Question 1

Relying on usual, customary, and reasonable costs were an attempt to control costs under managed care.

Accepted Answer

A) True 
 B)False

Question 2

Managed care began as an outgrowth of the Health Maintenance Organizations Act of 1963.

Accepted Answer

A) True 
 B)False

Question 3

Third-party payers operate at only nongovernmental levels.

Accepted Answer

A) True 
 B)False

Question 4

An HMO is only one form of managed care.

Accepted Answer

A) True 
 B)False

Question 5

Which of the following is the best definition for the insured?

Accepted Answer

A)  the insurance company that agrees to pay for health care 
B)  the one holding the insurance policy 
C)  the prepayment of a specified amount for health care coverage 
D)  The insured includes the private insurance companies, employers, and managed care organizations. 
A)  the insurance company that agrees to pay for health care 
B)  the one holding the insurance policy 
C)  the prepayment of a specified amount for health care coverage 
D)  The insured includes the private insurance companies, employers, and managed care organizations.

Question 6

There are _____ parts to the Medicare Program.

Accepted Answer

A)  ONE 
B)  TWO 
C)  THREE 
D)  FOUR 
A)  ONE 
B)  TWO 
C)  THREE 
D)  FOUR

Question 7

Match the type of health care reimbursement program with its descriptor.
-covers prescription care for those over 65 years of age

Accepted Answer

A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS 
A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS

Question 8

A preferred provider organization (PPO) requires patients to go through a gatekeeper to see a specialist.

Accepted Answer

A) True 
 B)False

Question 9

The RBRVS (resource-based relative value scale) system uses a coding system for typical procedures that can be done in the physician's office. This coding system is called ______________________.

Accepted Answer

The answer of The RBRVS (resource-based relative value scale) system...

Question 10

Define unbundling.

Accepted Answer

To bill for a package of healt

Question 11

Workers' Compensation programs compensate employees immediately for lost wages due to work-related injuries and illnesses.

Accepted Answer

A) True 
 B)False

Question 12

Which of the following is a payment methodology that is set by a formula for a set amount, regardless of quantity or nature of services rendered?

Accepted Answer

A)  fee-for-service 
B)  prospective payment system 
C)  resource-based relative value system 
D)  capitation 
A)  fee-for-service 
B)  prospective payment system 
C)  resource-based relative value system 
D)  capitation

Question 13

Match the type of health care reimbursement program with its descriptor.
-covers employees who suffer work-related injuries and illnesses

Accepted Answer

A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS 
A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS

Question 14

The initiation of DRGs resulted in a significant cost savings to Medicare.

Accepted Answer

A) True 
 B)False

Question 15

Which of the following practices were common with the fee-for-service plan?

Accepted Answer

A)  developing of a chargemaster 
B)  balance billing for uncovered charges 
C)  unbundling to increase costs per item 
D)  retrospective payment system 
E)  all of the descriptors apply to the fee-for-service plan 
A)  developing of a chargemaster 
B)  balance billing for uncovered charges 
C)  unbundling to increase costs per item 
D)  retrospective payment system 
E)  all of the descriptors apply to the fee-for-service plan

Question 16

To make the fee-for-service system work, Medicare adopted the Diagnosis-Related Group (DRG).

Accepted Answer

A) True 
 B)False

Question 17

Match the type of health care reimbursement program with its descriptor.
-covers veterans of the armed services who are permanently and totally disabled

Accepted Answer

A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS 
A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS

Question 18

Coverage refers to those health care services that have previously been identified as reimbursable under the insurance plan.

Accepted Answer

A) True 
 B)False

Question 19

Match the type of health care reimbursement program with its descriptor.
-program designed to provide financing for the poor and impoverished

Accepted Answer

A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS 
A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS

Question 20

How many days of skilled nursing care are covered under Part A?

Accepted Answer

A)  30 
B)  60 
C)  90 
D)  100 
A)  30 
B)  60 
C)  90 
D)  100

Relying on usual, customary, and reasonable costs were an attempt to control costs under managed care.

Managed care began as an outgrowth of the Health Maintenance Organizations Act of 1963.

Third-party payers operate at only nongovernmental levels.

An HMO is only one form of managed care.

Which of the following is the best definition for the insured?

There are _____ parts to the Medicare Program.

Match the type of health care reimbursement program with its descriptor. -covers prescription care for those over 65 years of age

A preferred provider organization (PPO) requires patients to go through a gatekeeper to see a specialist.

The RBRVS (resource-based relative value scale) system uses a coding system for typical procedures that can be done in the physician's office. This coding system is called ______________________.

Define unbundling.

Workers' Compensation programs compensate employees immediately for lost wages due to work-related injuries and illnesses.

Which of the following is a payment methodology that is set by a formula for a set amount, regardless of quantity or nature of services rendered?

Match the type of health care reimbursement program with its descriptor. -covers employees who suffer work-related injuries and illnesses

The initiation of DRGs resulted in a significant cost savings to Medicare.

Which of the following practices were common with the fee-for-service plan?

To make the fee-for-service system work, Medicare adopted the Diagnosis-Related Group (DRG).

Match the type of health care reimbursement program with its descriptor. -covers veterans of the armed services who are permanently and totally disabled

Coverage refers to those health care services that have previously been identified as reimbursable under the insurance plan.

Match the type of health care reimbursement program with its descriptor. -program designed to provide financing for the poor and impoverished

How many days of skilled nursing care are covered under Part A?

Health Care Delivery Systems

The Health Information Management Profession

Legal Issues

Ethical Standards

Health Data Content and Structures

Nomenclatures and Classification Systems

Quality Health Care Management

Health Statistics

Research

Database Management

Information Systems Technology

Informatics

Management Organization

Human Resource Management

Financial Management

Filters

Exam 16: Reimbursement Methodologies

Relying on usual, customary, and reasonable costs were an attempt to control costs under managed care.

Managed care began as an outgrowth of the Health Maintenance Organizations Act of 1963.

Third-party payers operate at only nongovernmental levels.

An HMO is only one form of managed care.

Which of the following is the best definition for the insured?

There are _____ parts to the Medicare Program.

Match the type of health care reimbursement program with its descriptor. -covers prescription care for those over 65 years of age

A preferred provider organization (PPO) requires patients to go through a gatekeeper to see a specialist.

The RBRVS (resource-based relative value scale) system uses a coding system for typical procedures that can be done in the physician's office. This coding system is called ______________________.

Define unbundling.

Workers' Compensation programs compensate employees immediately for lost wages due to work-related injuries and illnesses.

Which of the following is a payment methodology that is set by a formula for a set amount, regardless of quantity or nature of services rendered?

Match the type of health care reimbursement program with its descriptor. -covers employees who suffer work-related injuries and illnesses

The initiation of DRGs resulted in a significant cost savings to Medicare.

Which of the following practices were common with the fee-for-service plan?

To make the fee-for-service system work, Medicare adopted the Diagnosis-Related Group (DRG).

Match the type of health care reimbursement program with its descriptor. -covers veterans of the armed services who are permanently and totally disabled

Coverage refers to those health care services that have previously been identified as reimbursable under the insurance plan.

Match the type of health care reimbursement program with its descriptor. -program designed to provide financing for the poor and impoverished

How many days of skilled nursing care are covered under Part A?

Health Care Delivery Systems

The Health Information Management Profession

Legal Issues

Ethical Standards

Health Data Content and Structures

Nomenclatures and Classification Systems

Quality Health Care Management

Health Statistics

Research

Database Management

Information Systems Technology

Informatics

Management Organization

Human Resource Management

Financial Management

Filters