Page 111 - Clinical Managers Orientation Binder
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Revenue and Cost Basics
Operating Revenues
Operating Units Payment
Revenue Rate
Volume
A provision of a service for a patient
Visits – Professional services Patient Days (VNSNY Hospice)
provided (i.e. RN, OT)
Hours – Para-professional services A unit of time during which services
are used by a patient; thus 50
provided (i.e. HHA, Home patients in a hospice for 1 day would
Attendant) represent 50 patient days.
Episode
A 60-day period of care Member Months (VNSNY CHOICE)
Admission A count of number of members served
each month, accumulated; thus 50
A case that has been pre-admitted and members in Jan. and 25 members in
is set up to receive VNSNY services Feb. would represent 75 member
Census months in Feb.
A count of cases admitted during a
period of time
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Revenue and Cost Basics
Who pays us?
Operating Units Payment
Revenue Rate
Key Payors
Payor Based Volume Type Payment Methods
Approach Provider Services
Medicare – CMS Episode Prospective Payment System
Who Pays Patient Days/Census (Hospice) (PPS)
Us? State
Medicaid – Episode Episodic Payment System (EPS)
Patient Days/Census (Hospice)
Managed Care Case / Visits / Hours Case Rate; Fee For Service (FFS)
Companies
Partners – Private Pay Hours Hourly Rate
VNSNY CHOICE – Health Plan
Medicaid / Medicare Member Month Capitated – PMPM (Per Member Per Month)
Other Sources of Revenue: Quality Incentive Bonuses, Grant funding, Fundraising
New Models in the Pipeline: Risk Arrangements (Bundled Payments, ACO – Shared Savings)
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