Cost and Revenue Glossary

Not Included:

• "Cost of sales and/or cost of other medical activities”;
• Support staff cost, which is included in the Business Operations, Front Office, Clinical and Ancillary staff sections;
• Provider costs, which is included in the Providers section;
• Cost included in “Purchased services for capitation patients”; and
• Nonmedical cost.”

Total General Operating Cost

A sum of “Information technology” through “Cost allocated to medical practice from parent organization.”

Information Technology [6800-6860]¹¹

Cost of practice-wide data processing, computer, telephone, and telecommunications services.

Included:

• Cost of local and long-distance telephone, radio paging, and internet service providers;
• Rental and/or depreciation cost of major data processing, computer and telecommunications furniture, equipment, hardware, and software subject to capitalization;
• Hardware and software repair and maintenance contract cost;
• Cost of data processing services purchased from an outside service bureau;
• Cost of data processing supplies and minor software and equipment not subject to capitalization; and
• Cost of IT purchased services including maintaining of EHRs and patient portals.

Not included:

• Cost of specialized information services equipment dedicated for exclusive use in the departments of clinical laboratory, radiology, and imaging, or other ancillary services departments. Such cost is included in “Clinical laboratory,” “Radiology and imaging,” and “Other ancillary services”; or
• Cost of contract programmers, which is included in “Total contracted support staff”.

Drug Supply [7210-7213]¹¹

Cost of drugs purchased for general practice use.

Included:

• Cost of medical/surgical supplies and instruments used in providing medical/surgical services; and
• Cost of laundry and linens.

Not included:

• Cost of specialized supplies dedicated for exclusive use in the departments of clinical laboratory, radiology and imaging, or other ancillary services departments. Such cost is included in “Clinical laboratory,” “Radiology and imaging,” and “Other ancillary services”;
• Cost of pharmaceuticals, medical supplies and equipment sold to patients primarily for use outside the practice and not used in providing medical/surgical services. Examples include prescription drugs, hearing aids, optical goods, and orthopedic supplies. Such cost is included in “Cost of sales and/or cost of other medical activities”; or
• The cost of any equipment subject to depreciation. Such cost is reported as a subset in “Information technology,” “Furniture and equipment,” “Clinical laboratory,” “Radiology and imaging,” and “Other ancillary services.”

Building and Occupancy [6100, 6120-6190]¹¹

Cost of general operation of buildings and grounds.

Included:

• Rental, operating lease, and leasehold improvements for buildings and grounds;
• Interest paid on loans for real estate used in practice operations;
• Cost of utilities such as water, electric power, space heating fuels, etc.;
• Cost of supplies and materials used in housekeeping and maintenance; and
• Other costs such as building repairs and security systems.

Not included:

• Interest paid on short-term loans, which is included in “Miscellaneous operating cost”;
• Interest paid on loans for real estate not used in practice operations, such as nonmedical
• office space in practice-owned properties. Such interest is included in “Nonmedical cost”;
•  
• Cost of producing revenue from sources such as parking lots or leased office space from practice owned properties. Such cost is included in “Nonmedical cost”; or
• Depreciation costs.

Building Depreciation [6110-6113]¹¹

Depreciation cost for buildings and grounds.

Not included:

• Interest paid on short-term loans, which is included in "Miscellaneous operating cost”;
• Interest paid on loans for real estate not used in operations such as nonmedical office space in practice-owned properties;
• Rental, operating lease, and leasehold improvements for buildings and grounds;
• Interest paid on loans for real estate used in ASC operations;
• Cost of utilities such as water, electric power, and space heating fuels;
• Cost of supplies and materials used in housekeeping and maintenance; or
• Other costs such as building repairs and security systems.

Furniture and Equipment [6200,6220-6230,7100, 7120, 7130, 7710, 7712-7713]¹¹

Cost of furniture and equipment in general use in the practice.

Included:

• Rental cost of furniture and equipment used in reception areas, patient treatment/exam rooms, physician offices, and administrative areas; and
• Other costs related to clinic furniture and equipment, such as maintenance cost.

