Reimbursement Quizzes 1, 3, 4, 5, 7-A, 7-B, 8-A, 8-B, 9, 2, 6, & 10 Final Review Q2uestions and Answers
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Healthcare Reimbursement
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Healthcare Reimbursement
There are 3 parties in healthcare reimbursement. Who is the second party? Provider of care or services
All of the following methods are types of episode-of-care reimbursement EXCEPT: Self-insured plan
Which of the three models for health systems predominates in the United States? Private health i...
Reimbursement Quizzes 1, 3, 4, 5, 7-A, 7-
B, 8-A, 8-B, 9, 2, 6, & 10 Final Review
Q2uestions and Answers
There are 3 parties in healthcare reimbursement. Who is the second party? ✅Provider
of care or services
All of the following methods are types of episode-of-care reimbursement EXCEPT:
✅Self-insured plan
Which of the three models for health systems predominates in the United States?
✅Private health insurance model
Payers that use per-diem payment rates reimburse the provider a fixed rate for each
day a covered member is hospitalized. ✅True
A patient sees an orthopedic physician for treatment of a fracture sustained in an
industrial accident. The patient worked for Vaughn Manufacturing Company where the
accident occurred. Vaughn Manufacturing carried worker's compensation insurance.
The workers' compensation insurance paid the fees of the orthopedist. Which entity is
the "third-party"? ✅Worker's compensation insurance
What is the purpose of managed care? ✅To reduce the costs of healthcare services,
and To improve the quality of care for patients
In the healthcare industry, what is the term for receiving compensation for healthcare
services that were previously provided? ✅Reimbursement
In the healthcare insurance sector, what does UCR stand for? ✅usual Customary and
Reasonable
In which type of reimbursement methodology does the health insurance company have
the greatest degree of risk? ✅Retrospective
Which healthcare payment method does Medicare use to reimburse physicians based
on the cost of providing services in terms of effort, overhead, and malpractice
insurance? ✅Resource-based relative value scale
Why do health insurers pool premium payments for all the insureds in a group and use
actuarial data to calculate the group's premiums? ✅To assure that the pool is large
enough to pay losses of the entire group
,Medicare's payment system for home health services consolidates all types of services,
such as speech, physical, and occupational therapy, into a single lump sum payment.
What type of healthcare payment method does this lump sum payment represent?
✅Global payment
All of the following are discounted fee-for-service healthcare payment methods
EXCEPT: ✅APG's (Ambulatory patient groups)
Which of the following is NOT an episode-of-care reimbursement methodology?
✅Managed Care
The bill that the pathologist's office submitted for a laboratory test was $54.00. In its
payment notice (remittance advice), the healthcare plan lists its payment for the
laboratory test as $28.00. What does the amount of $54.00 represent? ✅Charge
In which type of reimbursement methodology do healthcare insurance companies
reimburse providers after the costs have been incurred? ✅Retrospective payment
Which act promoted the adoption and use of EHR's and other health information and
communication technologies? ✅HITECH
In the U.S. health system, which payer has the greatest influence on payment methods?
✅Federal government
From the patient's healthcare insurance plan, the rehabilitation facility received a fixed,
pre-established payment for the patient rehabilitation after a total knee replacement.
What type of healthcare payment method was the patient's healthcare insurance plan
using? ✅Case-based
The financial manager of a physician group practice explained that the healthcare
insurance company would be reimbursing the practice for its treatment of the
exacerbation of congestive heart failure that Mrs. Zale experienced. The exacerbation,
treatment, and resolution covered approximately five weeks. The payment covered all
the services that Mrs. Zale incurred during the period. What method of reimbursement
was the physician group practice receiving? ✅Episode-of-care
There are 3 parties in healthcare reimbursement. Who is the first party? ✅Patient or
guarantor
Which discounted fee-for-service healthcare payment method does Medicare use to
reimburse physicians? ✅RBRVS
Which of the following payment methods are global? ✅Block grants, Surgical
packages, and Bundling
, The constant trend of increased national spending on healthcare is a concern because
as spending on healthcare increases, the money available for other sectors of the
economy decreases. ✅True
Where and when did health insurance become established in the United States?
✅Texas, 1929
All of the following data elements are on a remittance advice EXCEPT: ✅Claim
attachement
Which of the following characteristics is the greatest advantage of group healthcare
insurance? ✅Greater benefits for lower premiums
From a remittance advice, providers can determine how much money they can: ✅Write
off
A group of individual entities whose healthcare costs are combined for evaluating
financial history and estimating future costs is: ✅A risk pool
In regards to health insurance, the percentage that the guarantor pays is called the:
✅Coinsurance
Co-insurance and co-payments are types of: ✅Cost sharing
The amount during a timeframe beyond which all covered healthcare services for an
insured or dependent are paid 100 percent by the insurance plan is: ✅The stop-loss
benefit
Which of the following is a limitation in insurance? ✅Formulary
All of the following types of procedures and services typically require prior approval
EXCEPT: ✅Emergency services for suspected stroke
Potential moral hazards in consumer driven healthcare plans would be: ✅Being an
inpatient when being an outpatient would have had the same outcome
Under a voluntary healthcare insurance plan, who pays the remainder of a healthcare
bill after the insurance company pays? ✅Guarantor
All of the following entities are voluntary healthcare insurance EXCEPT: ✅Medicare
Which types of prescription drug is the LEAST costly for insureds using their drug
benefit? ✅Preferred generic
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