Deck 8: Healthcare Financing

Question 1

Used in both fee for service and prepaid plans, copayments are costs that the patient must pay at the time they receive the services. It is a designated dollar amount.

Answer 1

True

Question 2

The Flexible Spending Account (FSA)has the following characteristics:

A)An option of setting aside pretax income to pay for out of pocket medical expenses.
B)The funds accumulated over a year must be spent within the year.
C)Allows employees who work for small companies (less than 50 employees)who have high deductible plans, can use an MSA to set aside pretax dollars to be used for their premiums and non reimbursed healthcare expenses.
D)All of the statements are correct.

Answer 2

All of the statements are correct.

Question 3

Most insurance policies require a contribution from the covered individual which may be a copayment, deductible or coinsurance which is called cost sharing.

Answer 3

True

Question 4

A classification system called resource utilization group (RUG)was designed to differentiate patients based on how much they use the resources of the facility. As the patient's condition changes, the rate of reimbursement changes. A per diem rate was established using these classifications.

Question 5

Why was health insurance developed?

A)To reduce the amount of absenteeism by employees.
B)Companies' felt responsible for the health of their employees.
C)Companies wanted to provide free health care services to their employees.
D)Like homeowner's insurance or life insurance, provide protection to an employee in the event they required health care.

Question 6

Flexible spending accounts (FSA)provide employees with the option of setting aside pretax income to pay for out of pocket medical expenses. Employees must submit claims for these expenses and are reimbursed from their spending accounts. The drawback is that the amount set aside must be spent within one year.

Question 7

Most insurance policies require a monetary contribution from the covered individual which is called:

A)Copayment
B)Deductible
C)Coinsurance
D)All three are correct.

Question 8

Nearly 60% of Medicare enrollees are male, which corresponds to the longer life expectancy of a U.S. male.

Question 9

In a managed care organization, the organization reimburses the provider at a ___________

Question 10

Most insurance policies require a contribution from the covered individual which may be a copayment, deductible or coinsurance which is called cost participation.

Question 11

Accountable care organizations (ACOs)are groups of providers and hospitals who volunteer to give coordinated care to Medicare patients.

Question 12

A recent trend in health insurance plans is consumer driven health plans which are tax advantage plans with high deductible coverage. The most common CDHPs are health reimbursement arrangements (HRAs)and health savings accounts (HSAs).

Question 13

Medicare is a program based on an individual's income.

Question 14

The most common type of prospective reimbursement is a service benefit plan which is used primarily by managed care organizations.

Question 15

A company who provides their own health insurance will purchase reinsurance from another insurance company to protect themselves from any catastrophic losses. The reinsurance sets a stop loss measure that limits the amount the company will pay for claims.

Question 16

Medicare Part B is also referred to as Medicare Advantage and it can be considered a managed care model.
Medicare Part C

Question 17

Managed care plans are a type of health program that combines administrative
costs and service costs for cost control.

Question 18

Medicare is an entitlement program because people, after paying into the program for years, are entitled to receive benefits.

Question 19

Medicare Part B is primarily financed from payroll taxes and is considered hospital insurance.
Medicare Part A

Question 20

Self funded or self insurance programs are health insurance programs that are implemented and controlled by the company itself. They retain all of the risk in providing health insurance to their employees by paying any claims from their employees. Both the employee and employer pay into the fund.

Question 21

Describe Medicare Part C .

Question 22

Describe Medicare Part A Hospital Insurance

Question 23

Describe Medicare Part B Voluntary medical insurance

Question 24

In a healthcare organization, which health care position is responsible for accounting and reporting functions?

A)Treasurer
B)Internal auditor
C)Comptroller
D)Compensation officer

Question 25

What is Medicare Part B?

A)It is the managed care component of Medicare.
B)Provides for prescription drug plans
C)Supplemental health plan to cover physician services.
D)It is financed from payroll taxes.

Question 26

Describe Medicare Part D Prescription Drug Benefit .

Question 27

Implemented in October 2000, the________________-which is a prospective payment used by Medicare, pays a fixed predetermined rate for each 60-day episode of care, regardless of the services.

A)Home Health Resource Group (HHRG)
B)Resource Utilization Group (RUG)
C)Bundled Payments Initiative
D)None are correct

Question 28

The most common type of healthcare services reimbursement is called:

A)Service benefit plan
B)Retrospective benefit plan
C)Cost shifting plan
D)All are correct

Question 29

This type of prospective payment system for skilled nursing facilities, used by Medicare, provides for a per diem based on the clinical severity of patients. What is this called?

A)Home health Resource group
B)Retrospective Bundled group
C)Resource Utilization group
D)All are correct

Question 30

Describe Medigap .

Question 31

The ACA created ______________as an optional Medicaid benefit, which focuses on community health services to Medicaid enrollees with disabilities. This will enable consumers to receive care at home or at community health centers rather than going to a hospital or their facility.

A)Community First Choice
B)Community First Option
C)Accountable Care Organization
D)All are correct Short Answer/Essay

Question 32

Another term for the disbursement of funds to pay for healthcare services, which is often called_____________, is carried out in accordance to the administrative procedures of the program.

A)claims processing
B)deposit processing
C)balance billing
D)auditing