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1. Question : (TCO 7) Coordination of benefits refers to:
Student Answer:  a penalty assessed for going out of network.
 assessing payment responsibility when multiple payers exist.
 benefit plan list of covered services.
 vertical integration of health plans.
 2. Question : (TCO 7) A withhold is a feature for payment to health care provider that:
Student Answer:  provides a mechanism for reducing risk to the payer.
 restricts covered services to beneficiaries.
 is used most frequently in indemnity health plans.
 none of the above.
 3. Question : (TCO 7) A medical group includes a provision in its contract with an HMO to receive larger PMPM payments if the HMO members are chronically ill. This type of provision is referred to as a:
Student Answer:  Stop Loss
 Adverse Selection
 Insurement
 None of the above
 4. Question : (TCO 7) Suppose that AT&T had made an offer to acquire Merck Pharmaceuticals. Ignoring potential antitrust problems, this merger would be classified as a:
Student Answer:  Cross-border merger
 Horizontal merger
 Conglomerate merger
 Vertical merger
 5. Question : (TCO 7) An HMO has a Point of Service (POS) option for its members, but will pay only 80 percent of approved charges. If a member goes out of network for a medical procedure with a charge of $2,000, of which $1,200 is approved, how much must the member pay?
 6. Question : (TCO 7) An uninsured patient receives services with charges of $5,000 from a hospital. The hospital staff bills the patient $1,000 and records $4,000 as charity care. If the hospital’s ratio of cost to charges is 50%, what amount would the hospital recognize as charity care in Schedule H of IRS Form 990?
 7. Question : (TCO 7) Why is tax-exempt financing cited as a benefit received by not-for-profit healthcare providers?