Deck 22: Controlling Health Care Costs

Question 1

Insurance companies can legally refuse to pay for certain services if they are not preauthorized.

Answer 1

True

Question 2

​If an insurance plan is based on negotiated fees with health care providers, this means that the providers:

A) ​agree in advance to accept set fees for specific services.
B) ​will not refer patients to specialists without preauthorization.
C) ​cannot charge patients a co-pay.
D) ​get authorization from the insurance company before giving treatment.

Answer 2

​agree in advance to accept set fees for specific services.

Question 3

Health care specialists are also referred to as gatekeepers.​

Answer 3

False

Question 4

The youth of this nation are showing an alarming increase in obesity, poor diet, and lack of physical fitness, which is resulting in an onset of chronic conditions at a very young age.

Question 5

Medicare will pay for all medications that are prescribed by the patient's primary physician.

Question 6

Poor work habits, such as arriving late, can contribute to an increase in malpractice lawsuits filed by patients.

Question 7

Why is it argued that the fee-for-service method of determining medical expenses/costs has contributed to rising health care costs?​

A) ​It rewards health care providers who prescribe the most services.
B) ​Insurance companies must pay the full amount of services provided.
C) ​The practice of preventive health care is discouraged.
D) ​Too many people use health care services.

Question 8

Before the Patient Protection and Affordable Care Act, if a person had a preexisting health problem, this often meant that he or she:​

A) ​must join an HMO.
B) ​had difficulty purchasing health insurance.
C) ​qualified for Medicare.
D) ​paid a high co-pay for office visits.

Question 9

A health maintenance organization (HMO)is composed of health care providers who:​

A) ​contract with large groups to provide care on a fee-for-service basis.
B) ​offer benefits for the employees of large companies.
C) ​offer a predetermined medical care benefit package.
D) ​offer services to elderly and low-income patients.

Question 10

A major concern in the United States today is how to effectively control dramatically rising health care costs.

Question 11

Medicare Part A applies to cost incurred during inpatient care.

Question 12

When a health care provider is paid a set amount for each person covered by an insurance plan, regardless of how many services each person requires, this is called:​

A) ​capitation.
B) ​co-pay.
C) ​fee-for-service.
D) ​negotiated fee.

Question 13

​What is meant by "spreading the risk" among enrollees in a health insurance plan?

A) ​Physicians may only charge predetermined amounts for services.
B) ​Only groups who work for large companies are covered.
C) ​Some enrollees never use the services.
D) ​Only certain services are paid for.

Question 14

How does a prepaid health plan encourage efficiency in the provision of health care services?​

A) ​It penalizes patients for overuse of services.
B) ​Health care providers can make higher profits.
C) ​The cost of individual services is set in advance.
D) ​It discourages the use of unnecessary tests and treatments.

Question 15

Health care costs are evenly distributed among all patients.

Question 16

Which of the following conditions may qualify an individual for insurance coverage through Medicare?​

A) ​Very low income
B) ​Severe disability
C) ​Age 60
D) ​Veteran status

Question 17

One response to rising costs has been the development of managed care plans, which contain specific built-in cost controls.

Question 18

The fee-for-service method of determining medical costs means that:​

A) ​insurance companies pay a fixed amount for medical services.
B) ​physicians set their own prices for services.
C) ​the government helps pay for services.
D) ​patients must pay a certain percentage of the fee.

Question 19

The goal of managed care is to provide good care while practicing efficiency and controlling costs.

Question 20

How do physicians who are PCPs contribute to the control of health care costs?

A) ​Eliminate the need for expensive specialists
B) ​Evaluate and coordinate the health care needs of patients
C) ​Provide all services in one facility
D) ​Agree to charge only predetermined amounts

Question 21

Which of the following is a result of the development of DRGs?​

A) ​Expanded services for Medicare patients
B) ​Longer hospital stays for many illnesses and conditions
C) ​Increased demand for home health services
D) ​Advances in medical research

Question 22

Which of the following allows members to choose to receive a service from a participating or nonparticipating provider?​

A) ​POS (point-of-service plan)
B) ​PPO (preferred provider organization)
C) ​EPO (exclusive provider organization)
D) ​HMO (health maintenance organization)

Question 23

Why is it a good business practice to keep accounts receivable as low as possible?​

A) ​Complies with government regulations
B) ​Decreases expensive paperwork
C) ​Can use the money to earn interest or pay debts
D) ​Provides better service to patients

Question 24

Match each term with the following correct definition.​
​A cost-sharing provision that stipulates that the insured is to assume a percentage of the costs of covered services.

A)​Premium
B)​Co-pay
C)​PPO
D)​Medicaid
E)​ICD-10
F)​Accounts receivable
G)​Coding
H)​Priority
I)​Deductible
J)Coinsurance

Question 25

Match each term with the following correct definition.​
​Code used to describe the condition or disease being treated, also known as the diagnosis.

