Deck 13: Provider Payment Systems

Question 1

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

A) Contractors
B) Patients
C) Vendors
D) a & c

Answer 1

Patients

Question 2

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

A) Access
B) Cost
C) Quality
D) All of the above

Answer 2

All of the above

Question 3

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

A) Great success
B) Fair success
C) Little or no effect
D) None of the above

Answer 3

Little or no effect

Question 4

Blue Cross Blue Shield got its start in:

A) 1929
B) 1949
C) 1959
D) 1965

Question 5

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

A) 1955
B) 1960
C) 1965
D) 1967

Question 6

Health Maintenance Organization (HMO) is:

A) A perspective payment method
B) A legally Incorporated organization that offers health insurance
C) An organization that rations care
D) A rating method used by indemnity insurers

Question 7

Value Based Purchasing is:

A) A monthly payment by a person to an insurer
B) A method of reimbursement based on payment for services rendered
C) A method to control costs through monitoring and prescribing
D) A payment methodology designed to provide incentives to providers for delivering quality care at lower costs

Question 8

Never events are:

A) Adverse patient outcomes due to provider negligence that are not typically not reimbursed
B) Methods of rewarding quality of care
C) Quality populations based on payment
D) Payment strategies for reducing health care spending

Question 9

Accountable care organizations performance is measured by:

A) Patient experience
B) Care coordination
C) Preventative health care
D) All of the above

Question 10

Hospital reimbursement by Medicare includes:

A) Case rates
B) Ambulatory payment classifications
C) Cash Rates
D) a & b

Question 11

A payor may be a regulator.

Question 12

Evidence based medicine refers to the best evidence currently available.

Question 13

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

Question 14

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

Question 15

Medicare has only two parts, A & B.

Question 16

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

Question 17

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

Question 18

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

Question 19

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