CHSA CHSA Healthcare Finance & Reimbursement 2 — Questions and Answers
Question 1: Which federal program provides health insurance coverage for individuals aged 65 and older as well as certain younger individuals with disabilities?
- Medicaid
- CHIP
- Medicare (Correct answer)
- TRICARE
Correct 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.
Question 2: A healthcare administrator is reviewing a budget variance report showing an unfavorable volume variance. What does this indicate?
- Costs per unit of service were higher than budgeted
- Actual patient volume was lower than the budgeted volume (Correct answer)
- Staff productivity was below budgeted expectations
- Payer mix shifted to lower-reimbursing payers
Correct 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.
Question 3: What is the purpose of the Medicare Cost Report that hospitals must submit annually?
- Reporting quality metrics and patient outcomes to CMS
- Providing a detailed accounting of costs and charges to settle cost-based payments and update rate calculations (Correct answer)
- Disclosing physician compensation arrangements to ensure Stark Law compliance
- Reporting hospital-acquired infection rates and sentinel events
Correct 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.
Question 4: Which coding system is used to classify diagnoses and inpatient procedures for Medicare billing purposes in the US?
- CPT (Current Procedural Terminology)
- ICD-10-CM/PCS (Correct answer)
- HCPCS Level II
- SNOMED-CT
Correct 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.
Question 5: A hospital administrator notices that the facility's days in accounts receivable (A/R) has increased significantly. Which scenario most likely explains this?
- The hospital has been collecting payments faster than average
- There are billing errors, increased denials, or slow payer payment processing (Correct answer)
- Patient volume has decreased, reducing total receivables
- The hospital recently converted to a new EHR system and claims dropped
Correct 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.
Question 6: Under value-based purchasing programs, Medicare adjusts hospital payments based on performance in which categories?
- Only mortality rates and readmission rates
- Clinical outcomes, patient experience, care process, and efficiency measures (Correct answer)
- Staff credentials and workforce development metrics
- Community health improvement programs and charity care provision
Correct 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.
CHSA CHSA Healthcare Finance & Reimbursement 2
Which federal program provides health insurance coverage for individuals aged 65 and older as well as certain younger individuals with disabilities?