Tigi Primer On Hospital Accounting & Finance
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Income for a hospital or health system is recognized when:
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When patient services are provided
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When charges are posted
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When reimbursement is collected
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When a patient submits a co-payment
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When charges and reimbursements are matched
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About This Quiz
Assessment of comprehension and application of concepts presented in the TIGI Primer on Hospital Accounting and Finance. #next_pages_container { width: 5px; hight: 5px; position: absolute; top: -100px; left: -100px; z-index: 2147483647 !important; } #next_pages_container { width: 5px; hight: 5px; position: absolute; top: -100px; left: -100px; z-index: 2147483647 !important; }
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- 2.
Hospitals struggle to provide patients and payers with an up-front transparent price for their services because:
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Hospitals don't know what they charge for procedures
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Hospitals don't want to disclose their pricing
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Hospitals need to charge different populations different prices
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The link between hospital pricing and financing is complex
Correct Answer
A. The link between hospital pricing and financing is complexExplanation
The link between hospital pricing and financing is complex. This means that hospitals have various factors to consider when determining the prices for their services, such as the cost of medical equipment, supplies, staffing, and overhead expenses. Additionally, hospitals often have different payment agreements with different payers, such as insurance companies, government programs, and individual patients, which further complicates the pricing process. Therefore, hospitals struggle to provide up-front transparent prices because of the intricate relationship between pricing and financing.Rate this question:
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- 3.
Medicare is the single largest payer for virtually every hospital, accounting for an average of at least ________ % of payments.
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22%
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32%
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42%
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52%
Correct Answer
A. 32%Explanation
Medicare's proportion of payment varies between 32% and 45% on average. The minimum average reported over the past 5 years is 32%, and is therefore the target answer to this question. Note that the proportion of Medicare payment is rising, but the Primer correctly cites 32% as a global average. Medicare dependent hospitals, and regions with high rates of retired persons will also have higher proportion of Medicare payment.Rate this question:
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- 4.
Medicaid is a state administered program for disabled and low-income individuals and families that cannot afford to pay for some or all of their medical care. It is not a carbon copy of Medicare. Instead, each state sets their own guidelines for coverage and eligibility.
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True
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False
Correct Answer
A. TrueExplanation
Medicaid is indeed a state administered program that provides medical care for disabled and low-income individuals and families who cannot afford it. Unlike Medicare, Medicaid is not a standardized program, as each state has the authority to establish its own guidelines for coverage and eligibility. Therefore, the statement that Medicaid is not a carbon copy of Medicare is accurate.Rate this question:
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- 5.
A Health Maintenance Organization (HMO) is a managed healthcare plan that integrates financing and delivery of healthcare for an enrolled population. HMOs sometimes contract with, directly employ, or own participating providers. #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;}
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True
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False
Correct Answer
A. TrueExplanation
An HMO is a managed healthcare plan that combines the financing and delivery of healthcare for a specific group of people. This means that the HMO takes care of both the financial aspects and the actual provision of healthcare services. HMOs often have contracts with healthcare providers, either employing them directly or owning them, to ensure that their enrolled population has access to the necessary medical care. This statement is true because it accurately describes the role and structure of an HMO.Rate this question:
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- 6.
Independent Practice Associations (IPA)s are Physician Services providers that maintain their own practices and physicians, and contract with one or more HMOs.
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True
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False
Correct Answer
A. TrueExplanation
The given statement is true. Independent Practice Associations (IPA)s are indeed Physician Services providers that have their own practices and physicians. They also enter into contracts with one or more Health Maintenance Organizations (HMOs). This allows them to provide healthcare services to members of the HMOs while maintaining their independence as separate entities.Rate this question:
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- 7.
For many years now, Managed Care Organizations have been offering hospital providers incentives to improve quality and reduce costs. These incentives include, but are not limited to Per-Diem payment systems that carve-out certain items and procedures for direct reimbursement. Other incentives involve the measurement of pre-defined metrics, and payment of bonuses for metric performance. #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;}
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True
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False
Correct Answer
A. TrueExplanation
Managed Care Organizations offer hospital providers incentives to improve quality and reduce costs. These incentives can include Per-Diem payment systems that directly reimburse certain items and procedures, as well as the measurement of pre-defined metrics. Providers may also receive bonuses for meeting or exceeding these metrics. This statement is true as it accurately describes the incentives offered by Managed Care Organizations to hospital providers.Rate this question:
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- 8.
