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HINM 230 com final Exam Questions and Answers Why do health insurers pool premium payments for all the insureds in a group and use actuarial data to calculate the group's premiums? - ANSWER-To assure that the pool is large enough to pay losses of the entire group Where and when did health insu...

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  • November 4, 2024
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HINM 230 com final Exam Questions and

Answers


Why do health insurers pool premium payments for all the insureds in a group and use actuarial data to

calculate the group's premiums? - ANSWER✔✔-To assure that the pool is large enough to pay losses of

the entire group


Where and when did health insurance become established in the United States? - ANSWER✔✔-Texas,

1929


There are 3 parties in healthcare reimbursement. Who is the first party? - ANSWER✔✔-Patient or

guarantor


There are 3 parties in healthcare reimbursement. Who is the second party? - ANSWER✔✔-Provider of

care or services


There are 3 parties in healthcare reimbursement. Who is the third party? - ANSWER✔✔-Payer


In the healthcare insurance sector, what does UCR stand for? - ANSWER✔✔-Usual Customary and

Reasonable


In the healthcare insurance environment, what phrase means "per head"? - ANSWER✔✔-Per Capita


What payment methods are global payments? - ANSWER✔✔-All of the above


The federal government funds significant portions of which groups' healthcare? - ANSWER✔✔-All of the

above


Copyright ©Stuvia International BV 2010-2024 Page 1/9

, Copyright © KAYLIN 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH NOVEMBER, 2024


In the United States, what is healthcare insurance? - ANSWER✔✔-Reduction of a person's or a group's

exposure to risk for unknown healthcare costs by the assumption of that risk by an entity


In the healthcare industry, what is the term for receiving compensation for healthcare services that were

previously provided? - ANSWER✔✔-Reimbursement


In which type of reimbursement methodology do healthcare insurance companies determine payment

to providers before the services have been delivered? - ANSWER✔✔-Prospective payment


In which type of reimbursement methodology does the health insurance company have the greatest

degree of risk? - ANSWER✔✔-Retrospective


Which type of reimbursement methodology is associated with the abbreviation "PMPM"? -

ANSWER✔✔-Capitated payment


In the healthcare industry, what is another term for "fee"? - ANSWER✔✔-Charge


In the accounting system of the physician office, the account is categorized as "self-pay." How should the

insurance analyst interpret this category? - ANSWER✔✔-The guarantor will pay the entire bill


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? - ANSWER✔✔-Charge


Which discounted fee-for-service healthcare payment method does Medicare use to reimburse

physicians? - ANSWER✔✔-RBRVS


What is the per diem payment method? - ANSWER✔✔-Fixed rate for each day a covered member is

hospitalized



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