Healthcare final 3- finance and workforce

question

Which of the following is a recognized medical specialty? a. Optometry b. Clinical psychology c. Cytotechnology d. Audiology e. Psychiatry
answer

e. psychiatry
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Which of the following is a recognized allied health professional? a. Allergist b. Anesthesiologist c. Nuclear Medicine d. Chiropractic e. Pathologist
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c. nuclear medicine
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What setting employs the largest number of health care workers? a. Physician offices b. Home health agencies c. Nursing homes d. Hospitals e. Group homes
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d. hospitals
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Which of the following statements about workforce planning and development is true? a. Demographics are measurable. b. Health insurers are unable to predict the cost of health care demand. c. The demand for health care is unpredictable. d. Decision makers are unable to anticipate the kind of workforce they will need. e. Decision makers are unable to plan for epidemics or disasters.
answer

a. demographics are measurable
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Which of the following is most often true when describing the influence of workforce resources on health care system outcomes? a. The amount and mix of health care workers influences health care access. b. The amount and mix of health care workers influences health care cost. c. The amount and mix of health care workers influences health care quality. d. All of the above. e. Workforce size and type of workers does not influence system outcomes.
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d. all of the above
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Which of the following best describes sources of influence on the future health care workforce? a. Mix and size of the current workforce b. Decisions about payment, education policy, and technology c. Private policy about hiring d. Decisions about technology e. General changes in thinking
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a. mix and size of the current workforce
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Which of the following best describes specialty care when compared to primary care? a. First point of contact for patients using health care b. Gatekeepers in the health care system c. Focused, intense, episodic d. Major role in coordinating care e. Focus on the whole person
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c. focused intense, episodic
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Which of the following best describes physician supply in the United States? a. There are not enough physicians b. Too many specialists c. Not enough rural doctors d. Supply of doctors is growing but a better distribution is needed by geography and specialty e. Physician supply is too old.
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b. too many specialists
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Which of the following statements about non-physician providers is most often true? a. Dentists provide better access to children than medical physicians. b. Pharmacy care is becoming less complex thanks to computers. c. Physician assistants are doing more to meet the demand for primary care than nurse practitioners. d. Nurse practitioners are doing more to meet the demand for primary care than physician assistants. e. Nurse practitioners must have a supervising physician.
answer

d. nurse practitioners are going more to meet the demand for primary care than physician assistants
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Which of the following statements about health care administrators is most often true? a. Administrators are required to have a degree in administration. b. Administrators must have a degree in business administration c. Hospital administrators must be licensed by each state. d. Health care administrators are challenged by powerful interests both inside and outside their system. e. Health care administrators operate not-for-profit organizations.
answer

d. health care administrators are challenged by powerful interests both inside and outside their system
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What two factors are used to calculate health care expenditures for group of employees, members of a health insurance plan, a state or a nation? a. Payment amounts for each type of service, patient use of each type of service b. Payment amounts from each payer, patients covered by each payer c. Time and location d. Historical use of services, and historical prices for some services e. International comparisons, and comparisons between states
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a. payment amounts for each type of service, patient use of each type of service
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According to authors Shi and Singh, which of the following contributes to increased health care expenditures? a. Control payments to providers b. Control investments in research and development c. Expand health insurance coverage d. Designate services as not covered by insurance e. Control the use of health care
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c. expand health insurance coverage
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How are insured most likely to benefit from cost-sharing? a. Pay less for premiums b. Pay less for visits c. Pay less for services d. Encourages access to care e. None of the above
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c. pay less for services
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Under the Affordable Care Act, which of the following services is least likely to involve cost sharing? a. Pediatric care b. Preventive services c. Emergency services d. Hospitalization e. Prescription drugs
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b. preventative services
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Which type of private health insurance is most likely to have the lowest premium? a. High deductible health plan b. Individual private health insurance c. Private group health insurance d. Preferred Provider Insurance e. Health Maintenance Organization
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a. high deductible health plan
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Which of the following best describes trends in health insurance from 2008-2013 as features of the Affordable Care Act were being phased into effect? a. Falling premiums and rising deductibles b. Rising premiums and rising deductibles c. Stable premiums and Rising deductibles d. Rising premiums and stable deductibles e. Stable premiums and deductibles
answer

