Question 1

In the healthcare payment system are various stakeholders. These include:&#10;A) Contractors&#10;B) Patients&#10;C) Vendors&#10;D) a & c

Accepted Answer

Patients are a primary stakeholder in the healthcare payment system, as they are directly involved in receiving healthcare services and often bear some portion of the cost.

Question 2

The objectives of the U.S. healthcare payment system include:&#10;A) Access&#10;B) Cost&#10;C) Quality&#10;D) All of the above

Accepted Answer

The U.S. healthcare payment system aims to ensure access to healthcare services, manage and reduce costs, and maintain or improve the quality of care.

Question 3

Medicare's value based payment demonstrations have had what effect on expenditures?&#10;A) Great success&#10;B) Fair success&#10;C) Little or no effect&#10;D) None of the above

Accepted Answer

Medicare's value-based payment demonstrations have generally shown little or no effect on reducing expenditures. While these programs aim to improve quality and reduce costs, evidence from various demonstrations indicates that achieving significant savings has been challenging.

Question 4

Blue Cross Blue Shield got its start in:&#10;A) 1929&#10;B) 1949&#10;C) 1959&#10;D) 1965

Accepted Answer

Blue Cross Blue Shield was founded in 1929. It began as a partnership between a hospital and its patients, where the hospital would provide certain services in exchange for a fixed, annual fee. This model laid the groundwork for modern health insurance.

Question 5

The Medicare program was enacted as part of the Social Security Act in:&#10;A) 1955&#10;B) 1960&#10;C) 1965&#10;D) 1967

Accepted Answer

The Medicare program was enacted as part of the Social Security Act in 1965, providing health insurance to people aged 65 and older.

Question 6

Health Maintenance Organization (HMO) is:&#10;A) A perspective payment method&#10;B) A legally Incorporated organization that offers health insurance&#10;C) An organization that rations care&#10;D) A rating method used by indemnity insurers

Accepted Answer

Health Maintenance Organizations (HMOs) are legally incorporated organizations that provide comprehensive health care services to their members on a prepaid basis. They are not merely a payment method, a rationing organization, or a rating method used by insurers.

Question 7

Value Based Purchasing is:&#10;A) A monthly payment by a person to an insurer&#10;B) A method of reimbursement based on payment for services rendered&#10;C) A method to control costs through monitoring and prescribing&#10;D) A payment methodology designed to provide incentives to providers for delivering quality care at lower costs

Accepted Answer

Value Based Purchasing is a payment methodology that incentivizes healthcare providers to deliver high-quality care at lower costs, rather than paying solely for the quantity of services rendered.

Question 8

Never events are:&#10;A) Adverse patient outcomes due to provider negligence that are not typically not reimbursed&#10;B) Methods of rewarding quality of care&#10;C) Quality populations based on payment&#10;D) Payment strategies for reducing health care spending

Accepted Answer

Never events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. These events are so serious that they are considered unacceptable and not reimbursable by many insurance providers, including Medicare and Medicaid, because they are typically associated with provider negligence.

Question 9

Accountable care organizations performance is measured by:&#10;A) Patient experience&#10;B) Care coordination&#10;C) Preventative health care&#10;D) All of the above

Accepted Answer

Accountable care organizations (ACOs) are groups of doctors, hospitals, and other health care providers who work together to provide coordinated care to their patients. ACOs are measured on their performance in three key areas: patient experience, care coordination, and preventive health care.

Question 10

Hospital reimbursement by Medicare includes:&#10;A) Case rates&#10;B) Ambulatory payment classifications&#10;C) Cash Rates&#10;D) a & b

Accepted Answer

Medicare reimburses hospitals through case rates, which are fixed amounts for specific diagnoses or procedures, and ambulatory payment classifications, which are payment systems for outpatient services. Cash rates are not a standard method of Medicare reimbursement.

Question 11

A payor may be a regulator.

Accepted Answer

The answer of A payor may be a regulator....

Question 12

Evidence based medicine refers to the best evidence currently available.

Accepted Answer

The answer of Evidence based medicine refers to the best...

Question 13

Shared savings is a payment strategy used to give the patient a percentage share of savings on their care.

Accepted Answer

The answer of Shared savings is a payment strategy used...

Question 14

Copayments and deductibles have been a part of insured patients responsibility from the beginning of employer insurance offerings.

Accepted Answer

The answer of Copayments and deductibles have been a part...

Question 15

Medicare has only two parts, A & B.

Accepted Answer

The answer of Medicare has only two parts, A &...

Question 16

Per diem rates refer to a rate that covers everything a hospital provides during an entire inpatient stay.

Accepted Answer

The answer of Per diem rates refer to a rate...

Question 17

Steerage is influencing of patients to use a particular set of providers.

Accepted Answer

The answer of Steerage is influencing of patients to use...

Question 18

Capitation is a form of payment that compensates the provider a certain amount per capita for a defined set of services.

Accepted Answer

The answer of Capitation is a form of payment that...

Question 19

Experience rating is a method of setting group premium rates that are based on projected healthcare costs of a group.

Accepted Answer

The answer of Experience rating is a method of setting...

Deck 13: Provider Payment Systems