Question 1

Which of the following is true about diagnosis-related groups (DRGs)? Select all that apply.&#10;A) Rewards cost savings&#10;B) Is a prospective pricing system&#10;C) Is an insurance classification system&#10;D) Relies on the provider's coding system

Accepted Answer

Retrospective payment Planer were predominant prior to the mid-1980s and the introduction of DRGs.With the retrospective systems,hospitals and other providers were paid after services and treatments were performed through a complicated "cost-based" formula.Leading to the implementation of DRGs,a technical review committee noted that "until 1982,Medicare employed a retrospective cost-based reimbursement approach whereby hospitals could recover from Medicare most of what they spent on Medicare beneficiaries … [with] little incentive to contain costs" and encouraged additional capacity,technologies,and complex services (Office of Technology Assessment,1983,p.3).DRGs were developed to address case load,costs,and reward structures for cost savings.

Question 2

Prior approval is not typically necessary for which of these systems?&#10;A) Fee-for-service (FFS)&#10;B) Consumer-driven system&#10;C) Point-of-service plan (POS)&#10;D) Retrospective payment plan

Accepted Answer

Point of Service (POS)Planer generally occur through a specified network of providers.The patient selects a primary care provider from this network.The primary care provider serves as a gatekeeper and consultations with others must have prior approval for reimbursement.

Question 3

Which of the following statements accurately describe the ICD-10 codes? Select all that apply.&#10;A) Focus on the causes of death&#10;B) Focus on causes of morbidity&#10;C) Contain nearly 5,000 classification codes&#10;D) Affect diagnosis and inpatient coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA)

Accepted Answer

In 2012,the ICD-9 system began the transition to ICD-10 for all diagnoses and inpatient procedures.There were nearly 5,000 classifications of disease in IDC-9,but this was expanded to nearly 8,000 in IDC-10 with increased details and focus on causes of morbidity (Moriyama et al.,2011).The IDC-10 uses three to seven-digit codes and affects all diagnosis and inpatient coding for everyone covered by HIPAA.

Question 4

The focus of macroeconomics is on supply and demand decisions for which of the following?&#10;A) Individuals&#10;B) Business firms&#10;C) National entities&#10;D) Legal organizations

Accepted Answer

Consider the term economics,which is the study of production of a product or service along with issues of supply and demand and distribution of that product or service for the continuity or wellbeing of some entity.You may have taken courses in macroeconomics,which focuses on the decisions for national or global entities,or in microeconomics,which considers decisions of individuals or businesses on supply and demand in a defined marketplace.

Question 5

Which of the following are true of Medicaid eligibility requirements? Select all that apply.&#10;A) There are differences, depending on the state of residence.&#10;B) Federally mandated eligibility defines individuals who are categorized as &#34;medically needy.&#34;&#10;C) Additional eligibility requirements include immigration status and documentation of citizenship.&#10;D) Many states provide benefits and care for pregnant women significantly above the minimum level.

Accepted Answer

States address both federally mandated eligibility groups and other optional populations.For some groups,mandated eligibility requirements are based on 100 percent of the federal poverty level (FPL).The FPL is updated on an annual basis..Low income is only one test for Medicaid eligibility,with other financial resources tested at threshold levels as determined by each state within the federal guidelines (Klees & Wolfe,2013,p.22).States can apply to increase the eligibility level,and many states provide benefits and care for pregnant women significantly above the minimum level.Additional eligibility requirements include state residency,immigration status,and documentation of citizenship.Optional populations include the medically needy,as identified by the state,or selected groups who are above the minimum income requirement.In addition,the state can assess premiums or copayments to optional groups.The Affordable Care Act has provided additional eligibility for adults with the standard of 133 percent of the FPL since 2014.

Question 6

The gross national product (GNP)is a measure of the domestic goods and services produced within the nation on an annual basis.

Accepted Answer

The GNP refers to the goods and services produced in a nation (defined by ownership location)and is measured on an annual basis.Alternately,you will see comparisons with the gross domestic product,or GDP,which is restricted to the goods and services produced within the nation (defined geographically),thus excluding business not located in the particular nation.

Question 7

Which of the following is considered a third-party payer?&#10;A) Employer&#10;B) Consumer&#10;C) Healthcare provider&#10;D) Insurance company

Accepted Answer

Consider the payers for healthcare as first,second,and third parties.First-party payers are the individuals,you as the seeker of the healthcare service,whether as an individual who is a private payer or as a member of a group plan with specified copays or minimums to be met.The second-party payers are the providers or plan administrators or the employer who collects premiums,pays,or copays for a group of individuals.Third-party payers are the insurers who have collected the premiums,assessed and accepted the risk of the group and reimburses the providers for providing the service.

Question 8

Medicare is an example of which of the following payment systems?&#10;A) Prospective payment system&#10;B) Patient-driven payment system&#10;C) Market-driven payment system&#10;D) Retrospective payment system

Accepted Answer

The prospective payment system (PPS)is a fixed payment method that is based on a predetermined amount for the usual care needed for a patient with a specific condition.The Medicare program has been an example of a prospective pricing model since 1982 and the development of DRGs.

Question 9

Which of the following are the major factors driving healthcare costs in the United States? Select all that apply.&#10;A) Aging of the population&#10;B) Increase in the birth rate&#10;C) Research and development&#10;D) Demand for services in the current economy

Accepted Answer

Financing healthcare in the United States is more than simply a supply and demand equation.The four major factors driving healthcare costs include technology and prescription drugs,chronic disease,aging of the population,and administrative costs (Kimbuende,Ranji,Lundy,& Salganicoff,2013,p.550).

Question 10

In addition to the cost of providing care to patients,which of the following are also calculated into the cost of healthcare?&#10;A) Past consumer healthcare experiences&#10;B) Business decisions on patient insurance&#10;C) Consumer demand and ability to purchase healthcare&#10;D) None of the above

Accepted Answer

These costs include not only the provision of care to patients as goods and services,but also physical resources,the preparation of practitioners across disciplines,research and development,and methods of financing all of these.

Question 11

A healthcare system willing to be held accountable for both clinical and financial outcomes with the goal of risk reduction is an example of which of the following?&#10;A) Medicaid&#10;B) Capitation&#10;C) Managed care&#10;D) Medical savings account (MSA)

Accepted Answer

The answer of A healthcare system willing to be held...

Question 12

The amount of money provided to pay for a particular episode of care based on an agreed or approved process is the definition of which of the following?&#10;A) Reimbursement&#10;B) Cost of healthcare&#10;C) Copayment by the patient&#10;D) Goods and services provided for care

Accepted Answer

The answer of The amount of money provided to pay...

Question 13

Which of the following is true about healthcare economics? Select all that apply.&#10;A) It focuses on supply and demand rather that patient satisfaction.&#10;B) It focuses on how components of healthcare differ from those of private agencies.&#10;C) It is a branch of economics that examines local governmental control of healthcare.&#10;D) It analyzes how different parts of the healthcare system works together to meet patient needs.

Accepted Answer

The answer of Which of the following is true about...

Question 14

Benefits of the Affordable Care Act (ACA)have been categorized in all of the following areas EXCEPT:&#10;A) Care and access&#10;B) Coverage and costs&#10;C) Consumer protections&#10;D) State-specific provisions

Accepted Answer

The answer of Benefits of the Affordable Care Act (ACA)have...

Question 15

Similar to the United States,which of the following nations spends a large proportion on healthcare insurance and administration?&#10;A) France&#10;B) Canada&#10;C) Sweden&#10;D) United Kingdom

Accepted Answer

The answer of Similar to the United States,which of the...

Deck 16: Economics and Healthcare Policy