Exam 13: Provider Payment Systems

In the healthcare payment system are various stakeholders. These include:

Experience rating is a method of setting group premium rates that are based on projected healthcare costs of a group.

Medicare has only two parts, A & B.

Per diem rates refer to a rate that covers everything a hospital provides during an entire inpatient stay.

Shared savings is a payment strategy used to give the patient a percentage share of savings on their care.

Steerage is influencing of patients to use a particular set of providers.

Value Based Purchasing is:

Accountable care organizations performance is measured by:

Evidence based medicine refers to the best evidence currently available.

Medicare's value based payment demonstrations have had what effect on expenditures?

Copayments and deductibles have been a part of insured patients responsibility from the beginning of employer insurance offerings.

Capitation is a form of payment that compensates the provider a certain amount per capita for a defined set of services.

Blue Cross Blue Shield got its start in:

Hospital reimbursement by Medicare includes:

Health Maintenance Organization (HMO) is:

The objectives of the U.S. healthcare payment system include:

Never events are:

The Medicare program was enacted as part of the Social Security Act in:

A payor may be a regulator.