CHFP Module 1 Certification Test
_____ the intentional deception or misrepresentation of statistics for advantage. _____
includes crook penalties. The burden of proof is high. (beyond affordable doubt) - ANS-fraud
______ _________ contracts normally overlay a conventional payment methodology
(consisting of fee-for-service, consistent with diem, consistent with case or episodic) with a
retrospective agreement mechanism that stocks savings (known as upside hazard) or losses
(disadvantage danger) from the negotiated goal. Risk-based contracts might also
encompass provisions that praise vendors for attaining certain non-price associated metrics
inclusive of first-class desires or penalize them for now not meeting (or reporting) them. -
ANS-threat primarily based
________ includes unintended actions (errors) which can be inconsistent with widely
wide-spread, sound medical, enterprise or financial practices. Abuse consists of civil
financial consequences. The burden of proof is decrease (preponderance of evidence) -
ANS-abuse
_________ 25% of the regular according to-procedure charge - ANS-Third and Subsequent
system
_________ at 50% of the everyday in step with-procedure price - ANS-Secondary technique
_________ at 50% of the regular in step with-process rate - ANS-Secondary technique
_________ at 50% of the regular in line with-process price - ANS-Secondary process
_________ the payer (authorities or commercial) and the issuer (or institution of carriers)
percentage financially in each the risks and the rewards of providing healthcare services at a
negotiated fee, giving all parties a economic stake inside the settlement's performance.
(definition) - ANS-threat based agreement
__________ at 100% of the in keeping with-manner fee - ANS-Primary process
____________ is the tendency fitness care practitioners to do extra checking out and to
provide extra take care of patients than might otherwise be essential to defend themselves in
opposition to capacity litigation. - ANS-Defensive
_____________ that providers must pay insurers to cowl the value of shielding in opposition
to the proceedings and paying large jury awards.
A. Ambulatory payment classifications
B. Reimbursement Insurance cost plan
C. Health proactive Insurance fashionable act
,D. Increased coverage charges - ANS-D. Increased insurance charges
(MIPS)-MERIT BASED INCENTIVE PAYMENT SYSTEM- Adjusts Part B doctor payments
as a whole lot as 4 percentage up or down in 2019, growing to nine percentage in 2022 and
past, primarily based on 4 categories of performance: Quality (changing PQRS),
Improvement Activities (a brand new category), Advancing Care Information (changing EHR)
and fee (changing VM). - ANS-
14% of elderly Americans get hold of their care thru Medicare. - ANS-
three additives of a finances for a healthcare commercial enterprise - ANS-1. Cash budget
2. Capital budget
3. Operating price range
50% Americans obtain healthcare as a gain via their employers. - ANS-
A _________ will pay a distinctive rate for each process finished on a patient in a healthcare
issuer or ambulatory care facility, or by using a medical doctor. - ANS-Health plan
A wreck-even evaluation is ready to:
A. Understand the level of extent had to cover the expenses of doing commercial enterprise
and generate a profit - ANS-
A capital expenditure is defined as the acquisition of land, buildings, or gadget for use, now
not resale, in imparting offerings to patients or customers. These objects should have an
expected beneficial life of a couple of 12 months and exceed a minimum value of threshold
(usually $1,000 or greater, relying on the dimensions and nature of the business).
A capital expenditure is depreciated over the expected useful lifestyles of the asset. The
level of constant asset acquisitions as well as the beneficial lifestyles of every asset drives
depreciation charges on the income statement higher or decrease. In the overall budgeting
system, the exchange in depreciation should be taken under consideration to ensure the
commercial enterprise can continue to generate a effective margin.
Capital expenditures (and the associated depreciation) normally represented 6-10% of
operating charges in a healthcare business. Since resources to be had to purchase capital
objects are generally scarce, manage - ANS-
a charge-based price mechanism in which a provider is paid both listing charge (complete
prices) or a percent of prices (complete costs less a discount) for the precise services
rendered. - ANS-Fee-for-provider
A critical detail of operating with a budget is knowing that it's far a management device, no
longer a financial device. A budget units objectives and targets based totally on a plan
advanced through management. While finance and accounting body of workers actively take
part in finances training and helping managers in quantifying the targets inclusive of sales or
expenses, it's miles senior control that guides the goal-setting technique based totally at the
dreams of the strategic plan. - ANS-
,A vital first step in imposing a commercial enterprise intelligence function is to agree on a
information strategy that specifies:
What facts is accumulated
What is measured
A process to protect the accuracy of such facts
Once this method is installed, control should determine what metrics can be monitored. In a
few cases, the metrics monitored can be dictated by using authorities regulators or private
fitness plans.
