History of Health Care Reimbursement System
posted by mielchie .
I included the answers below but i don't know if my answers are correct please send me your opinions. thanks
1.By creating a committee on social welfare, the American
Association of Labor Legislation helped to
A. Decrease public hospital costs.
B. Implement fee schedules.
C. Implement health care coverage for the working class
D. Create the Indian Health Service.
2. You belong to an HMO. By paying the HMO premium and being
treated through that HMO, you’re helping to
A. Increase plan enrollment.
B. Decrease managed care costs.
C. Provide more managed care options for enrollees.
D. Control plan costs for everyone.
3. Under major medical insurance, $250 must be paid before the company assumes liability.
Who is responsible for paying this $250?
A. The policyholder C. The provider
B. The insurer D. The third-party payer
4. Which type of medical service reimbursement is the least used today?
B. Preferred provider organization
C. Health maintenance organization
5. You own a company in a state where state funds aren’t mandated for employee health
insurance. What’s one option for providing your employees with health care coverage for
A. Medicaid plans C. Medical savings plans
B. Referrals to other network groups D. Self-insurance coverage
6. Low income and categorically needy are both eligibility requirements for
A. Medicare. C. CHAMPVA.
B. Medicaid. D. TRICARE.
7. You need to speak to someone about additional coverage to Medicare Parts A and B.
Which of the following organizations should you contact?
A. TRICARE C. CHAMPVA
B. Blue Cross and Blue Shield D. Indian Health Service
8. Mary needs Medicaid coverage. Where should she start looking for information to
determine her eligibility?
A. The local hospital social services department
B. Her employer
C. The federal government Web site
D. The state in which she lives
9. Medicare and Medicaid financial issues put constraints on
A. Physician services. C. Public hospitals.
B. Critical care centers. D. Outpatient services.
10. Which of the following is an expanded option for participation in private health care plans?
A. Medicare Part A C. Medicare Advantage
B. Medicare Part B D. Medigap
11. The ability to accurately predict yearly expenses was one reason that large companies
A. Offer HMO programs. C. Self-insure their employees.
B. Enroll in managed care plans. D. Offer medical spending plans.
12. Which health insurance program is designed to complement the retirement, survivor, and
disability insurance enacted under Title II of the Social Security Act?
C. State Children’s Health Insurance Program
D. Civilian Health and Medical Program—Veterans Administration
13. You’re a physician who wants to join together with other HMO physicians but not give up
your individual practice. The best choice for you may be a/an
A. Integrated delivery system.
B. Preferred provider organization.
C. Independent practice association.
D. Primary care physician practice.
14. You started working for a private insurance company before the inception of managed
care. You’ve been talking with your co-worker about how different reimbursement was in
the past. You commented that before managed care, your employer reimbursed providers
A. Prospective basis. C. Cash-benefit basis.
B. Retrospective, fee-for-service basis. D. Medically needy basis.
15. Your niece may be eligible for health care coverage under the State Children’s Health
Insurance Program. Where should your niece first start reviewing eligibility requirements?
A. Social services
B. Place of employment
C. In the state where she resides
D. The Centers for Medicare and Medicaid Services
Mrs. Jones was admitted to the hospital for the first time this year on September 15. On
September 25, she was transferred to a skilled nursing facility where she stayed until
October 30. She was discharged from the SNF with home health care and a walker.
16. What reimbursement amount will the hospital receive from Medicare?
A. $12,856 C. $16,000
B. $13,648 D. $23,000
17. What’s the total amount the patient owes for the hospital stay?
A. $0 C. $1,980
B. $792 D. $16,000
18. How much does the patient owe for the SNF stay?
A. $0 C. $1,485
B. $99 D. $2,300
19. How much does the patient owe for home health care?
A. $0 C. $2,500
B. $500 D. $7,000
20. What’s the total amount that Medicare will pay for the home health care?
A. $2,000 C. $7,000
B. $2,500 D. $9,000
Here are my answers please help me if my answers are correct i need to pass this thanks very much it's a big help thank you.
1.C 6.B 11.C 16.A
2.D 7.B 12.A 17.B
3.A 8.B 13.C 18.C
4.A 9.C 14.B 19.B
5.D 10.C 15.C 20.C
I'm fairly sure that most of your answers are correct. However, this is not my field, and I do not know about numbers 4, 8, 10, 13 and 16-20.