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HINM 230 Final Study Guide Questions and Answers

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HINM 230 Final Study Guide Questions and Answers Why do health insurers pool premium payments for all the insureds in a group and use actuarial data to calculate the group's premiums? - ANSWER-To assure that the pool is large enough to pay losses of the entire group Where and when did health i...

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  • November 4, 2024
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HINM 230 Final Study Guide Questions

and Answers


Why do health insurers pool premium payments for all the insureds in a group and use actuarial data to

calculate the group's premiums? - ANSWER✔✔-To assure that the pool is large enough to pay losses of

the entire group


Where and when did health insurance become established in the United States?


Select one: - ANSWER✔✔-Texas, 1929 BCBS covered school teachers in Texas


There are 3 parties in healthcare reimbursement. Who is the first party? - ANSWER✔✔-Patient or

guarantor - parent responsible for patient's bill


There are 3 parties in healthcare reimbursement. Who is the second party? - ANSWER✔✔-Provider of

care or services - physician, clinic, hospital, nursing home or other healthcare entity


There are 3 parties in healthcare reimbursement. Who is the third party? - ANSWER✔✔-Payer, an

insurance company or health agency that pays the provider


In the healthcare insurance sector, what does UCR stand for? - ANSWER✔✔-Usual Customary and

Reasonable


Which of the following phrases mean "per head"? - ANSWER✔✔-Per capita




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, Copyright © KAYLIN 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH NOVEMBER, 2024


What payment methods are global payments? - ANSWER✔✔-like case rate payments, the third party

payer makes one combined payment to cover the services of multiple providers, typically physicians,

who are treating a single episode-of-care




Medicare's payment system for home health services consolidates all types of services, such as speech,

physical, and occupational therapy, into a single lump sum payment.


The federal government funds significant portions of which groups' term-13 healthcare? - ANSWER✔✔-

Seniors, People With Disability, End-Stage Renal Disease, Active Duty and Retired Military


In the United States, what is healthcare insurance? - ANSWER✔✔-Reduction of a person's or a group's

exposure to risk for unknown healthcare costs by the assumption of that risk by an entity


In the healthcare industry, what is the term for receiving compensation for healthcare services that were

previously provided? - ANSWER✔✔-Reimbursement


In which type of reimbursement methodology do healthcare insurance companies determine payment

to providers before the services have been delivered? - ANSWER✔✔-Prospective payment


In which type of reimbursement methodology does the health insurance company have the greatest

degree of risk? - ANSWER✔✔-Retrospective


Which type of reimbursement methodology is associated with the abbreviation "PMPM"? -

ANSWER✔✔-Capitated payment


In the healthcare industry, what is another term for "fee"? - ANSWER✔✔-Charge




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