Also, the employer can also want to degree other metrics that suggest development closer to
strategic goals. - ANS-Data strategy
A drawback with the direct and step-down strategies is that nor is specifically useful in
estimating the prices of a selected provider including a medical institution or emergency
room visit. This may be very critical whilst a manager wishes to decide the prices of a carrier
to set a fee for that carrier to negotiate a specific charge charge. This is known as
activity-primarily based costing or "ABC." Activity based totally costing is a backside-up or
micro costing method, in comparison to an allocation driven, top-down costing technique
used on the Medicare Cost Report.
The manner of completing an ABC evaluation may be damaged into four steps.
Gather total prices and pastime data
Determine what drives expenses (healthcare prices are often driven by means of time)
Measure value drivers
Convert fee drivers into fees and calculate overall consistent with-unit costs - ANS-
A final critical element in commercial enterprise intelligence, specifically in health [1] care, is
a procedure for maintaining the integrity of information. Data integrity is critical not most
effective for correct reporting of medical statistics that would have an impact on patient care,
however additionally for comparing the fees of care beneath constant or potential fee
methodologies.
As healthcare statistics structures come to be greater state-of-the-art, the amount of records
available is growing hastily. Business intelligence personnel need to intently display records
accuracy, put into effect records integrity tests and work with medical and administrative
gadget users to cope with person errors that might compromise information great. -
ANS-facts integrity
a flat quantity that the patient will pay at on every occasion of provider - ANS-copayment
A form of episodic price wherein the health plan can pay a unmarried potential charge for all
offerings provided by means of physicians, the healthcare issuer and put up-acute
companies. - ANS-bundled fee
A myriad of gFacility Providers
Examples of facility vendors encompass hospitals, professional nursing centers, assisted
dwelling facilities, home fitness agencies, and ambulatory surgical treatment centers. -
ANS-Facility companies
A a part of the running budget, specifying the quantity of work load predicted at some point
of the term protected through a price range.
, Statistical price range - ANS-
A fee based on the patient's prognosis is called a - ANS-(DRG) Diagnosis Related Group
A charge based on the patient's prognosis is referred to as a Diagnosis Related Group
(DRG) charge. DRGs are maximum broadly utilized in payments to healthcare carriers. A
DRG is a type of a sickness or injury into one among approximately 750 exclusive
categories.
The amount paid is a flat charge in line with discharge and is adjusted based on:
Relative severity of the affected person's circumstance - ANS-
a percentage of the coverage payment amount this is paid by the affected person, at the
side of the quantity paid with the aid of the insurer. - ANS-coinsurance
A technique through which organizational facts is analyzed and converted into statistics
usable through choice-makers - ANS-commercial enterprise intelligence
A set of federal compliance rules to make sure standardization of billing, privacy and
reporting as establishments convert to digital structures is referred to as:
A. Health Insurance widespread Act
B. Reimbursement Insurance Act
C. Medicare Reporting Act
D. Health Insurance portability and Accountability Ac - ANS-D. Health Insurance Portability
and Accountability Act
A subset of the running finances of a business, focusing on the running expenses of that
enterprise.
Expense Budget - ANS-
A subset of the working price range of a enterprise, focusing on the operating revenues of
that commercial enterprise.