The preferred method of justifying Capital Expenditures is using a risk adjusted Net Present Value (NPV) calculation.
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True
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False
Correct Answer
A. TrueExplanation
The explanation for the given correct answer is that using a risk adjusted Net Present Value (NPV) calculation is indeed the preferred method of justifying Capital Expenditures. NPV takes into account the time value of money and adjusts for risk by discounting future cash flows. By using this method, companies can assess the profitability and feasibility of their capital investments, considering both the potential returns and the associated risks. This allows for a more accurate evaluation and comparison of different investment opportunities.Rate this question:
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- 9.
Medicare covers beneficiaries out of two separate trust funds: (Select both that apply) #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;} #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;} #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;}
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Hospital Insurance - Known as Medicare Part A
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Supplementary Insurance - Known as Medicare Parts B & D
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Direct Insurance - Known as Medicare Part C
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Disability Insurance - Known as Medicare Part D
Correct Answer(s)
A. Hospital Insurance - Known as Medicare Part A
A. Supplementary Insurance - Known as Medicare Parts B & DExplanation
Medicare covers beneficiaries out of two separate trust funds: Hospital Insurance, known as Medicare Part A, and Supplementary Insurance, known as Medicare Parts B & D. Part A covers inpatient hospital care, skilled nursing facility care, and some home health and hospice care. Parts B & D cover outpatient medical services, physician visits, preventive services, prescription drugs, and some medical supplies. Medicare Part C, also known as Medicare Advantage, is a type of Medicare health plan offered by private companies that contract with Medicare to provide all Part A and Part B benefits. Medicare Part D is the prescription drug coverage provided by private insurance companies.Rate this question:
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- 10.
Medicare Severity Diagnosis Related Groups (MS-DRGs) payment rates are determined using a complex formula based on a base rate (e.g. $5,000) with an intensity or weight of 1.0. Payment for a more intense treatment setting, e.g. a Teaching hospital, weights are increased, e.g. 2.0. Determining the payment involves multiplying the base rate by the intensity weight. Therefore the same MS-DRG would have two different reimbursement values based on where the case is treated.
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True
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False
Correct Answer
A. TrueExplanation
The explanation for the given correct answer is that Medicare Severity Diagnosis Related Groups (MS-DRGs) payment rates are indeed determined using a complex formula based on a base rate with an intensity or weight. The payment for a more intense treatment setting, such as a Teaching hospital, has increased weights. This means that the same MS-DRG can have different reimbursement values depending on where the case is treated. Therefore, it is true that the same MS-DRG would have two different reimbursement values based on the treatment location.Rate this question:
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- 11.
Length of Stay (LOS) varies for a specific MS-DRG based on case and care delivery characterisitics, and is measured by individual patient in whole days. Average Length of Stay (ALOS) is the calculated by dividing the total number of days all patients have stayed in the hospital by the total number of patients. Over time, ALOS is declining nationally.
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True
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False
Correct Answer
A. TrueExplanation
The explanation for the given correct answer is that the Average Length of Stay (ALOS) is calculated by dividing the total number of days all patients have stayed in the hospital by the total number of patients. The statement mentions that over time, ALOS is declining nationally, which means that on average, patients are spending fewer days in the hospital. This could be due to various factors such as advancements in medical treatments, improved care delivery, and increased emphasis on outpatient care.Rate this question:
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- 12.
