question

Denials Report & Denials Rate

answer

Total # of denials ./. total claims submitted

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*LLC

answer

Limited Liaiblity Company - unlimited owners & limit the am't of taxes

question

*Disaster Recovery Planning

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Should include prevention, detection & correction

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*Pod

answer

Has nurses, exam rooms & physicians offices all located in the same area

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*Quantitative Risk Analaysis

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Measure of the probabilities of variouus adverse events & the likely extent of the losses if a particular event occurs

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EHR Date

answer

1/1/2015 - Providers who have NOT implemented EHR will begin to see a reduction in Medicare payment

question

Procedure Code Sets

answer

ICD 9 CM Volume II (hospital input charges HCPCS Level II CPT

question

CPT & HCPCS Dates

answer

1/1

question

ICD 9 Dates

answer

10/1

question

Bad Debt Ratio

answer

bad debt right offs are adjustments that will result in no collections

question

Bad Debt Ratio

answer

Total bad debt for period ./. total charges for period

question

State Prompt Payment Laws

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If payments are late by insurance companies

question

The following will NOT prevent claim denials

answer

Provide medical documentation with an appeal letter to support the service rendered

question

Productivity Report

answer

Details the volume of procedures being performed by each provider

question

Denials Report & Denials Rate

answer

Important to cash flow - use weekly to identify denials. Should always stay below 5%

question

Denials Report & Denials Rate Formula

answer

Total # of denials ./. tot claims submitted

question

Adjustments to collection

answer

Used for monitoring fluctuations in adjustments

question

**Adjustment to Collections Ratio Formula

answer

Tot adjustments for period ./. Tot collections for period

question

Net Collection Rate

answer

Determines how well a business is collecting on eligible revenue. Better to look at net collection rates over a 3-6-9-12 mo period of time

question

Net Collection Rate Formula

answer

Tot Receipts - Refunds ./. Tot Charges - Contractual Adj

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A/R Aging Summary

answer

Used to identify the aging of receivables & if accounts are being collected in a timely manner

question

**PQRS

answer

Physicain Quality Reporting System = eligible providers are all health care providers, but not out pt surgery center or labs

question

**PPACA

answer

Pt Protection & Affordable Act = allows sharing of IRS data to identfiy fraudulent providers with tax debts

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VOB

answer

Verification of Benefits

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ROI

answer

Return on Investment

question

PECOS

answer

Provider Enrollment, Chain & Ownership System

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Medicare EHHR Incentive Program

answer

does NOT include NPs, but does include drs of MD, podiatrists, dentists, psychiatrists

question

VPN

answer

Virtual Private Network = extremely secure connections between private networks tunneled through the internet

question

False Claims Act & Qui Tam

answer

Whistle Bloer Act - prohibits any person from knowingly presenting or causing false claims

question

Rule by All

answer

all physician partners are involved in decision making

question

**Profit Share Plan

answer

contributions only by the employer; if offered to employer, must be offered to employee

question

FMLA

answer

Family Medical Leave Act = only applies to employer groups with 50 or more employees & gives up to 12 wks unpaid leave & holds the job

question

**EDI = Electronic Data Interchange

answer

Current version for HIPPA transactions is X12 Version 5010, NCPDP Version D.0

question

HIPPA Breach - under 500 pts

answer

report once yearly

question

HIPPA Breech - over 500 pts

answer

but at least 12 pt addresses out of date, publish a print ad of the breech in nespaper & include the date of the breech & when it was discovered; a brief description of incident ; descriptioin of unsecured PHI involved & suggested steps for individuals to take to protect against problems

question

HIPPA breech - over 500 pts

answer

must notify local media & notify Secretary of HHS

question

HIPPA

answer

applies to providers, health plans, clearinghouses, anyone who submits any health info in an electronic manner

question

Business Associates Agreement

answer

needed when any entity is sharing PHI. NOT used for employees. Also, NOT used for janitors, building maintenance or tax accountants

question

HIPPA Breech of PHI of 45 records

answer

requires pt notification within 60 days of breech

question

Offsite biller

answer

Required to log on to remote server that has automatic logoff feature set

question

Subpoena for medical records

answer

You can send records requested by court order without authorization from pt

question

Employment Questions OK to ask

answer

worked under different name ever convicted of crime if U.S. citizen education level including degrees & certifications If relatives employed by organizations prior employment

question

Employment Questions NOT ok to ask

answer

age, race, sex, religion, national origin, disability, pregnancy

question

401K

answer

Employer & employee BOTH contribute

question

HR forms kept in separate file from employee's personnel file & in locked location

answer

OSHA compliance completed FMLA form Employment eligibilty forms (INSS form 1-9) Worker's compenstation disability forms

question

**Income Statement Model

answer

this physician compensation model requires allocation of revenue & expenses to each physicain in the practice

question

Mid Levels

answer

Need Standard of Care agreement if only billing incident to

question

**SWOT Analysis

answer

Strengths, Weaknesses, Opportunities, Threats

question

**Anti-Kickback Law

answer

can't solicit or receive payment for pt referrals

question

**Compliance Plan

answer

Includes: designate compliance officer training & education Written policies for denial mgmt software Internal auditing

question

**Stark Law

answer

Prohibits physicians from referring pts to medical facilities in which the physician or member of immediate family has a financial interest

question

**Stark Law Exceptions

answer

preventive screeing tests, immunications & vaccines

question

**OSHA

answer

Bloodborne pathogens Occupationsal exposure determination Use of universal precatuions Use of engineering & work practice controls Use of personal protective equipment Vaccincation policy for Hep B Evaluation for use of safer needles & sharps Post exposure evaluation & follow up Containment of regulated aste Communication of hazards to employees

question

OSHA - types that must be reported

answer

Death missed days from work restricted work or job transfer medical treatment beyond first aid loss of consciousness

question

You're buying aCT scan. What laws to consider?

answer

Stark & AntiKickback

question

**OIG published resource for AntiKickback Laws

answer

Fraud Alert

question

QI = Quality Improvement

answer

Routine measurement of performance; QI fixes processes, not people

question

QA = Quality Assurance

answer

Internal audit of billing procedures to verify compliance with fed & state regulations

question

QC = Quality Control

answer

a system of technical activities that measures against a criteria or standard (i.e. lab equipment calibrations)

question

**Plan-Do-Check-Act

answer

A quality cycle & QI method that systematically impacts a process or system

question

Insurance Reform

answer

* 1/1/15 - pymt reduction for MDs with no EHR * Medical cost ratio = 85% * Adult children til age 26 on family policies * Must provide preventive health * No annual or lifetime maxiums * Can't cancel coverage when beneficiary gets sick * no prior auth for ER * restriction on out of pocket maximum, copay & deductibles * no pre-existing conditions * 5% increase in mental health services * employers with 50+ employees are fined for not offering coverage * employers with <25 ill be offered subsidies

question

S Corp

answer

limits the # of shareholders, not taxed twice, profit can flow thru to partners equally

question

Business Relationships

answer

bankers, accountants, attorneys, investment adviosrs

question

C Corp

answer

most formal; offers stock with or without voting rights & have unlimited shareholder. Provides ownership of business to physicians as they join the practice, but are taxed twice, 1st at the corporate level, then again at the physicain level

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