Accounting Zelman Test 1

Front 1

Ambulatory Procedure Classifications (APCs):

Back 1

Ambulatory Procedure Classifications (APCs): Enacted by the federal government in 2000, a prospective payment system for outpatient services, similar to DRGs, which reimburses a fixed amount for a bundled set of services

Front 2

Cost-shifting:

Back 2

Charging one group of patients more in order to make up for underpayment by others. Most commonly, charging some privately insured patients more in order to make up for underpayment by Medicaid or Medicare

Front 3

Capitation

Back 3

A system which pays providers a specific amount in advance to care for the health care needs of a population over a specific time period.

Front 4

Care Mapping

Back 4

A process which specifies in advance the preferred treatment regimen for patients with particular diagnoses. This is also referred to as a clinical pathway, clinical protocol, or practice guideline.

Front 5

Compliance:

Back 5

Compliance: The need to abide by governmental regulations, whether they be for the provision of care, billing, privacy, security, etc.

Front 6

Cost-shifting:

Back 6

Charging one group of patients more in order to make up for underpayment by others. Most commonly, charging some privately insured patients more in order to make up for underpayment by Medicaid or Medicare.

Front 7

Defensive Medicine

Back 7

The tendency of health care practitioners to do more testing and to provide more care for patients than might otherwise be necessary, simply to protect themselves against potential litigation.

Front 8

DRGs:

Back 8

DRGs: A patient classification scheme used by Medicare that clusters patients into categories on the basis of patients' illnesses, diseases and medical problems. These classifications are then used to pay providers a set amount based on the diagnosis related group in which the patient has been classified

Front 9

Global Payments:

Back 9

A system to pay providers whereby the fees for all providers (hospitals, physicians, home health care agencies) are included in a single negotiated amount. This is sometimes called "bundling" of services.
In non-global payment systems, each provider is paid separately.

Front 10

Health Insurance Portability and Accountability Act (HIPAA):

Back 10

A set of federal compliance regulations enacted in 1996 to ensure standardization of billing, privacy, and reporting as institutions enter a paperless age.

Front 11

Prospective Payment System

Back 11

The payment system used by Medicare to reimburse providers a predetermined amount. Several payment methods fall under the umbrella of PPS, including: DRGs (inpatient admissions); APCs (outpatient visits); RBRVS (professional services); and RUGs

Front 12

Risk Pools

Back 12

: A generally large population of individuals who are all simultaneously insured under the same arrangement, regardless of working status. Health care utilization - and therefore cost - is more stable for larger groups than it is for smaller groups, which makes larger groups' cost more predictable for insurers.

Front 13

Accumulated Depreciation

Back 13

The total amount of depreciation taken on an asset since it was put into use.

Front 14

Amortization:

Back 14

The allocation of the acquisition cost of debt to the period which it benefits

Front 15

Assets:

Back 15

Resources that the organization owns, typically recorded at their original costs

Front 16

Basic Accounting Equation

Back 16

Assets = Liabilities + Net Assets

Front 17

Charity Care Discoun

Back 17

Discounts from Gross Patients Accounts Receivable given to those who cannot pay their bills.

Front 18

Current Assets

Back 18

Assets which will be consumed (used up) within one year (or one time period).

Front 19

Current Liabilities:

Back 19

Financial obligations due within one year (or one time period).

Front 20

Depreciation:

Back 20

A measure of how much a tangible asset (such as plant or equipment) has been "used up" or consumed.

Front 21

Fund Balance:

Back 21

term used until 1996 for owners' equity by not-for-profit health care organizations. It was replaced with the present term, net assets, for non-governmental, not-for-profit organizations.

Front 22

Liabilities

Back 22

The financial obligations of the organization (i.e. debts).

Front 23

Liquidity:

Back 23

A measure of how quickly an asset can be converted into cash

Front 24

Net Assets:

Back 24

In not-for-profit organizations, the difference between assets and liabilities (assets minus liabilities).

Front 25

Net Income:

Back 25

: Excess of revenues over expenses

Front 26

Non-current Assets:

Back 26

The resources of the organization that will be used or consumed over periods longer than one year.

Front 27

Non-current Liabilities

Back 27

The financial obligations not due within one year.

Front 28

Notes to Financial Statements

Back 28

Additional key information written out in detail which is not presented in the body of the financial statement.

Front 29

Operating Income

Back 29

Income derived from the organization's main line of business

Front 30

Owner's Equity:

Back 30

In for-profit institutions, the difference between assets and liabilities (assets minus liabilities).

Front 31

Operating Income:

Back 31

Income derived from the organization's main line of business.

Front 32

Owner's Equity

Back 32

In for-profit institutions, the difference between assets and liabilities (assets minus liabilities).

Front 33

Owner's Equity:

Back 33

In for-profit institutions, the difference between assets and liabilities (assets minus liabilities).

Front 34

Third Party Payors

Back 34

Commonly referred to as third parties, these are organizations that pay on behalf of patients.

Front 35

Allowable Costs

Back 35

Costs which are allowable under the principles of reimbursement of government (Medicaid, Medicare) and other payors.

Front 36

Ambulatory Procedure Classifications (APCs

Back 36

Enacted by the federal government in 2000, a prospective payment system for outpatient services, similar to DRGs, which reimburses a fixed amount for a bundled set of services.

