CHSA CHSA Healthcare Finance & Revenue Cycle 2 — Questions and Answers
Question 1: In healthcare budgeting, a 'zero-based budget' requires department managers to:
- Start from the prior year's budget and adjust by a fixed percentage
- Justify every expense from a baseline of zero each budget cycle (Correct answer)
- Use only capital funds approved by the board
- Limit spending to federally mandated cost caps
Correct 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.
Question 2: Which type of healthcare budget forecasts the expected revenues and expenses related to patient care services?
- Capital budget
- Operating budget (Correct answer)
- Cash flow budget
- Master staffing budget
Correct answer: Operating budget
The operating budget covers day-to-day revenues (patient services, ancillary income) and expenses (salaries, supplies, utilities) for a defined period.
Question 3: The term 'capitation' in managed care refers to a payment model where providers receive:
- A fee for each individual service rendered
- A fixed per-member per-month (PMPM) payment regardless of services used (Correct answer)
- A bundled payment per episode of care
- A percentage of the insurer's premium revenue
Correct 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.
Question 4: A healthcare administrator reviewing a payer's Explanation of Benefits (EOB) would use it primarily to:
- Assign medical diagnosis codes
- Understand how a claim was processed and identify any adjustments or denials (Correct answer)
- Schedule follow-up appointments
- Verify a patient's HIPAA authorization
Correct 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.
Question 5: Which federal program provides health coverage to low-income individuals and is jointly funded by federal and state governments?
- Medicare Part A
- CHIP (Children's Health Insurance Program) adult tier
- Medicaid (Correct answer)
- TRICARE
Correct answer: Medicaid
Medicaid is a joint federal-state program that covers low-income adults, children, pregnant women, elderly, and people with disabilities.
Question 6: What does the term 'charge master' (or chargemaster) refer to in hospital finance?
- The hospital's annual financial audit report
- A comprehensive list of all billable services, supplies, and their standard prices (Correct answer)
- The physician fee schedule negotiated with Medicare
- The internal cost allocation ledger
Correct 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.
CHSA CHSA Healthcare Finance & Revenue Cycle 2
In healthcare budgeting, a 'zero-based budget' requires department managers to: