CHSA Healthcare Finance & Reimbursement Flashcards
6 cards from real CHSA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CHSA Healthcare Finance & Reimbursement flashcards as text
Which federal program provides health insurance coverage for individuals aged 65 and older as well as certain younger individuals with disabilities?
Answer: Medicare
Medicare is the federal health insurance program covering people 65 and older, certain individuals under 65 with qualifying disabilities, and people with end-stage renal disease.
A healthcare administrator is reviewing a budget variance report showing an unfavorable volume variance. What does this indicate?
Answer: Actual patient volume was lower than the budgeted volume
An unfavorable volume variance means the facility served fewer patients than projected in the budget, resulting in lower-than-expected revenue.
What is the purpose of the Medicare Cost Report that hospitals must submit annually?
Answer: Providing a detailed accounting of costs and charges to settle cost-based payments and update rate calculations
The Medicare Cost Report provides CMS with detailed financial data used to settle cost-based reimbursement, calculate future payment rates, and monitor financial performance.
Which coding system is used to classify diagnoses and inpatient procedures for Medicare billing purposes in the US?
Answer: ICD-10-CM/PCS
ICD-10-CM (diagnoses) and ICD-10-PCS (inpatient procedures) are the required coding systems for hospital inpatient Medicare claims and DRG assignment.
A hospital administrator notices that the facility's days in accounts receivable (A/R) has increased significantly. Which scenario most likely explains this?
Answer: There are billing errors, increased denials, or slow payer payment processing
Increasing days in A/R typically indicates problems in revenue cycle management such as billing errors, claim denials, payer delays, or inadequate follow-up on outstanding claims.
Under value-based purchasing programs, Medicare adjusts hospital payments based on performance in which categories?
Answer: Clinical outcomes, patient experience, care process, and efficiency measures
The Hospital Value-Based Purchasing (VBP) Program adjusts Medicare payments based on a composite score across clinical outcomes, patient experience (HCAHPS), care processes, and efficiency/cost reduction measures.