Front 37

Capitation:

Back 37

Capitation: 1) A system which pays providers a specific amount in advance to care for the health care needs of a population over a specific time period. Providers are usually paid on per member per month (PMPM) basis.

Front 38

Charge-based:

Back 38

A method of payment which is based on the charge of the provider.

Front 39

Community Rating:

Back 39

A rating methodology required of indemnity and HMO insurers that guarantees that there will be equivalent amounts collected from members of a specific group without regard to demographics such as age, sex, size of covered group, and industry type

Front 40

Contact Capitation:

Back 40

A method of capitation whereby each specialty has its own capitation pool and use of services by a physician only affects that physician's compensation, not the whole specialty network's compensation.

Front 41

Contra-asset:

Back 41

An asset which, when increased, decreases the value of a related asset on the books. Two primary examples are Accumulated Depreciation, which is the contra-asset to Properties and Equipment, and the Allowance for Uncollectibles, which is the contra-asset to Accounts Receivable.

Front 42

Conversion Factor:

Back 42

Actuarial based formulas developed to adjust rates allowing for differences in population demographics.

Front 43

Copayment:

Back 43

Requiring the patient to pay part of the health care bill. These payments are used to prevent overutilization of services.

Front 44

Cost-based Reimbursement:

Back 44

Using the provider's cost of providing services (supplies, staff salaries, space costs, etc.) as the basis for reimbursement.

Front 45

Cost-shifting:

Back 45

Charging one group of patients more in order to make up for underpayment by others. Most commonly, charging some privately insured patients more in order to make up for underpayment by Medicaid or Medicare

Front 46

Deductibles:

Back 46

When the patient covered is responsible for paying a certain base amount before coverage begins.

Front 47

Experience Rating:

Back 47

The method of setting premium rates based on the actual health care costs of a group of groups.

Front 48

DRGs:

Back 48

A patient classification scheme used by Medicare that clusters patients into categories on the basis of patients' illnesses, diseases and medical problems. These classifications are then used to pay providers a set amount based on the diagnosis related group in which the patient has been classified.

Front 49

Gatekeepers:

Back 49

Providers (typically the PCP) who must preapprove care received by a patient, such as a visit to the specialist. Gatekeepers are utilized in most POS plans and HMO plans.

Front 50

HCFA:

Back 50

The Health Care Financing Administration. The US government department that oversaw the provision of and payment for health care provided under its entitlement programs (Medicare, Medicaid) until 2001.

Front 51

Health Maintenance Organization (HMO):

Back 51

): A legal corporation that offers health insurance and medical care. HMOs typically offer a range of health care services at a fixed price. See Capitation.

Front 52

Indemnity Insurance:

Back 52

A plan which reimburses physicians for services performed, or beneficiaries for medical expenses incurred. Typically, the employer and/or patient pays a monthly premium to the plan for a predetermined set of healthcare benefits.

Front 53

Managed Care:

Back 53

Any of a number of arrangements designed to control health care costs through monitoring, prescribing, or proscribing the provision of health care to a patient or population.

Front 54

Medicaid:

Back 54

A federally mandated program, operated and partially funded by individual states (in conjunction with the federal government) to provide medical benefits to certain low-income people. The state, under broad federal guidelines, determines what benefits are covered, who is eligible, and how much
providers will be paid.

Front 55

Medical Savings Accounts:

Back 55

A limited amount of money an employee can take as pretaxed income to pay for medically related items such as physician visits, pharmaceuticals, eyewear, dental visits, etc. The pretax income is placed in an escrow account held by the employer. The employee must submit receipts
for care received to get reimbursed.

Front 56

Medicare:

Back 56

A nationwide, federally financed health insurance program for people age 65 and older. It also covers certain people under 65 who are disabled or have chronic kidney (end-stage renal) disease. Medicare Part A is the hospital insurance program; Part B covers physicians' services. Created by the 1965 amendment to the Social Security Act.

Front 57

Payor:

Back 57

An entity that is responsible for paying for the services of a health care provider. Typically, this is an insurance company or a government agency. Commonly referred to as third parties

Front 58

Per Diem:

Back 58

An amount a payor will pay for one day of care, which includes all hospital charges associated with the inpatient day (including nursing care, surgeries, medications, etc.).

Front 59

Per Member Per Month (PMPM)

Back 59

Generally used by HMOs and their medical providers as an indicator of revenue, expenses, or utilization of services per member per one-month period.

Front 60

Preferred Provider Organization (PPO):

Back 60

A network of independent providers preselected by the payor to provide a specific service or range of services at predetermined (usually discounted) rates to the payor's covered members.

Front 61

Point of Service (POS)

Back 61

A hybrid between a HMO and a PPO in which patients are given the incentive to see providers participating in a defined network, but may see non-network providers, though usually at some additional cost

Front 62

RBRVS:

Back 62

A system of paying physicians based upon the relative value of the services rendered.

Front 63

RVU

Back 63

Relative Value Unit

Front 64

Staff Model HMO:

Back 64

An HMO which owns its clinics and employs its doctors.

Front 65

Subcapitation:

Back 65

Where the primary care physician pays a portion of the total capitated dollars received to another provider (i.e. specialist).

Front 66

Zero-based Budget (Capitation):

Back 66

Dividing the entire amount of capitation (the "budget") among all the providers, essentially leaving nothing or "zero" left at the end of every accounting period.