b. rising premiums and rising deductibles
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Which of the following parts of Medicare include coverage for the broadest scope of health care products and services? a. Part A b. Part B c. Part C d. Part D e. Part E
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b. part b
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Which of the following payment types is described as a monthly payment per member for all services needed by the patients in a covered plan? a. Capitation b. Fee for services c. Monthly fees d. Discounted fee for service e. Provider salary
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a. capitation
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Which of the following is a form of prospective payment? a. Fee for service b. Medigap c. Cost-plus payment d. Diagnosis-related groups e. Penalties for readmitting patients with the same diagnosis
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c. cost-plus payment
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an example of an allied health professional
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nuclear medicine
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when comparing psychiatrist to a clinical psychologist, what is important to realize
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tha psychiatry is a medical speciality
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expanding health insurance would also do what
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increase health expenditures
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premiums are something that are received by whom
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the insurer
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Most DOs are ___ and most MDs are ____
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generalists specialists
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in the US, physicians who are trained in family medicine.general practice, general internal medicine, and general pediatrics are considered primary care physicians aka
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generalists
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a type of physician who has been expanding since the mid 90s
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hospitalists
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there has been a what in the physician labor force
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increase
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___ of the primary workforce are 56 and older and near retirement and less the ______ of medical students are chose primary care
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one quarter one quarter
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maldistribution
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either a surplus or a shortage of the type of physicians needed to maintain the health status of a given population at an optimum level
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the US faces maldistributions in both ___ and ___
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geography and speciality
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what does HPSA stand for
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health professional shortage area
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what is HPSA
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designations by the department of human and health services for urban and rural areas, population groups, or medical or other public facilities that have a shortage of providers in primary care, dental care, and mental care
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federal programs that have demonstrated the success in increasing the supply of primary care services in rural area
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-national health service corps -migrant and community health center programs area health education centers
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makes scholarship support conditional on a commitment to future service in an undeserved area
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the national health service corps
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designated to provide primary care services to the poor and underserved using federal grants
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migrant and community health center programs
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the largest group of health care professionals
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the nursing profession
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examples of allied health professional
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technicians, assistants, therapists, and technologists
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someone who has received a certificate, associates, bachelors, masters degree, doctoral level prep, or post baccalaure training in a science related to health care and has responsibility for the delivery of health related services
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allied health professional
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What is the central role of health services financing in the United States? a) Support managed care b) Underwrite medical risk c) Balance the supply of health care professionals d) Fund health insurance
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d. fund health insurance
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What is the primary mechanism that enables people to obtain health care services? a) Payment for services b) Control of expenditures c) Health insurance d) Availability of services
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c. health insurance
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The phenomenon called ‘moral hazard’ results directly from a) inadequate payment to providers b) health insurance coverage c) the uninsured status of a segment of the U.S. population d) managed care enrollment
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b. health insurance coverage
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Liberal reimbursement for a given technology will _____ innovation, diffusion, and utilization of that technology. a) increase b) have no effect on c) decrease d) prevent
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increase
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Controlling total health care expenditures by restricting financing for health insurance. a) Top-down control b) Underwriting c) Underutilization d) Demand-side rationing
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d. demand side rationing
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In national health care systems, total expenditures are controlled mainly through
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supply-side rationing
question

Under community rating a) high-risk individuals pay a higher premium than low-risk individuals b) premiums are based on a group’s utilization of health care services c) premiums are based on risk rating d) both high-risk and low-risk people are charged the same premium
answer

both high-risk and low-risk people are charged the same premium
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Which method of risk assessment is required by the ACA for individual and small-group health insurance? a) Pure community rating b) Adjusted community rating c) Risk selection d) Experience rating
answer

d. adjusted community rating
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Under experience rating, a) deductibles and copayments are eliminated b) premiums rise for every one regardless of risk c) favorable risk groups pay a lower premium than high-risk groups d) costs shift from people in poor health to people in good health
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c. favorable risk groups pay a lower premium than high-risk groups
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What is the main advantage of group insurance? a) More comprehensive services can be covered than under an individual plan b) More people can obtain insurance from a single insurer c) Risk is spread out among a large number of insured d) The employer has to deal with only one insurance company
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c
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Self insurance was spurred by a) self-employed people b) managed care organizations c) employers d) government policy
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d
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The Employee Retirement Income Security Act (ERISA), 1974 a) exempts self-insured plans from certain mandatory benefits b) mandates that employers provide comprehensive health coverage under their health insurance benefits c) outlawed discrimination in health insurance and retirement benefits d) requires that low-income individuals be charged a lower premium than those in high-income categories
answer

a
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Cost is shifted from people in poor health to the healthy when a) first-dollar coverage is predominant b) premiums are based on community rating c) premiums are based on experience rating d) people purchase individual private health insurance policies instead of group policies
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b
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A health insurance plan pays for medical care only after the insured has first paid $1,000 out of pocket on an annual basis. The $1,000 annual cost is called a) first-dollar coverage b) premium c) coinsurance d) deductible
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d
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A copayment is generally paid a) in form of a deduction from payroll checks b) each time the insured receives health care services c) once a year d) by the employer to purchase health insurance on behalf of each covered employee
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b
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What was the main conclusion of the Rand Health Insurance Experiment a) Cost sharing lowered health care utilization but there were significant health consequences b) Cost sharing increased health care utilization c) Cost sharing did not affect health care utilization d) Cost sharing lowered health care utilization without any significant health consequences
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d
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Medigap policies are sold by a) HMOs b) Medicare c) private insurance companies
answer