Not included:

• Cost of specialized furniture and equipment dedicated for exclusive use in the information technology, clinical laboratory, radiology and imaging, or other ancillary services departments. Such cost is reported as a subset in “Information technology,” “Clinical laboratory,” “Radiology and imaging,” and “Other ancillary services” ;or
• Depreciation costs.

Furniture and Equipment Depreciation [6210, 7110, 7711]¹¹

Depreciation cost of furniture and equipment in general use in the practice.

Included:

• Depreciation cost of furniture and equipment used in reception areas, patient treatment/ exam rooms, physician offices, and administrative areas.

Not included:

• Cost of specialized furniture and equipment dedicated for exclusive use in the information technology, clinical laboratory, radiology and imaging, or other ancillary services departments. Such cost is included in “Information technology,” “Clinical laboratory,” “Radiology and imaging,” and “Other ancillary services”; or
• Other costs related to clinic furniture and equipment such as maintenance cost.

Administrative Supplies and Services [6300-6336, 6346, 6350- 6353, 6356, 6358, 6361, 6161-6524, 7230-7240 7730]¹¹

Cost of printing, postage, books, subscriptions, administrative and medical forms, stationery, payroll services, practice regulatory, licensure and accreditation, employee relations dinners, picnics, entertainment, practice uniforms, business vehicle/ transportation, recruiting, job position classified advertising, moving costs and other administrative supplies and services.

Included:

• Purchased medical transcription services; and
• Purchased answering services.

Professional Liability Insurance Premiums [6270-6726]¹¹

Also referred to as: Malpractice insurance
 

Premiums paid or self-insurance cost for malpractice and professional liability insurance for practice physicians, advanced practice providers, and employees.

Other Insurance Premiums [6700-6718]¹¹

Cost of other policies such as cyber insurance, fire, flood, theft, casualty, general liability, officers’ and directors’ liability, and reinsurance.

Legal Fees [6342]¹¹

Fees for professional legal services performed on a one-time or sporadic basis and are not employees of the organization.

Included:

• Fees related to legal services paid to attorneys who are not employees of the organization.

Consulting Fees [6345]¹¹

Fees for professional consulting services preformed on a one-time or sporadic basis.

Included:

• Fees for management, financial, and other outside consulting services.

Outside Professional Fees [6340-6341, 6343-5344, 7830-7839]¹¹

Fees for professional services performed on a one time or sporadic basis.

Included:

• Fees for accounting services; and
• Fees for actuarial consultants, and other professional fees not listed.

Not included:

• Information services, architectural and public relations consultant fees. Such costs are included in “Information technology,” “Building and occupancy,” and “Promotion and marketing”;
• Cost for contracted support staff, which is reported as “Total contracted support staff,”; or
• Cost for contracted physicians and locum tenens, which is reported as “Total physician” FTE and Cost.

Clinical Laboratory [7400-7440]¹¹

Cost of clinical laboratory and pathology procedures defined by CPT codes 80047-89398, 36415, and 36416 00100-01999, 10021-36410 and 99100-99140.

Included:

• Rental and/or depreciation cost of major furniture and equipment subject to capitalization;
• Repair and maintenance contract cost;
• Cost of supplies and minor equipment not subject to capitalization;
• Other costs unique to the clinical laboratory; and
• Cost of purchased laboratory technical services for fee-for-service patients.

Not included:

• Cost of purchased laboratory technical services for capitation patients. Such cost is reported as “Purchased services for capitation patients.”

Radiology and Imaging [7300-7340]¹¹

Cost of diagnostic radiology and imaging procedures defined by diagnostic radiology CPT codes 70010-764, diagnostic ultrasound CPT codes 76506-76999, diagnostic nuclear medicine CPT codes 78012-78999, echocardiography CPT codes 93303- 93355, noninvasive vascular diagnostic studies CPT codes 93880-93998, and electrocardiography CPT codes 93000-93042.

Included:

• Rental and/or depreciation cost of major furniture and equipment subject to capitalization;
• Repair and maintenance contract cost;
• Cost of radiological diagnostics (isotopes);
• Cost of supplies and minor equipment not subject to capitalization. This amount is the net after subtracting the revenue from silver recovery from X-ray film and processing fixer;
• Other costs unique to the radiology and imaging department; and
• Cost of purchased radiology technical services for fee-for-service patients.

