What are five elements pertaining to the establishment of a false claim under the False Claims Act?
What are five elements pertaining to the establishment of a false claim under the False Claims Act?
HIPAA privacy standards were designed to accomplish what three broad objectives? Explain each.
Stark II laws prohibit physician referrals to entities in which the physician has a financial relationship. What are 10 specific designated health services (DHS) for which referrals by physicians who have financial relationships with the entity providing the DHS are prohibited?
Discuss the following:
Qui tam
HIPAA Privacy Rule
EMTALA
Compliance programs
Please see the Course Assignments section in the Introduction and Resources Module for further details and the grading rubric for this assignment.
HSM340 Health Services Finance
Week 2 Homework
Respond to the following six questions. Each accurate and complete response is worth 10 points.
Explain the difference between the accrual basis of accounting and the cash basis of accounting?
What are the major reasons for accrual accounting? How are revenues and expenses defined under accrual accounting?
What is an audit in the context of financial accounting?
Explain the double-entry accounting system and the duality concept. How are they related?
The HC method, which uses unadjusted historical costs, does not take into account depreciation expenses, purchasing power, and unrealized gains in replacement value. Despite these weaknesses as a financial reporting method, the HC method is used more frequently for accounting purposes than other methods, such as the HC-GPL, CV, and CV-GPL methods. Why is this so?
Define and describe the purpose of fund accounting (now called net assets).
HSM340 Health Services Finance
Week 3 Homework
Respond to the following three problems. Show your work for any calculations performed. Each accurate and complete response is worth 20 points.
Problem 1. David Jones, the new administrator for a surgical clinic, was trying to determine how to allocate his indirect expenses. His staff was complaining that the current method of taking a percentage of revenues was unfair. He decided to try to allocate utilities based on square footage of each department, administration based on direct costs, and laboratory based on tests. Use the information in the chart below to answer the question.
Square Footage
Direct Expenses
Lab Tests
Utilities
200,000
Administration
2,000
500,000
Laboratory
2,000
625,000
Day-op Suite
3,000
1,400,000
4,000
Cystoscopy
1,500
350,000
500
Endoscopy
1,500
300,000
500
Total
10,000
3,375,000
5,000
Based on the scenario above, what are the Endoscopy Department’s total expenses?
Problem 2. Your hospital has been approached by a major HMO to perform all their MS-DRG 470 cases (major joint procedures). They have offered a flat price of $10,000 per case. You have reviewed your charges for MS-DRG 470 during the last year and found the following profile:
Average Charge
$15,000
Average LOS
5 Days
Routine Charge
$3,600
Cost/Charge 0.80
Variable Cost % 60
Operating Room
2,657
0.80
80
Anesthesiology
293
0.80
80
Lab
1,035
0.70
30
Radiology
345
0.75
50
Medical Supplies
4,524
0.50
90
Pharmacy
1,230
0.50
90
Other Ancillary
1,316
0.80
60
Total Ancillary
$11,400
0.75
50
In the above data set, assume that the hospital’s cost to charge ratio is 0.80 for routine services and 0.75 for all other ancillary services. Using this information, what would the average cost of MS-DRG 470 be?
Problem 3. A free-standing ambulatory care center averages $70 in charges per patient. Variable costs are approximately $12 per patient, and fixed costs are about $1.5 million per year. Using these data, how many patients must be seen each day, assuming a 365-day operation, to reach the break-even point?
HSM340 Health Services Finance
Week 4 Homework
Respond to the following three problems. Show your work for any calculations performed. Each accurate and complete response is worth 20 points.
Problem 1. Formulate your answer based on the below information. The intensity of care delivered dropped from a budgeted case mix of 0.90 to an actual case mix of 0.85. What dollar effect did this have on actual costs?
You have been asked by management to explain the variances in costs under your inpatient capitated contract. The following data is provided. Use the following data to calculate the variances.
Budget
Actual
Inpatient Costs
$12,568,500
$16,618,350
Members
42,000
42,000
Admission Rate
0.070
0.095
Case Mix Index
0.90
0.85
Cost per Case (CMI = 1.0)
$4,750
$4,900
Problem 2. Based on the information below, what rate must be set to generate the required $80,000 in profit in the preceding example?
