HEALTHCARE FINANCE:
  Revenue cycle: scheduling → registration → coding → billing → payment
  Accounts receivable: days in AR target < 40-50 days
  Denial rate: target < 5% of claims
  Collection rate: gross vs net collection rate
  Operating margin: (revenue - expenses) / revenue × 100
  Payer mix: Medicare/Medicaid vs commercial — affects reimbursement rates

  DRG (Diagnosis Related Group):
    Medicare inpatient payment methodology
    Fixed payment based on diagnosis category
    MS-DRG: CMS Medicare Severity DRGs (750+ groups)
    Higher severity = higher payment weight
    CC/MCC: complication/comorbidity adds to DRG weight

HEALTHCARE QUALITY:
  HEDIS: Health Effectiveness Data and Information Set
    Used by health plans to measure care quality
    Examples: mammography rates, diabetes A1c control, blood pressure
  HCAHPS: Hospital Consumer Assessment of Healthcare Providers
    Patient satisfaction surveys — tied to Medicare reimbursement
    Domains: nurse communication, physician communication, discharge info
  Core measures: Joint Commission standards (sepsis, VTE prevention)
  Patient safety indicators: HAC (hospital-acquired conditions)

REGULATORY COMPLIANCE:
  HIPAA: privacy (PHI protection), security (electronic PHI)
  EMTALA: emergency care regardless of ability to pay
  ACA: insurance reforms, Medicaid expansion, quality reporting
  Stark Law / Anti-Kickback: physician self-referral restrictions
  CMS Conditions of Participation: hospital accreditation standards
  Joint Commission: voluntary accreditation (most hospitals pursue)

FRONT END (access management):
  Scheduling, registration, insurance verification
  Pre-authorization for procedures
  Financial counseling and payment plans
  Point-of-service collections

MIDDLE (clinical and coding):
  Medical documentation by providers
  Clinical documentation improvement (CDI)
  Medical coding (ICD-10-CM, CPT, DRGs)
  Charge capture — ensure all billable services recorded

BACK END (billing and collections):
  Claim submission (electronic 837 transaction)
  Remittance processing (835 ERA)
  Denial management and appeals
  Bad debt and charity care write-offs
  Outsourced vs in-house billing decisions

KEY METRICS:
  Days in AR: lower is better (< 40 days target)
  Clean claim rate: claims paid without correction on first submission (> 95%)
  Denial rate: percentage denied (< 5% target)
  Net collection rate: actual collections vs net collectible
  DNFB (discharged not final billed): tracks coding backlog

HEALTHCARE ADMIN ROLES: CEO, CFO, COO, department directors, practice managers
FACHE: requires 3 years management experience + exam + references
CMPE: for medical practice managers specifically (MGMA)

REIMBURSEMENT MODELS:
  Fee-for-service (FFS): pay per service (traditional)
  Value-based: pay based on outcomes (CMS MACRA/MIPS)
  Capitation: fixed per-member per-month regardless of utilization
  Bundled payments: single payment for episode of care

KEY LAWS: HIPAA | EMTALA | ACA | Stark | Anti-Kickback | False Claims Act