BUSI 323 Quiz 2 Revenue Determination solutions complete answers

BUSI 323 Quiz 2 Revenue Determination solutions complete answers 

 

What are the three major ways that healthcare providers can control their revenue function?

 

Which of the following is the best way a hospital can minimize the chances of running afoul of healthcare laws and regulations?

 

Which of the five policy groups include bad debts as an element of community benefit?

 

Employer premium costs for healthcare coverage are often lowest in which type of health plan?

 

Which of the following is the main source of financing for long-term care, paying 40% or the nation's bill for both nursing home care and long-term care?

 

The purpose of which of the following is to provide greater parity to relative charge structures at U.S. hospitals?

 

Which of the following typically represents the largest area of charity care?

 

True or False? Providing medically unnecessary care to a patient and then billing Medicare for it is an example of Medicare fraud.

 

True or False? FCA charges against providers can be brought by individuals under a qui tam action.

 

True or False? EMTALA allows a hospital to transfer an emergency patient to another hospital because of the patient's inability to pay.

 

True or False? Prosecution under the FCA requires that specific intent to defraud the government was present.

 

Which of the following can a healthcare provider vary across different payers?

 

What type of hospitals show the worst overall CVI scores compared to the U.S. median?

 

The James Clinic is an organization of 100 physicians in a variety of specialties. They recently contracted with Prudential Health Plan on a capitated basis to provide all medical services to Prudential's members for the next 3 years. This HMO model would be defined as a(n):

 

Assume that a long-term care facility provides inadequate nutrition, wound care, and medication administration to its residents. It provides this substandard care to residents for which it bills government programs. Under which healthcare law or regulation is it at risk of being prosecuted?

 

Which parts of Medicare are commonly referred to as the “original Medicare plan”?

 

Capitation plans are more common for physician payment because:

 

What component of internal control sets the tone of an organization, influencing the control consciousness of its people?

 

Outcome quality measurement is conducted through which of the following, which is established for each facility by Medicare?

 

Contract clauses that permit which of the following should be removed from contract documents?

 

The existence of healthcare plan __________ produced healthcare provider __________.

 

A medical group includes a provision in its contract with an HMO to receive larger PMPM payments if the HMO members are chronically ill. This type of provision is referred to as a(n):

 

You are trying to establish a PMPM rate for primary care physicians. Actuarial estimates project 2,500 visits per 1,000 members per year. You have contracted with a primary care medical group at $45.00 per visit with a $5.00 copayment that you will receive. What PMPM rate should you set?

 

Which of the following is the best way to compare hospital costs?

 

Which of the following is directly affected by three key areas: pricing, health plan contract negotiation, and billing and coding?

 

How do a high percentage of Medicaid patients influence a hospital's prices?

 

What are the three factors that influence pricing?

 

An HMO has a point-of-service (POS) option for its members but will pay only 80% of approved charges. If a member goes out of network for a medical procedure with a charge of $2,000, of which $1,200 is approved, how much must the member pay?

 

What is the primary provision of EMTALA?

 

How could a hospital legally avoid being covered by EMTALA?

 

How are Medicaid payments to providers limited by the federal government?

 

How is charity care usually defined?

 

How does the Stark Law impact physicians?

 

A nursing home contracts with an HMO for skilled nursing care at $2.00 PMPM. If costs are expected to average $120 per day, what is the maximum utilization of days per 1,000 members that the nursing home can experience before it begins to lose money?

 

Why is the unreimbursed cost of Medicare most often not included as an element of community benefit?

 

What firms must file an IRS Form 990 on an annual basis?

 

Should hospitals and physicians “undercode” Medicare patient stays and patient visits in order to reduce the possibility of being charged under the False Claims Act?

 

List and discuss the three payment-determination bases.

 

What is the False Claims Act (FCA) and how does it impact providers of healthcare services?