Practice management - Final Exam
who pays for health care services?
3 - correct answer ✔government plans
private insurance
uninsured (self-pay)
what are the 4 government health care service plans? - correct answer
✔medicare
medicaid
TriCare/VA
Federal Employee Health Benefits (FEHB)
medicare and medicaid were established _________ Amendments of 1965 -
correct answer ✔Social Security Act
what are the 2 traditional reimbursement models - correct answer
✔traditional indemnity insurance/fee-for service
managed care
what is another name for traditional indemnity insurance - correct answer
✔Fee-for Service (FFS)
fees for each good/service billed by the provider are paid by the plan or
patient - correct answer ✔FFS
seeks to control costs through negotiated fees and utilization management
while maintaining quality of care delivered - correct answer ✔managed care
,reimburses the provider a set amount for each patient they are for under the
managed care plan; often per member, per month (PMPM) - correct answer
✔Capitation
reimburse a fee for each service rendered but at a lower negotiated cost
under the managed care contract - correct answer ✔fee schedules
what is the trending/future healthcare and reimbursement model - correct
answer ✔value-based care
healthcare delivery where hospitals and physicians are paid based on health
outcomes - correct answer ✔value-based care
groups of organizations/specialties which parter in providing coordinated care
to reduce overlapping costs while enhancing quality - correct answer
✔accountable care organization/patient-centered medical home
what are the 3 value-based reimbursement models? - correct answer
✔bundled payments
hospital value-based purchasing (VBP)
Alternative payment models (APMs)
simplifies payments into one reimbursement for a single "episode of care"
currently used by CMS and private insurance to reimburse acute care hospital
episodes of care - correct answer ✔bundled payments
acute care hospitals receive payments based on quality of care delivered -
correct answer ✔hospital value based purchasing (VBP)
, gives added incentive payments to provide high-quality and cost-effective
care. Can apply to a specific clinical condition, a care episode, or a population
- correct answer ✔alternative payment models (APM)
what are the qualifications to medicare? - correct answer ✔- 65 years of age
and older or
- under 65 with permanent kidney inadequacy or ALS (Lou Gehrig's Disease)
- under 65 if permanently disabled
what are the 4 parts of medicare? - correct answer ✔part A
part B
part C
part D
part A of medicare is for - correct answer ✔hospitals
part B of medicare is for - correct answer ✔physician services
part C of medicare is for - correct answer ✔medicare advantage plans
part D of medicare is for - correct answer ✔Medicare's prescription drug plan
to receive medicare part A without premiums, you must have paid the ____
taxes for 10 years. Eligible individuals must pay a premium for part B - correct
answer ✔FICA
who pays for health care services?
3 - correct answer ✔government plans
private insurance
uninsured (self-pay)
what are the 4 government health care service plans? - correct answer
✔medicare
medicaid
TriCare/VA
Federal Employee Health Benefits (FEHB)
medicare and medicaid were established _________ Amendments of 1965 -
correct answer ✔Social Security Act
what are the 2 traditional reimbursement models - correct answer
✔traditional indemnity insurance/fee-for service
managed care
what is another name for traditional indemnity insurance - correct answer
✔Fee-for Service (FFS)
fees for each good/service billed by the provider are paid by the plan or
patient - correct answer ✔FFS
seeks to control costs through negotiated fees and utilization management
while maintaining quality of care delivered - correct answer ✔managed care
,reimburses the provider a set amount for each patient they are for under the
managed care plan; often per member, per month (PMPM) - correct answer
✔Capitation
reimburse a fee for each service rendered but at a lower negotiated cost
under the managed care contract - correct answer ✔fee schedules
what is the trending/future healthcare and reimbursement model - correct
answer ✔value-based care
healthcare delivery where hospitals and physicians are paid based on health
outcomes - correct answer ✔value-based care
groups of organizations/specialties which parter in providing coordinated care
to reduce overlapping costs while enhancing quality - correct answer
✔accountable care organization/patient-centered medical home
what are the 3 value-based reimbursement models? - correct answer
✔bundled payments
hospital value-based purchasing (VBP)
Alternative payment models (APMs)
simplifies payments into one reimbursement for a single "episode of care"
currently used by CMS and private insurance to reimburse acute care hospital
episodes of care - correct answer ✔bundled payments
acute care hospitals receive payments based on quality of care delivered -
correct answer ✔hospital value based purchasing (VBP)
, gives added incentive payments to provide high-quality and cost-effective
care. Can apply to a specific clinical condition, a care episode, or a population
- correct answer ✔alternative payment models (APM)
what are the qualifications to medicare? - correct answer ✔- 65 years of age
and older or
- under 65 with permanent kidney inadequacy or ALS (Lou Gehrig's Disease)
- under 65 if permanently disabled
what are the 4 parts of medicare? - correct answer ✔part A
part B
part C
part D
part A of medicare is for - correct answer ✔hospitals
part B of medicare is for - correct answer ✔physician services
part C of medicare is for - correct answer ✔medicare advantage plans
part D of medicare is for - correct answer ✔Medicare's prescription drug plan
to receive medicare part A without premiums, you must have paid the ____
taxes for 10 years. Eligible individuals must pay a premium for part B - correct
answer ✔FICA