c
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In general, how do bronze, silver, gold, and platinum health plans differ? a) They differ according to cost sharing. b) They differ according the benefits offered. c) They differ according to the length of service with an employer. d) They differ according to both benefits and cost sharing.
answer

a
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To purchase private insurance through an exchange, premium subsidies are made available to people with incomes up to a) 138% of federal poverty level b) 400% of federal poverty level c) 200% of federal poverty level d) 300% of federal poverty level
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b
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The majority of beneficiaries receiving health care through Medicare are a) elderly b) financially poor c) those suffering from end-stage renal disease d) disabled
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a
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What is the main function of the Medicare Payment Advisory Commission (MedPAC)? a) To control total Medicare expenditures b) To advise the US Congress on various issues affecting the Medicare program c) To establish Medicare policy d) To determine Medicare reimbursement to various providers
answer

b
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To finance Medicare Part A, a) enrollees are required to pay a subsidized premium b) employee wages are taxed up to a certain ceiling that is raised each year c) only employers are required to pay a payroll tax d) all income earned by a working person is subject to Medicare tax
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d
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Skilled nursing care is covered under _____ of Medicare. a) Part D b) Part C c) Part A d) Part B
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c
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The HI portion of Medicare is financed through a) Premiums from enrollees b) General taxes c) Payroll taxes d) None of the above
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c
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For Medicare beneficiaries, the maximum stay in a SNF during a benefit period cannot exceed a) 30 days b) 60 days c) 100 days d) None of the above
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c
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For hospitalizations, Medicare beneficiaries must pay a deductible a) each time they are admitted to a hospital Correct Response b) once per benefit period c) on discharge from a hospital d) None of the above
answer

b
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Medicare Part B premiums are a) standard for everyone b) market-based c) income-based d) None of the above
answer

c
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SMI provides a) prescription drugs b) hospital coverage c) skilled nursing facility coverage d) physician services
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d
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Part C of Medicare specifically covers a) rehabilitation services b) preventive care c) prescription drugs d) None of the above
answer

d
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Why was Medicare Part C created? a) To extend benefits to people with end-stage renal disease b) To channel beneficiaries into managed care programs c) To add a prescription drug benefit to the Medicare program d) To provide services to children up to the age of 19
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b
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The SMI Trust Fund is for a) Part A b) Part B c) Parts A and B d) Parts B and D
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d
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The primary criterion to become eligible for Medicaid is a) age b) family emergency c) medical necessity d) financial status
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d
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By law, federal matching funds to the states for Medicaid cannot be less than a) 50% b) 25% c) 80%
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a 50%
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The insurance arm of military health care is called a) VHA b) TRICARE c) VISN d) CHAMPUS
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b
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To receive payment for services delivered, providers must file a ____ with third-party payers. a) charge b) fee-schedule c) claim d) bill
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c
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The use of fee-for-service reimbursement a) has been eliminated b) has not been affected by innovative methods c) has been increased d) has been greatly reduced
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d
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_____ reimbursement is based on the assumption that health care is provided in a set of identifiable and individually distinct units of services. a) Prospective b) Cost-plus c) Bundled-fee d) Fee-for-service
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d
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What is the incentive under fee-for-service reimbursement? a) Insurers have an incentive to reduce premium costs b) Payers have the incentive to reduce reimbursement c) Providers have an incentive to deliver nonessential services d) Patients have the incentive to consume more services than necessary
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c. providers have an incentive to deliver nonessential services
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In general, prospective payment systems establish reimbursement for a) bundled services b) costs incurred in the delivery of services c) services already provided d) resources already used
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a. bundled services
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RVUs reflect a) coding of physician services b) resource inputs c) the dollar value of services d) units of services delivered
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b. resource inputs
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Preferred providers are paid a) capitated fees b) bundled fees c) prospective fees d) negotiated discounted fees
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d. negotiated discounted fees
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When a fixed monthly fee per enrollee is paid to a provider, it is called a) Bundled fee b) Capitation c) Retrospective reimbursement d) Charge
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b. capitation
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Capitation removes the incentive to a) underutilize health care. b) file a reimbursement claim. c) provide unnecessary services. d) control costs.
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c. provide necessary services
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Under retrospective reimbursement, a health care organization is paid according to a) predetermined rates. b) the costs incurred in operating the institution. c) fees established by the organization. d) the number of patients served.
answer

