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indemnity insurance trend
going away, going more toward value based care
cost sharing
splits costs to reduce risk
3 types: copayment, deductibles, coinsurance
copayment
fixed amount for a covered service payed by patient to provider
deductible
amount you pay before insurance starts to pay
coinsurance
portion of costs you pay after you’ve paid deductible
type of insurance that accounts for over half of all healthcare spending
medicare
gdp of healthcare
projected 17%-20% 2026
who bears cost of providing care to uninsured
everyone
is medicare state or federal
federal
is medicaid state or federal
both
who is covered w medicare
elderly (65+)
disabled
end-of-life diseases
who is covered w medicaid
low income
indigent
did ACA affect medicare or medicaid
medicaid
how did ACA impact # of uninsured individuals
increased # of uninsured
did all states expand medicaid under ACA
no
who provides majority of health coverage in US
private insurance/employer sponsored
risk
money that might be lost due to insuring those who use healthcare
social security act 1965 (SSA)
established medicare and medicaid
tax equity/fiscal responsibility act 1982 (TEFRA)
established medicare cost controls
balanced budget act 1997
cost controls
medicare part c
medicare and modernization act 2003
created medicare part d
affordable care act 2010
mandated health insurance
types of private health insurance
medigap
employer sponsored
commercial
do private health insurances use one or multiple methods of payment
multiple
types of public health insurance
CHIP
medicare
medicaid
tricare (military)
trend in health care insurance
moving toward value based reimbursement
how does CMS reimburse physicians
resource based relative value scale (RBRVS)
what does cms stand for
centers for medicare and medicaid services
accountable care organizations
groups of providers that come together to take care of a defined population
moral hazard
people who have insurance are more likely to participate in risky behavior
pre-existing condition
conditions had before being covered by insurance
makes person a bigger risk
uncompensated care
bad debt
charity care
what expenditures account for a majority of healthcare spending
hospitals
medicare part a
hospitals
medicare part b
physicians
medicare part c
medigap
medicare advantage plans
medicare part d
drugs
medigap
private insurance you can buy that covers any cost sharing of medicare
CHIP
low income families that do not qualify for medicaid
managed care plans
hmo
ppo
pos
indemnity
fee for service w/o control
for profit firms
can participate in politics
not tax exempt
can’t fundraise
not for profit firms
can’t participate in politics
tax exempt
fundraise
ar
accounts receivable
matters b/c the longer money sits there the less likely you are to receive it
average time it takes for payments to be made to hospitals and providers
30-40 days
capitation
fixed amount per enrollee “member” per month (paid per person)
puts risk on provider rather than insurance
managerial accounting
internal accounting
financial accounting
external accounting
how are costs classified
behavior
traceability
decision-making capability
fixed costs
salary workers
variable costs
hourly workers
supply costs
cost allocation
determining total costs of producing a service
purpose of cost allocation
ensure proper allocation of costs to departments
allocate non-revenue producing costs to revenue-producing
set accurate pricing for services
chargemaster
list of services with 1 price for each
working capital
current assets - current liabilities
short term assets used in day to day operations
sources of working capital
permanent: what is always in account
net income: what is coming in
temporary
purpose of working capital
increase revenues and reduce expenses
self-pay patients: pay full or discount
pay full
primary goal of managing ar
reduce the collection period
supply chain
delivery of appropriate patient care supplies
provision of cost control
find best prices and reduce over-utilization
master budget
all financial info for organization
combo of operating & capital
operating budget
annual budget
capital budget
expenditures for long-term assets whose useful life is more than 1 year
retrospective payments
determined after services
charges, charges minus contracted rate, cost, reimbursement modified
prospective payments
determined before services
per day, per diagnosis, capitation
contribution margin
revenue contributed to an org after variable costs are subtracted
primary function of board/governing body
ensure proper use of resources
Note
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