You have been asked to establish a pricing structure for radiology on a per-procedure basis. Present budgetary data is presented below:
Budgeted Procedures
10,000
Budgeted Cost
$400,000
Desired Profit
$80,000
It is estimated that Medicare patients comprise 40 percent of total radiology volume and will pay on average $38.00 per procedure. Approximately 10 percent of the patients are cost payers. The remaining charge payers are summarized below:
Payer
Volume%
Discount%
Blue Cross
20
4
Unity PPO
15
10
Kaiser
10
10
Self Pay
5
40
50%
Problem 3. What is the amount of variance that is attributed to the difference between the budgeted and actual wage rate per hour?
Use the following data to calculate the variances.
The following information has been prepared for a home health agency.
Budget
Actual
Wage Rate per Hour
$16.00
$17.00
Fixed Hours
320
320
Variable Hours per Relative
Value Unit (RVU)
1.0
1.1
Relative Value Units (RVUs)
1,000
1,200
Total Labor Hours
1,320
1,640
Labor Costs
$21,120
$27,880
Cost per RVU
$21.12
$23.23
Budgeted costs at actual volume would be $25,344 ($21.12 × 1,200), and the total variance to be explained is $2,536 Unfavorable ($27,880 – $25,344). Be sure to specify whether the variance is favorable or unfavorable.
HSM340 Health Services Finance
Week 5 Assignment
CAPITAL BUDGETING PROCESS
Your professor will divide the class into small groups of 3 or 4 students. Each group will meet using an online collaboration tool such as Cisco Spark, Google Hangout, Skype, etc. to complete this assignment.
Groups will submit a presentation answering the following questions either by a voice over PowerPoint or another mode of online delivery at the end of the week addressing the following (with references included on the final page APA formatted):
Organizations that decide to issue bonds generally go through a series of steps. Discuss the six steps.
An alternative to traditional equity and debt financing is leasing. Leasing is undertaken primarily for what purposes?
Discuss the two major types of leases.
Discuss the terms short-term borrowing and long-term financing.
What are the primary sources of equity financing for not-for-profit healthcare organizations?
The capital budgeting process occurs in several stages, but generally includes what?
Discuss and list the three discounted cash flow methods.
Please see the Course Assignments section in the Introduction and Resources Module for further details and the grading rubric for this assignment.
HSM340 Health Services Finance
Week 6 Assignment
CASH AND WORKING CAPITAL
Your professor will divide the class into small groups of 3 or 4 students. Each group will meet using an online collaboration tool such as Cisco Spark, Google Hangout, Skype, etc.
Groups will submit a presentation answering the following questions either by a voice over PowerPoint or another mode of online delivery at the end of the week addressing the following (with references included on the final page APA formatted):
What are four general phases of the working capital cycle?
What are the three primary sources of short-term funds?
An organization’s short-term investment options for idle cash include what four areas? List and provide their characteristics.
Discuss the term float.
Please see the Course Assignments section in the Introduction and Resources Module for further details and the grading rubric for this assignment.
HSM340 Health Services Finance
Week 7 Homework
Respond to the following three problems. Show your work for any calculations performed. Each accurate and complete response is worth 20 points.
Problem 1. An HMO has a Point of Service (POS) option for its members, but will pay only 80 percent of approved charges. If a member goes out of network for a medical procedure with a charge of $2,000, of which $1,200 is approved, how much must the member pay?
Problem 2. A hospital has contracted with an HMO to provide acute care inpatient services for $1,000 per day, subject to a 10 percent withhold. The proposed budget for inpatient services is based upon expected utilization of 600 days per 1,000 members at $1,000 per day, or $600,000 per 1,000 members. The hospital risk pool will be split equally between the hospital and a primary care physician group. If only 450 days per 1,000 members were utilized in the first year, how much would the hospital be paid per 1,000 members?
Problem 3. An uninsured patient receives services with charges of $5,000 from a hospital. The hospital staff bills the patient $1,000 and records $4,000 as charity care. If the hospital’s ratio of cost to charges is 50%, what amount would the hospital recognize as charity care in Schedule H of IRS Form 990?
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