A)​Premium
B)​Co-pay
C)​PPO
D)​Medicaid
E)​ICD-10
F)​Accounts receivable
G)​Coding
H)​Priority
I)​Deductible
J)Coinsurance

Question 26

Which of the following is an example of co-pay?​

A) ​Patient pays $10 every time they have an office visit.
B) ​Patient is denied a referral to a specialist.
C) ​Patient pays a set amount every month.
D) ​Patient pays 20 percent of the charges for health care services.

Question 27

Match each term with the following correct definition.​
​Amount required to be paid by the insured before benefits become payable.

A)​Premium
B)​Co-pay
C)​PPO
D)​Medicaid
E)​ICD-10
F)​Accounts receivable
G)​Coding
H)​Priority
I)​Deductible
J)Coinsurance

Question 28

If health care professionals are cross-trained, this means that they:​

A) ​have more than one college degree.
B) ​are qualified to work in more than one type of health care facility.
C) ​can work without direct supervision.
D) ​have learned to perform duties in addition to those expected of those with their job title.

Question 29

Match each term with the following correct definition.​
Amount that patients who are covered by insurance must pay themselves for health care services.

A)​Premium
B)​Co-pay
C)​PPO
D)​Medicaid
E)​ICD-10
F)​Accounts receivable
G)​Coding
H)​Priority
I)​Deductible
J)Coinsurance

Question 30

What is meant by "to earn a profit"?​

A) ​To keep accounts receivable low
B) ​To keep accounts payable high
C) ​Money remaining after all costs paid
D) ​To maximize the cost of money

Question 31

What is the MOST serious consequence for a facility if treatments administered to patients are frequently reported and coded incorrectly?​

A) ​Accusations of fraud
B) ​Lower profits than expected
C) ​Failure to obtain reimbursement from insurance companies
D) ​Failure to obtain reimbursement from insurance companies.

Question 32

Match each term with the following correct definition.​
​State-administered program to help pay costs of health care for low-income and disabled individuals.

A)​Premium
B)​Co-pay
C)​PPO
D)​Medicaid
E)​ICD-10
F)​Accounts receivable
G)​Coding
H)​Priority
I)​Deductible
J)Coinsurance

Question 33

Which category of expenses is often the highest for a health care organization?​

A) ​Facility
B) ​Personnel
C) ​Equipment and supplies
D) ​Financing

Question 34

Match each term with the following correct definition.​
​Amount a customer pays an insurance company in exchange for coverage of certain health care expenses.

A)​Premium
B)​Co-pay
C)​PPO
D)​Medicaid
E)​ICD-10
F)​Accounts receivable
G)​Coding
H)​Priority
I)​Deductible
J)Coinsurance

Question 35

Match each term with the following correct definition.​
​That which is most important.

A)​Premium
B)​Co-pay
C)​PPO
D)​Medicaid
E)​ICD-10
F)​Accounts receivable
G)​Coding
H)​Priority
I)​Deductible
J)Coinsurance

Question 36

Match each term with the following correct definition.​
​Group of health care providers who offer medical care benefit packages.

A)​Premium
B)​Co-pay
C)​PPO
D)​Medicaid
E)​ICD-10
F)​Accounts receivable
G)​Coding
H)​Priority
I)​Deductible
J)Coinsurance

Question 37

Match each term with the following correct definition.​
​Assignment of standardized numbers to diagnoses and procedures.

A)​Premium
B)​Co-pay
C)​PPO
D)​Medicaid
E)​ICD-10
F)​Accounts receivable
G)​Coding
H)​Priority
I)​Deductible
J)Coinsurance

Question 38

How do diagnostic-related groups (DRGs)help control Medicare costs?​

A) ​Assist physicians to make more accurate diagnoses
B) ​Simplify administrative expenses
C) ​Limit the coverage available to patients who have preexisting conditions
D) ​Limit reimbursements to hospitals to amounts based on expected rather than actual costs of treatment

Question 39

​Which of the following is true about prepaid plans?

A) ​Fees are negotiated at time of service.
B) ​Providers are paid before rather than after services are performed.
C) ​Preauthorization is required.
D) ​Providers are paid after rather than before services are performed.

Question 40

Match each term with the following correct definition.​
​Money that has not been collected or is owed for services rendered.

A)​Premium
B)​Co-pay
C)​PPO
D)​Medicaid
E)​ICD-10
F)​Accounts receivable
G)​Coding
H)​Priority
I)​Deductible
J)Coinsurance

Question 41

Give at least one argument in favor of and at least one argument against the practice of prepayment for covering health care services.

Question 42

You are a respiratory therapist in a large inner city hospital.Describe ways that you can help the facility control costs.Include examples of ways to improve personal efficiency.

Question 43

List three goals of managed care.