Not included:

• Cost of purchased radiology technical services for capitation patients. Such costs are reported as “Purchased services for capitation patients”; or
• Cost of procedures for radiation oncology CPT codes 77261-77799 or therapeutic nuclear medicine CPT codes 79005-79999. Such costs are included in “Other ancillary services.”

Promotion and Marketing [6600]¹¹

Cost of promotion, advertising and marketing activities, including patient newsletters, information booklets, flyers, brochures, yellow page listings, and public relations consultants.

Other Ancillary Services [7500-7640]¹¹

Operating costs for all ancillary services departments except clinical laboratory and radiology and imaging.

Included:

• Operating costs for departments such as physical therapy, optical, ambulatory surgery, radiation oncology, therapeutic nuclear medicine, etc.;
• Rental and/or depreciation cost of major furniture and equipment subject to capitalization;
• Repair and maintenance cost;
• Cost of supplies and minor equipment not subject to capitalization;
• Other costs unique to the ancillary services departments; and
• Cost of purchased “other ancillary” technical services for fee-for-service patients.

Not included:

• Cost of purchased “other ancillary” technical services for capitation patients. Such costs are reported as “Purchased services for capitation patients”;
• Cost of physical therapy and orthopedic items, such as crutches and braces, sold to patients. Such cost is included in “Cost of sales and/or cost of other medical activities”; or
• Cost of optical items, such as eyeglasses and contact lenses, sold to patients. Such cost is included in “Cost of sales and/or cost of other medical activities.”

Billing and Collections Purchased Services [6354-6355, 6357, 6930]¹¹

When a medical practice decides to purchase billing and collections services from an outside organization as opposed to hiring and developing its own employed staff to conduct billing and collections activities, the cost for such purchased services is considered “Billing and collections purchased services.”

Included:

• Claims clearinghouse cost.

Medical practices may receive management or other services from an MSO, PPMC, hospital or other parent organization in return for a fee. The fee could be a contracted fixed amount, a percentage of collections or any other mutually agreed upon arrangement.

Included:

• Fees paid to an MSO/PPMC, hospital or parent organization for management services including management, administrative, and/or related support services; and
• The cost of support staff employed by the MSO/PPMC, if these costs were not reported separately in the Staff section.

Not included:

• The cost of support staff employed by the MSO/PPMC, if these costs were reported in the "Staff” section.

Miscellaneous Operating Cost [7740]¹¹

Operating cost not included previously.

Not Included:

• Federal or state income taxes, which are included in “Nonmedical cost;” or
• Principal paid on loans, which is not reported anywhere in this dataset.

Cost Allocated to Medical Practice from Parent Organization

When a medical practice is owned by a hospital, integrated delivery system, or other entity, the parent organization often allocates indirect costs to the medical practice. These indirect costs may have different names depending on the situation. Examples of alternative names are “shared services costs” or “uncontrollable costs.” These costs may be arbitrarily assigned to the medical practice may be the result of negotiations between the practice and the parent organization, or the result of some sort of cost accounting system. Often, these indirect costs include a portion of the salaries of the senior management team of the parent organization, a portion of corporate human resources costs, or a portion of corporate marketing costs.

Depending on the type of cost, the cost may be allocated to the medical practice as a function of the ratio of medical practice FTE to total system FTE, the ratio of medical practice square footage to total system square footage, or the ratio of medical practice gross charges to total system gross charges. Depending on the culture of the integrated system, these indirect costs may or may not even show up on the financial statements of the medical practice.

Not included:

• Cash loans made to subsidiaries. Cash for loans does not appear anywhere in this dataset.

Total Operating Cost Also referred to as: Overhead The sum of “Total support staff cost” and “Total general operating cost.” Total Operating and Advanced Practice Provider Cost The sum of “Total operating cost,” and “Total advanced practice provider cost.” Total Cost The sum of “Total operating cost,” “Total physician cost,” and “Total advanced practice provider cost.”