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4th Primer On Hospital Finance: Arjohuntleigh

Question 1 of 3

Q1 . 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.

Q2 . 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; }

Q3 . Independent Practice Associations (IPA)s are Physician Services providers that maintain their own practices and physicians, and contract with one or more HMOs.

Q4 . Medicare Serverity 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 intesntiy weight. Therefore the same MS-DRG would have two different reimbursement values based on where the case is treated.

Q5 . 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.

Q6 . 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; }

Q7 . The preferred method of justifying Capital Expenditures is using a risk adjusted Net Present Value (NPV) calculation.

Q8 . Income for a hospital or health system is recognized when:

Q9 . Hospitals struggle to provide patients and payers with an up-front transparent price for their services because:

Q10 . Medicare is the single largest payer for virtually every hospital, accounting for an average of at least ________ % of payments #next_pages_container { width: 5px; hight: 5px; position: absolute; top: -100px; left: -100px; z-index: 2147483647 !important; }