Question 1

List two groups eligible for the FEHBP.

Accepted Answer

The answer of List two groups eligible for the FEHBP....

Question 2

TRICARE is a provider of health care services.

Accepted Answer

TRICARE is a health care program for military personnel, retirees, and their dependents, not a provider of health care services.

Question 3

Financial gain from patient/service referrals is known as _______________.

Accepted Answer

The answer of Financial gain from patient/service referrals is known...

Question 4

Describe workers' compensation. Include the rationale for its existence from an employer and employee perspective.

Accepted Answer

The answer of Describe workers' compensation. Include the rationale for...

Question 5

The following are covered under the FEHBP:

Accepted Answer

The FEHBP is a health insurance program for federal employees, retirees, and their dependents.

Question 6

Medicare is administered by _______________.

Accepted Answer

The answer of Medicare is administered by _______________....

Question 7

When providers feel that financial incentives are inadequate, they may opt out of:

Accepted Answer

Medicaid is the government healthcare program for low-income individuals and families, and it often has lower reimbursement rates for providers than other programs such as Medicare. When providers feel that financial incentives are inadequate, they may opt out of accepting Medicaid patients in order to prioritize patients with better-paying insurance plans or to make up for the lower reimbursement rates.

Question 8

In 2008 the largest Medicare provider expenditure occurred in the following category:

Accepted Answer

In 2008, the largest Medicare provider expenditure was for hospitals. This is consistent with historical trends where hospital care typically accounts for the largest share of healthcare spending in Medicare.

Question 9

The government as a payer of health care services has significant power in the health care delivery system. Identify and explain two of the three issues for government payment programs noted in the text. Include an example of each in your explanation.

Accepted Answer

The answer of The government as a payer of health...

Question 10

Health care providers must accept Medicaid patients.
30. An example of self-referral would be physicians making referrals to a lab facility in which they were partial owners.

Accepted Answer

Health care providers are not required to accept Medicaid patients; it is up to the provider to decide whether to participate in the Medicaid program.TrueAn example of self-referral is indeed when physicians refer patients to a facility in which they have a financial interest, such as being partial owners of a lab.

Question 11

The disease that makes a person eligible for Medicare without being over 65 years old is ________________.

Accepted Answer

The answer of The disease that makes a person eligible...

Question 12

All of the following describe the 2010 Patient Protection and Affordable Care Act regarding fraud and abuse except:

Accepted Answer

The statement "penalties for false claims will be decreased" is incorrect. In fact, the ACA increases penalties for false claims, expands the government's ability to recover overpayments, and creates new anti-fraud provisions to prevent fraud and abuse in healthcare programs. Therefore, the best choice is D.

Question 13

In all but a few states, more than 50% of the Medicaid population is in managed care.

Accepted Answer

According to data from the Kaiser Family Foundation, as of 2019, all states except Wyoming, Alaska, and North Dakota had more than half of their Medicaid population enrolled in managed care programs. This means that in the majority of states, more than 50% of Medicaid beneficiaries receive their healthcare through managed care organizations.

Question 14

Physician's Medicare payments are paid based on limits set by _______________.

Accepted Answer

The answer of Physician's Medicare payments are paid based on...

Question 15

In 2008 the total number of Medicare enrollees was:

Accepted Answer

According to data from the Centers for Medicare & Medicaid Services, in 2008 the total number of Medicare enrollees was 45 million.

Question 16

Hospitals are the largest recipients of workers' compensation dollars.

Accepted Answer

Workers' compensation dollars are primarily spent on medical treatment costs and wage replacement benefits for injured workers, not directly to hospitals. While hospitals do receive payments for medical services rendered, other costs such as rehabilitation, medication, and administrative expenses also constitute significant portions of workers' compensation expenditures.

Quiz 4: The Payment Process: Government Payment Programs