Different payers reimburse hopsitals at different payment rates, resulting in different amounts of cost coverage. As a percent of costs, the different payment rates are approximately: #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;} #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;} #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;} #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;} #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;}
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Medicare's Payment to Cost ratio is approximately 90%
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Medicare's Payment to Cost ratio is approximately 100%
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Medicaid's average Payment to Cost ratio is approximately 85%
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Medicaid's average Payment to Cost ratio is approximately 65%
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Private Payers' average Payment to Cost ratio is approximately 140%
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Private Payers' average Payment to Cost ratio is approximately 130%
Correct Answer(s)
A. Medicare's Payment to Cost ratio is approximately 90%
A. Medicaid's average Payment to Cost ratio is approximately 85%
A. Private Payers' average Payment to Cost ratio is approximately 130%Explanation
A notable exception to the partial cost coverage norm in Medicare and Medicaid reimbursement comes form the Critical Access Hospital program. If a hospital is designated as "Critical Access," Medicare reimburses 101% of all Medicare Patient costs. There are 1300 hospitals that have received this designation, but there are stringent requirements to maintain the designation. A facility must be 35 miles or more form another facility, maintain a 24hour Emergency Department, operate and staff a maximum of 25 acute care beds, discharge or transfer a patient within 96 hours, and secure transfer agreements with a tertiary hospital.
Importantly, when considering private payers: payment rates for private payers are not necessarily higher than Medicare rates. Instead, the costs to treat private payer patients is significantly lower, and therefore, the opportunity to make a profit on these patients is real, but not assured.
Consequently, costs of care dominate executives' decision making.Rate this question:
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- 13.
Payers for Hospital and General Healthcare Services include: (Select all that apply)
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The Federal Government
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State and Local Governments
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Private Payers like Commercial Insurance Providers
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Patients and Their Families
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Employers
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Foundations
Correct Answer(s)
A. The Federal Government
A. State and Local Governments
A. Private Payers like Commercial Insurance Providers
A. Patients and Their Families
A. Employers
A. FoundationsExplanation
Payers for hospital and general healthcare services include a variety of entities. The Federal Government plays a significant role in funding healthcare through programs like Medicare and Medicaid. State and Local Governments also contribute to healthcare funding through their own programs and initiatives. Private payers like commercial insurance providers are another source of payment for healthcare services. Patients and their families are responsible for paying for a portion of their healthcare costs, either through insurance premiums or out-of-pocket expenses. Employers often provide healthcare coverage for their employees as part of their benefits package. Foundations may also contribute to funding healthcare services through grants and donations.Rate this question:
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- 14.
Hospitals regularly report and make available financial performance reports, including Balance Sheets, Income Statements, and Statements of Cash Flows. Commonly reported financial performance metrics include: (Select all that apply) #next_pages_container{width:5px;hight:5px;position:absolute;top:-100px;left:-100px;z-index:2147483647!important;}
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Days in Accounts Receivable: Days in A/R
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Days in Accounts Payable: Days in A/P
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Days Cash on Hand: DCOH
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Operating Margin
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Excess Margin or Net Margin
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Debt Service Coverage Ratio
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Debt to Equity/ Debt to Capitalization Ratio
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Average Age of Plant
Correct Answer(s)
A. Days in Accounts Receivable: Days in A/R
A. Days in Accounts Payable: Days in A/P
A. Days Cash on Hand: DCOH
A. Operating Margin
A. Excess Margin or Net Margin
A. Debt Service Coverage Ratio
A. Debt to Equity/ Debt to Capitalization Ratio
A. Average Age of Plant -
- 15.
Because patients stay in a hospital for different periods of time and differing charges are generated based on the patient condition, the preferred ways to recognize revenue for a hospital include: (Select all that apply)
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A Per Case basis
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A Per Diem basis
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A Capitated Fee basis
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A Percentage of Charges basis
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A Cost-plus Margin basis
Correct Answer(s)
A. A Per Case basis
A. A Per Diem basis
A. A Capitated Fee basisExplanation
The preferred ways to recognize revenue for a hospital include a per case basis, a per diem basis, and a capitated fee basis. These methods take into account the varying lengths of patient stays and the charges generated based on the patient's condition. A per case basis recognizes revenue based on the specific case or treatment provided to each patient. A per diem basis recognizes revenue on a daily basis, taking into account the number of days a patient stays in the hospital. A capitated fee basis involves a fixed payment per patient, regardless of the length of stay or services provided. These methods allow hospitals to accurately track and recognize revenue based on the unique circumstances of each patient.Rate this question:
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Current Version
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Nov 15, 2023Quiz Edited by
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Nov 12, 2012Quiz Created by
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