Revenue Budget - ANS-
A phrase of caution have to be considered while evaluating adjustments in receivables or
payables for healthcare agencies, as there are some sensible limitations to how far an entity
can benefit coins from those forms of transactions. When considering an boom in
receivables, managers have to find a affordable balance between competitive collections to
reduce receivables and proscribing using cash thru will increase in receivables. An overly
aggressive collection policy might also alienate sufferers or health plans and need to be
tempered with the want to completely gather the quantity due from the patient or health plan
in a timely fashion. - ANS-
A 0-primarily based approach is one wherein managers begin each price range projection as
though there have been no past enjoy and each line object is justified as to its
reasonableness each yr duration this method can bring about a tightly controlled finances,
_____ the intentional deception or misrepresentation of statistics for advantage. _____
includes crook penalties. The burden of proof is high. (beyond affordable doubt) - ANS-fraud
______ _________ contracts normally overlay a conventional payment methodology
(consisting of fee-for-service, consistent with diem, consistent with case or episodic) with a
retrospective agreement mechanism that stocks savings (known as upside hazard) or losses
(disadvantage danger) from the negotiated goal. Risk-based contracts might also
encompass provisions that praise vendors for attaining certain non-price associated metrics
inclusive of first-class desires or penalize them for now not meeting (or reporting) them. -
ANS-threat primarily based
________ includes unintended actions (errors) which can be inconsistent with widely
wide-spread, sound medical, enterprise or financial practices. Abuse consists of civil
financial consequences. The burden of proof is decrease (preponderance of evidence) -
ANS-abuse
_________ 25% of the regular according to-procedure charge - ANS-Third and Subsequent
system
_________ at 50% of the everyday in step with-procedure price - ANS-Secondary technique
_________ at 50% of the regular in step with-process rate - ANS-Secondary technique
_________ at 50% of the regular in line with-process price - ANS-Secondary process
_________ the payer (authorities or commercial) and the issuer (or institution of carriers)
percentage financially in each the risks and the rewards of providing healthcare services at a
negotiated fee, giving all parties a economic stake inside the settlement's performance.
(definition) - ANS-threat based agreement
__________ at 100% of the in keeping with-manner fee - ANS-Primary process
____________ is the tendency fitness care practitioners to do extra checking out and to
provide extra take care of patients than might otherwise be essential to defend themselves in
opposition to capacity litigation. - ANS-Defensive
_____________ that providers must pay insurers to cowl the value of shielding in opposition
to the proceedings and paying large jury awards.
A. Ambulatory payment classifications
B. Reimbursement Insurance cost plan
C. Health proactive Insurance fashionable act
,D. Increased coverage charges - ANS-D. Increased insurance charges
(MIPS)-MERIT BASED INCENTIVE PAYMENT SYSTEM- Adjusts Part B doctor payments
as a whole lot as 4 percentage up or down in 2019, growing to nine percentage in 2022 and
past, primarily based on 4 categories of performance: Quality (changing PQRS),
Improvement Activities (a brand new category), Advancing Care Information (changing EHR)
and fee (changing VM). - ANS-
14% of elderly Americans get hold of their care thru Medicare. - ANS-
three additives of a finances for a healthcare commercial enterprise - ANS-1. Cash budget
2. Capital budget
3. Operating price range
50% Americans obtain healthcare as a gain via their employers. - ANS-
A _________ will pay a distinctive rate for each process finished on a patient in a healthcare
issuer or ambulatory care facility, or by using a medical doctor. - ANS-Health plan
A wreck-even evaluation is ready to:
A. Understand the level of extent had to cover the expenses of doing commercial enterprise
and generate a profit - ANS-
A capital expenditure is defined as the acquisition of land, buildings, or gadget for use, now
not resale, in imparting offerings to patients or customers. These objects should have an
expected beneficial life of a couple of 12 months and exceed a minimum value of threshold
(usually $1,000 or greater, relying on the dimensions and nature of the business).
A capital expenditure is depreciated over the expected useful lifestyles of the asset. The
level of constant asset acquisitions as well as the beneficial lifestyles of every asset drives
depreciation charges on the income statement higher or decrease. In the overall budgeting
system, the exchange in depreciation should be taken under consideration to ensure the
commercial enterprise can continue to generate a effective margin.
Capital expenditures (and the associated depreciation) normally represented 6-10% of
operating charges in a healthcare business. Since resources to be had to purchase capital
objects are generally scarce, manage - ANS-
a charge-based price mechanism in which a provider is paid both listing charge (complete
prices) or a percent of prices (complete costs less a discount) for the precise services
rendered. - ANS-Fee-for-provider
A critical detail of operating with a budget is knowing that it's far a management device, no
longer a financial device. A budget units objectives and targets based totally on a plan
advanced through management. While finance and accounting body of workers actively take
part in finances training and helping managers in quantifying the targets inclusive of sales or
expenses, it's miles senior control that guides the goal-setting technique based totally at the
dreams of the strategic plan. - ANS-
,A vital first step in imposing a commercial enterprise intelligence function is to agree on a
information strategy that specifies:
What facts is accumulated
What is measured
A process to protect the accuracy of such facts
Once this method is installed, control should determine what metrics can be monitored. In a
few cases, the metrics monitored can be dictated by using authorities regulators or private
fitness plans.
