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HMGT 3301 Exam #1, Questions with accurate answers, 100% accurate.

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HMGT 3301 Exam #1, Questions with accurate answers, 100% accurate. What are the 6 main issues with a multi-payer system? (1) difficult for providers to track various health plans (2) providers have to hire claim processors (3) payments can be denied which forces rebilling (4) balanc...

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  • February 21, 2023
  • 22
  • 2022/2023
  • Exam (elaborations)
  • Questions & answers

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  • hmgt 3301 exam 1
  • questions with accurate answers
  • 100 accurate what are the 6 main issues with a multi payer system 1 difficult for providers to track various health plans 2 providers have

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HMGT 3301 Exam #1, Questions with
accurate answers, 100% accurate.

What are the 6 main issues with a multi-payer system?

(1) difficult for providers to track various health plans

(2) providers have to hire claim processors

(3) payments can be denied which forces rebilling

(4) balance billing may occur

(5) providers must engage in collection efforts

(6) government programs have complex regulation

What 4 things make the U.S. HCS unique?

(1) no automatic coverage

(2) no true "system"

(3) fragmented system

(4) continues to undergo periodic change

The HC workforce employs over _____ million people.

16.4

What are the 5 characteristics of the U.S. system?

(1) multiplicity of financial arraignments

(2) numerous insurance agencies/MCOs that employ various mechanisms for insuring against risk

(3) multiple payers that make their own determinations about cost for each service

(4) diverse settings of delivery

(5) numerous consulting firms offering expertise in planning, cost containment, electronic systems,
quality, restructuring resources

,What are the 3 missing dimensions of the U.S. HC system?

(1) planning

(2) direction

(3) coordination from a central agency

What are the 5 inefficiencies in the U.S. HC system?

(1) duplication

(2) overlap

(3) inadequacy

(4) inconsistency

(5) waste

What are the 2 primary objectives?

(1) access to HCS

(2) cost effective w/ quality standards

The U.S. leads the world in what 4 things?

(1) technology

(2) training

(3) research

(4) sophisticated institutions/products/processes

The Quad-Function Model is made up of what 4 things?

(1) financing

(2) insurance

(3) payment

(4) delivery

Employer-based health insurance

, private

Premium Cost Sharing w/ groups

Privately purchased health insurance

private

Government programs

public

Medicare (fed), Medicaid(fed+state), CHIP

List 3 special government groups

VA, Military, IHS

What are 2 reasons why employment-based insurance systems leave some people unemployed?

(1) small businesses cannot get group insurance at affordable rates and are unable to offer insurance

(2) participation in insurance program may be optional

What did the ACA do?

required all U.S. citizens and legal residents to be covered by public or private insurance

What 4 things make up Managed Care?

(1) seeks to achieve efficiency by integrating the functions

(2) controls utilization of services

(3) determines price

(4) payer is still employer or government




What is Managed Care?

an attempt to control utilization and manage the pricing established/volume of insurers

because traditionally the financier, insurer, provider and payer have been different entities

What are the 7 external forces affecting HC delivery?

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