b. the costs incurred in operating the institution
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What perverse incentive is present in retrospective reimbursement? a) Serving more patients would reduce profits. b) It leads to underutilization of health care services. c) Providers can increase their profits by increasing costs. d) Providers reduce their profits if they increase costs.
answer

c. providers can increase their profits by increasing costs
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The amount of reimbursement is determined before the services are delivered. a) Retrospective reimbursement b) Prospective reimbursement c) Cost-plus reimbursement d) Fee-for-service
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b. perspective reimbursement
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Which of the following is not a type of prospective reimbursement methodology? a) Case mix b) Diagnosis-related groups c) Cost-plus d) Ambulatory patient classification
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c. cost-plus
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A DRG represents a) number of discharges from the hospital b) cumulative days of care c) a group of principal diagnoses d) bundled fees established prospectively
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c. a group of principal diagnoses
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An MS-DRG is a refined DRG that includes a) patient severity b) adjustment for readmissions within 30 days of discharge c) costs incurred in treating a patient d) adjustment for treating patients on Medicaid
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a. patient severity
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Under the DRG method of reimbursement, an acute care hospital is paid a) a fixed amount for a particular DRG classification b) a fixed amount for each day of care c) a per-diem rate based on the DRG classification d) an amount based on the use of resources in treating a patient
answer

a.
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Under the DRG method of reimbursement, a psychiatric hospital is paid a) a fixed amount per admission b) a case-specific rate based on psychiatric DRGs c) a per-diem rate based on psychiatric DRGs d) an amount determined by resources used in treating a patient
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c.
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How is case mix determined for an inpatient facility? a) A case-mix index is created. b) Case mix is determined by the principal diagnosis of each patient. c) Patients are classified according to case-mix groups. d) A comprehensive assessment of each patient is done.
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d.
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What is the Minimum Data Set (MDS)? a) It facilitates the determination of case-mix groups in rehabilitation hospitals. b) It is a patient assessment instrument for skilled nursing facilities. c) It facilitates the determination of ambulatory payment classifications in outpatient centers. d) It is a data collection instrument used mainly for clinical research.
answer

b
question

If national health expenditures amount to 18% of the GDP, what does this mean? a) Health care costs are 18% of the total revenues in the health care industry. b) Health care consumes 18% of the total economic production. c) Domestic production of health care products and services has increased by 18%. d) The growth in total health care expenditures is 18%.
answer

b
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The largest share of national health expenditures is attributed to: a) Public health activities b) Net cost of private health insurance c) Personal health care d) Structures and equipment
answer

c
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Public (government) share of the total health care spending in the United States is approximately a) 45% b) 35% c) 55% d) 25%
answer

a.
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Adverse selection makes health insurance less affordable for a) high-risk individuals b) those in poor health c) those in good health d) those covered by public insurance
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c.
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True or False? Medicaid recipients are classified as medically uninsured.
answer

false
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True or False? Health insurance increases the demand for health care services.
answer

true
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True or False? Tax policy in the U.S. provides an incentive to obtain employer-paid health insurance.
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true
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True or False? People in older age groups represent a higher risk than those in lower age groups.
answer

true
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True or False? Under community rating, people are charged the same premium regardless of health risk.
answer

true
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true or False? Today, the majority of health insurance exists in the form of managed care plans.
answer

true
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True or False? By law, a health insurance plan must cover work-related injuries.
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false
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True or False? The government plays a significant role in financing health care services in the United States.
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true
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True or False? It is illegal for an insurance company to sell a Medigap plan to someone who is covered by Medicaid
answer

true
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True or False? Under the ACA, private health insurance will no longer be the main source of coverage.
answer

false
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True or False? The ACA requires that employers provide health insurance to part-time workers if the employer has 50+ full-time equivalent workers.
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false
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True or False? Health insurance plans are prohibited from having lifetime dollar limits on medical benefits.
answer

true
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True or False? Health insurance plans are allowed to have annual dollar limits on a person’s medical benefits.
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false
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True or False? Under the Medicare program, eligibility criteria and benefits are consistent throughout the US.
answer

true
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True or False? Part D of Medicare does not require the payment of a premium.
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false
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True or False? Long-term care services for the elderly are covered under Medicare.
answer

false
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True or False? Under the Medicaid program, eligibility criteria and benefits are consistent throughout the US.
answer

false
question

True or False? State governments are required to partially finance the Medicaid program.
answer

true
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True or False? According to a US Supreme Court decision, individual states can decide whether or not to expand their Medicaid programs to comply with the ACA.
answer

true
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True or False? Research shows that prospectively set bundled payment methods are effective in reducing health care spending without significantly affecting quality of care.
answer

true

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