HSM 340 Health Care Services Week 1 to 7 Financial Laws and Regulations
Complete an APA formatted 2 page paper (not including the title and reference pages) answering the following questions: 1. What are five elements pertaining to the establishment of a false claim under the False Claims Act? 2. HIPAA privacy standards were designed to accomplish what three broad objectives? Explain each. 3. 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? 4. Discuss the following: a. Qui tam b. HIPAA Privacy Rule c. EMTALA d. Compliance programs Week 2 Quiz 1. (TCO 2) A statement that reports inflows and outflows of cash during the accounting period in the categories of operations, investing, and financing, is called a(an): 2. (TCO 2) Which method(s) of financial reporting does (do) not recognize the impact of changes in purchasing power? 3. (TCO 2) Which of the following is the BEST example of a financial metric? 4. (TCO 2) What is/(are) the primary determinant(s) of firm value? 5. (TCO 2) How are revenues and expenses defined under accrual accounting? 6. (TCO 2) What is an audit (in the context of financial accounting)? 7. (TCO 2) 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? 8. (TCO 2) Define and describe the purpose of fund accounting (now called net assets). Week 3 Quiz 1. (TCO 3) From a hospital's perspective, what is most likely to be the highest risk arrangement with a payer? 2. (TCO 3) SKF Primary Care Clinic is deciding whether to purchase MRI equipment that would enable it to perform MRI imaging services in-house rather than sending its patients to its competitor's hospital three miles away. From a financial position, if SKF were to make its decision without using net present value analysis, the clinic would need to know (or at least reasonably estimate) which of the following information? 3. (TCO 3) Assume that the clinic used the price that they need to exactly break even at 10,000 shots. Fewer people than expected showed up and purchased the flu shot. The clinic would: 4. (TCO 3) Which of the following is the first step in any budgetary process? 5. (TCO 3) 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. 6. (TCO 3) 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: 7. (TCO 3) How are costs classified? Week 4 Midterm Exam 1. (TCO 4) Which of the following is part of a statistics budget? 2. (TCO 4) The following is an example of a _____________ budget: "The budget for the radiology department is different at 90 percent occupancy than at 80 percent occupancy." 3. (TCO 4) Effectiveness is a relationship between: 4. (TCO 3) What is the main reason that relative value units (RVUs) often are used in health care? 5. (TCO 3) Your controller has told you that the marginal profit of DRG 209 (major joint procedure) for a Medicare patient exceeds the marginal profit for an average charge patient. Why might this occur? 6. (TCO 2) The heading of every financial statement should contain the: 7. (TCO 2) Which of the following is the BEST example of a financial metric? Page 2 1. (TCO 4) Formulate your answer based on the below information. Costs per case increased to $4,900 from a budgeted value of $4,750. This increased actual total costs by what amount?.............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 2. (TCO 4) Based on the information below, assume that the only change in the original example data is that Blue Cross raises their discount to 20 percent. What price should be set? You have been asked to establish a pricing structure for radiology on a per-procedure basis. Present budgetary data is presented below:……………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: 3. (TCO 4) What is the amount of variance that can be attributed to the difference between budgeted and actual volume? Use the following data to calculate the variances. The following information has been prepared for a home health agency. 4. (TCO 2) Explain the difference between the accrual basis of accounting and the cash basis of accounting? 5. (TCO 2) What is an audit (in the context of financial accounting)? 6. (TCO 1) What are social responsibility and ethics as they relate to business-oriented organizations? How should social responsibility and ethics affect the decisions of even for-profit companies? 7. (TCO 2) Define and describe the purpose of fund accounting (now called net assets). Week 5 Assignment, Capital Budgeting Process Complete an APA-formatted two-page paper (not including the title and reference pages) answering the following questions. 1. Organizations that decide to issue bonds generally go through a series of steps. Discuss the six steps. 2. An alternative to traditional equity and debt financing is leasing. Leasing is undertaken primarily for what purposes? 3. Discuss the two major types of leases. 4. Discuss the terms short-term borrowing and long-term financing. 5. What are the primary sources of equity financing for not-for-profit healthcare organizations? 6. The capital budgeting process occurs in several stages, but generally includes what? 7. Discuss and list the three discounted cash flow method Week 6 Assignment, Cash and Working Capital Complete an APA-formatted two-page paper (not including the title and reference pages) answering the following questions. 1. What are four general phases of the working capital cycle? 2. What are the three primary sources of short-term funds? 3. An organization's short-term investment options for idle cash include what four areas? List and provide their characteristics. 4. Discuss the term float. HSM 340 Week 7 Quiz 1. (TCO 7) Coordination of benefits refers to: 2. (TCO 7) A withhold is a feature for payment to health care provider that: 3. (TCO 7) A medical group includes a provision in its contract with an HMO to receive larger PMPM payments if the HMO members are chronically ill. This type of provision is referred to as a: 4. (TCO 7) Suppose that AT&T had made an offer to acquire Merck Pharmaceuticals. Ignoring potential antitrust problems, this merger would be classified as a: 5. (TCO 7) 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? 6. (TCO 7) 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? 7. (TCO 7) Why is tax-exempt financing cited as a benefit received by not-for-profit healthcare providers?