Also, the employer can also want to degree other metrics that suggest development closer to
strategic goals. - ANS-Data strategy
A drawback with the direct and step-down strategies is that nor is specifically useful in
estimating the prices of a selected provider including a medical institution or emergency
room visit. This may be very critical whilst a manager wishes to decide the prices of a carrier
to set a fee for that carrier to negotiate a specific charge charge. This is known as
activity-primarily based costing or "ABC." Activity based totally costing is a backside-up or
micro costing method, in comparison to an allocation driven, top-down costing technique
used on the Medicare Cost Report.
The manner of completing an ABC evaluation may be damaged into four steps.
Gather total prices and pastime data
Determine what drives expenses (healthcare prices are often driven by means of time)
Measure value drivers
Convert fee drivers into fees and calculate overall consistent with-unit costs - ANS-
A final critical element in commercial enterprise intelligence, specifically in health [1] care, is
a procedure for maintaining the integrity of information. Data integrity is critical not most
effective for correct reporting of medical statistics that would have an impact on patient care,
however additionally for comparing the fees of care beneath constant or potential fee
methodologies.
As healthcare statistics structures come to be greater state-of-the-art, the amount of records
available is growing hastily. Business intelligence personnel need to intently display records
accuracy, put into effect records integrity tests and work with medical and administrative
gadget users to cope with person errors that might compromise information great. -
ANS-facts integrity
a flat quantity that the patient will pay at on every occasion of provider - ANS-copayment
A form of episodic price wherein the health plan can pay a unmarried potential charge for all
offerings provided by means of physicians, the healthcare issuer and put up-acute
companies. - ANS-bundled fee
A myriad of gFacility Providers
Examples of facility vendors encompass hospitals, professional nursing centers, assisted
dwelling facilities, home fitness agencies, and ambulatory surgical treatment centers. -
ANS-Facility companies
A a part of the running budget, specifying the quantity of work load predicted at some point
of the term protected through a price range.
, Statistical price range - ANS-
A fee based on the patient's prognosis is called a - ANS-(DRG) Diagnosis Related Group
A charge based on the patient's prognosis is referred to as a Diagnosis Related Group
(DRG) charge. DRGs are maximum broadly utilized in payments to healthcare carriers. A
DRG is a type of a sickness or injury into one among approximately 750 exclusive
categories.
The amount paid is a flat charge in line with discharge and is adjusted based on:
Relative severity of the affected person's circumstance - ANS-
a percentage of the coverage payment amount this is paid by the affected person, at the
side of the quantity paid with the aid of the insurer. - ANS-coinsurance
A technique through which organizational facts is analyzed and converted into statistics
usable through choice-makers - ANS-commercial enterprise intelligence
A set of federal compliance rules to make sure standardization of billing, privacy and
reporting as establishments convert to digital structures is referred to as:
A. Health Insurance widespread Act
B. Reimbursement Insurance Act
C. Medicare Reporting Act
D. Health Insurance portability and Accountability Ac - ANS-D. Health Insurance Portability
and Accountability Act
A subset of the running finances of a business, focusing on the running expenses of that
enterprise.
Expense Budget - ANS-
A subset of the working price range of a enterprise, focusing on the operating revenues of
that commercial enterprise.
Revenue Budget - ANS-
A phrase of caution have to be considered while evaluating adjustments in receivables or
payables for healthcare agencies, as there are some sensible limitations to how far an entity
can benefit coins from those forms of transactions. When considering an boom in
receivables, managers have to find a affordable balance between competitive collections to
reduce receivables and proscribing using cash thru will increase in receivables. An overly
aggressive collection policy might also alienate sufferers or health plans and need to be
tempered with the want to completely gather the quantity due from the patient or health plan
in a timely fashion. - ANS-
A 0-primarily based approach is one wherein managers begin each price range projection as
though there have been no past enjoy and each line object is justified as to its
reasonableness each yr duration this method can bring about a tightly controlled finances,
