1
FINANCIAL MANAGEMENT FOR PUBLIC HEALTH AND NON-
PROFITS WITH 100% VERIFIED QUESTIONS AND ANSWERS
AND BEST GRADED 2025
The least frequently performed measures - -answer--Assessing use of preventive and screening
services; Conducting behavioral risk factor surveys; Regularly evaluating the effect of services;
Allocating resources consistent with action plans; Deploying resources to meet identified needs
Program evaluation - -answer--Provides assessment of social interventions of the activities being
measured (Conceptualization, design, implementation, and utility)
HCPS codes - -answer--Used for reporting procedures by physicians for both inpatient and
outpatient procedures; used by hospitals for reporting outpatient procedures only;
info about procedure
Level I codes - -answer--Referred to as current procedure terminology (CPT) codes under HCPS
Fee-For-Service (FFS) - -answer--Reimbursement tied to amount of services rendered;
unbundled
Capitation - -answer--Reimbursement tied to patient population (# of enrollees); per member
per month payments.
ICD-9 codes - -answer--Required for procedure reporting for hospital inpatient procedures; used
for diagnosis reporting for all healthcare providers, including hospitals and physicians
, 2
HCPS & CPT code significance - -answer--Effect on provider payment for both facilities and
physicians.
Price impact based on market share - -answer--The greater the market share a company has the
higher the prices they can charge;
less competitors means prices can go up;
market share= competitive advantage
How to control revenue function - -answer--1) Set prices --in a way to generate the required
level of revenue needed to sustain operations (Medicare&Medicaid pay on fixed-fee-schedule
that has nothing to do with prices).
2) Contract negotiation --critical for health care firms that receive majority of revenue from
commerical insureers; negotiate rates higher than their costs
3) Billing and coding issues --All diagnoses must be recorded, or the right DRG may not be listed
on the bill, resulting in underpayment for services rendered.
Bundled services - -answer--Two key features:
1) Payment grouped into mutually exclusive set of categories
2) Fixed fee specified per unit of service
How to increase revenue function - -answer--Increase competitive position/advantage
1) Set prices
2) Contract negotiation
3) Billing & coding issues
Pricing upon different payers - -answer--Can negotiate different rates of payment with the most
important disctinction being unit of payment
, 3
HMO staff model - -answer--HMO must control primary physician network; employees of HMO
(non-contractual)
Four major payment units - -answer--1) Historical reimbursement
2) Specific services (charge payment)
3) Capitated rates
4) Bundled services
Adverse selection - -answer--Insurance companies must have both high-risk and low-risk; sick
(high-risk) people tend to buy health insurance but will equal losses for insurance companies;
EX: If significant number of AIDS patients are attracted to a health plan, both providers and
health plan may lose.
Other balance sheet accounts and their effects on cash - -answer--As the number of
transactions increases, the number of individual assets & liability also increases (aka accounts).
Duality principle states - -answer--For every debt there's a credit
Individual assets, liability, and net asset accounts always create a balance
Financial audit - -answer--When an outside party, usually a CPA firm, verifies, reviews and
renders an opinion about the finances of a company
Qui Tam - -answer--"Whistleblower" actions; provision of the Federal Civil False Claims Act; FCA
claims brought by individual
FINANCIAL MANAGEMENT FOR PUBLIC HEALTH AND NON-
PROFITS WITH 100% VERIFIED QUESTIONS AND ANSWERS
AND BEST GRADED 2025
The least frequently performed measures - -answer--Assessing use of preventive and screening
services; Conducting behavioral risk factor surveys; Regularly evaluating the effect of services;
Allocating resources consistent with action plans; Deploying resources to meet identified needs
Program evaluation - -answer--Provides assessment of social interventions of the activities being
measured (Conceptualization, design, implementation, and utility)
HCPS codes - -answer--Used for reporting procedures by physicians for both inpatient and
outpatient procedures; used by hospitals for reporting outpatient procedures only;
info about procedure
Level I codes - -answer--Referred to as current procedure terminology (CPT) codes under HCPS
Fee-For-Service (FFS) - -answer--Reimbursement tied to amount of services rendered;
unbundled
Capitation - -answer--Reimbursement tied to patient population (# of enrollees); per member
per month payments.
ICD-9 codes - -answer--Required for procedure reporting for hospital inpatient procedures; used
for diagnosis reporting for all healthcare providers, including hospitals and physicians
, 2
HCPS & CPT code significance - -answer--Effect on provider payment for both facilities and
physicians.
Price impact based on market share - -answer--The greater the market share a company has the
higher the prices they can charge;
less competitors means prices can go up;
market share= competitive advantage
How to control revenue function - -answer--1) Set prices --in a way to generate the required
level of revenue needed to sustain operations (Medicare&Medicaid pay on fixed-fee-schedule
that has nothing to do with prices).
2) Contract negotiation --critical for health care firms that receive majority of revenue from
commerical insureers; negotiate rates higher than their costs
3) Billing and coding issues --All diagnoses must be recorded, or the right DRG may not be listed
on the bill, resulting in underpayment for services rendered.
Bundled services - -answer--Two key features:
1) Payment grouped into mutually exclusive set of categories
2) Fixed fee specified per unit of service
How to increase revenue function - -answer--Increase competitive position/advantage
1) Set prices
2) Contract negotiation
3) Billing & coding issues
Pricing upon different payers - -answer--Can negotiate different rates of payment with the most
important disctinction being unit of payment
, 3
HMO staff model - -answer--HMO must control primary physician network; employees of HMO
(non-contractual)
Four major payment units - -answer--1) Historical reimbursement
2) Specific services (charge payment)
3) Capitated rates
4) Bundled services
Adverse selection - -answer--Insurance companies must have both high-risk and low-risk; sick
(high-risk) people tend to buy health insurance but will equal losses for insurance companies;
EX: If significant number of AIDS patients are attracted to a health plan, both providers and
health plan may lose.
Other balance sheet accounts and their effects on cash - -answer--As the number of
transactions increases, the number of individual assets & liability also increases (aka accounts).
Duality principle states - -answer--For every debt there's a credit
Individual assets, liability, and net asset accounts always create a balance
Financial audit - -answer--When an outside party, usually a CPA firm, verifies, reviews and
renders an opinion about the finances of a company
Qui Tam - -answer--"Whistleblower" actions; provision of the Federal Civil False Claims Act; FCA
claims brought by individual
