Deck 6: Health Insurance and Reimbursement Methods

Question 1

Which of the following was the first documented health insurance in the United States?

A) A sickness clause in 1874
B) Stand-alone insurance in 1929
C) Employment insurance in 1941
D) Health Maintenance Organization in 1973

Answer 1

A

Question 2

What was the purpose of the Health Maintenance Organization Act of 1973?

A) Provide a basic structure of health insurance for employees
B) Address the rising costs of Medicare
C) Provide a list of in network preferred providers to decrease costs
D) Provide emergency room care with an indemnity policy

Answer 2

B

Question 3

Which of the following best describes a Point of Service Plan?

A) This is a hybrid between PPOs and HMOs, where patients can receive covered treatment by out of network providers with a referral from primary physicians.
B) This is a group of healthcare providers that work to keep patients under the care of providers within their network.
C) This operates off of a list of preferred healthcare providers; patients save the most money by selecting preferred providers.
D) This offers patients emergency room care at a hospital of their choice, with a high deductible before insurance contribution.

Answer 3

A

Question 4

Which of the following requires that insurance plans provide enrollees with information about the plan features, funding, and gives the enrollees the right to sue for benefits?

A) Health Maintenance Organization Act
B) Patient Protection and Affordable Care act
C) Employee Retirement Income Security Act
D) Consolidated Omnibus Reconciliation Act

Question 5

The Consolidated Omnibus Reconciliation Act provides employees with healthcare coverage for how many days after termination of employment?

A) 30 days
B) 60 days
C) 90 days
D) 120 days

Question 6

Who are the parties involved in the coordination of health insurance?

A) Government, networks of providers, and employers
B) Insurance carriers, government, and healthcare providers
C) Healthcare providers, insurance carriers, and the person receiving care
D) Health Maintenance Organizations, patients, and employers

Question 7

Which model of reimbursement appears to alleviate problems with reimbursement schemes by encouraging quality over quantity?

A) Episode-of-care
B) Prospective payment
C) Retrospective payment
D) Fee-for-service

Question 8

Which of the following is a disadvantage to fee-for-service reimbursement?

A) Providers are reimbursed one lump sum for continuous care.
B) Providers are incentivized to promote volume over value.
C) Providers have less flexibility in the services they provide.
D) Providers are at greater risk of nonpayment for services.

Question 9

The commonality between Value-Based Purchasing (VBP) and Pay-for Performance (P4P) is:

A) VBP and P4P have the same setting, such as private health plans.
B) VBP and P4P were both initiated in 2004.
C) VBP and P4P focus on awards or penalties and the mechanism of payment.
D) VBP and P4P integrates information on quality with cost data.

Question 10

Which of the following is one of the core functions of primary care integrated by the PCMH model?

A) Maintain healthcare organizations' databases
B) Coordinate healthcare among different entities
C) Focus on the mechanism of payment
D) Recognize each patient's unique needs