Deck 22: Paying for Health Care

Question 1

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.

Answer 1

capitation.

Question 2

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

Answer 2

Evaluate and coordinate the health care needs of patients

Question 3

Health care specialists are also referred to as gatekeepers.

Answer 3

False

Question 4

Controlling the costs in a health care facility is the responsibility of the administration.

Question 5

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 6

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

Question 7

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

Question 8

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

Question 9

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

Question 10

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 11

Medicare Part A applies to cost incurred during inpatient care.

Question 12

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 13

Why is it argued that the fee-for-service method of determining medical expenses 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 14

Health care costs are evenly distributed among all patients.

Question 15

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

Question 16

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.

Question 17

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 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

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 20

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

Question 23

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 24

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 25

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 26

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) Some hospitals were paid more than they charged for a given service
D) Advances in medical research

Question 27

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

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

Question 29

Which statement is true about the Veterans Health Administration (VA)?

A) It is administered by the individual states.
B) It provides health care for all veterans.
C) It is the largest integrated health care systems in the United States.
D) It provides health care for active duty military.

Question 30

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) Low staff efficiency

Question 33

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 are paid
D) To maximize the cost of money

Question 34

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 37

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

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

Question 38

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 39

Which of the following is true about the Affordable Care Act of 2010?

A) It provides free health care to every American.
B) It is a part of the Medicare system for older Americans.
C) Its major purpose is to make health insurance more accessible.
D) Its major goal is to help Americans make healthy lifestyle choices.

Question 41

In the United States, the increasing incidence of _____, a disease characterized by insulin resistance, costs several billion dollars a year to treat.

Question 43

Many Americans prefer treatment with prescription _____ rather than making lifestyle changes to improve their health.

Question 45

Acting with _____ means considering facts and the best course of action in a given situation.

Question 46

Some estimates claim that as much as $210 billion is wasted each year on ______ medical services.

Question 47

_____ is a public health insurance program for low-income and low-asset individuals and families.