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?
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