CHSA Healthcare Finance & Revenue Cycle Flashcards

In healthcare budgeting, a 'zero-based budget' requires department managers to:

Answer: Justify every expense from a baseline of zero each budget cycle

Zero-based budgeting requires managers to justify all expenditures anew each period rather than simply adjusting last year's figures.

Which type of healthcare budget forecasts the expected revenues and expenses related to patient care services?

Answer: Operating budget

The operating budget covers day-to-day revenues (patient services, ancillary income) and expenses (salaries, supplies, utilities) for a defined period.

The term 'capitation' in managed care refers to a payment model where providers receive:

Answer: A fixed per-member per-month (PMPM) payment regardless of services used

Under capitation, the provider accepts financial risk by receiving a fixed monthly amount per enrolled member, whether or not that member receives services.

A healthcare administrator reviewing a payer's Explanation of Benefits (EOB) would use it primarily to:

Answer: Understand how a claim was processed and identify any adjustments or denials

The EOB details the claim amount billed, amount allowed, adjustments made, and patient responsibility, guiding any appeals or patient billing.

Which federal program provides health coverage to low-income individuals and is jointly funded by federal and state governments?

Answer: Medicaid

Medicaid is a joint federal-state program that covers low-income adults, children, pregnant women, elderly, and people with disabilities.

What does the term 'charge master' (or chargemaster) refer to in hospital finance?

Answer: A comprehensive list of all billable services, supplies, and their standard prices

The chargemaster is the hospital's master price list used as the starting point for all patient bills before payer adjustments.