U.S. Healthcare Reimbursement & Managed Care Mastery Exam: Risk Pools, Premiums, Copayments, Coinsurance, Deductibles, Capitation, Fee-for-Service, Prospective & Retrospective Payments, Episode-of-Care, Policyholder Rights, Covered Conditions & Services,

U.S. Healthcare Reimbursement & Managed Care Mastery Exam: Risk Pools, Premiums, Copayments, Coinsurance, Deductibles, Capitation, Fee-for-Service, Prospective & Retrospective Payments, Episode-of-Care, Policyholder Rights, Covered Conditions & Services, Dependent Coverage, Qualifying Life Events, Maximum Out-of-Pocket, Prior Authorization, Utilization Review, Gatekeepers, Case Management, Evidence-Based Guidelines, Ethical Principles, Nonmaleficence, Beneficence, Autonomy, Medical Identity Theft, IRB & Belmont Report, Medicare & Medicaid Policies, HMO/PPO/POS Models, IDS Integration, Financial Incentives, Adverse Selection, Morbidity Risk, and Revenue Cycle Management Exam Questions Verified and Provided with Compete A+ Graded Rationales Latest Updated 2026 Why do health insurers pool premium payments for all the insureds in a group and use actuarial data to calculate the group's premium? 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? California, 1932 There are 3 parties in healthcare reimbursement. Who is the first party? Patient or guarantor Who is the second party? Provider of care of services Who is the third party? Payer In the healthcare insurance sector, what does UCR stand for? Usual Customary and Reasonable What is the purpose of managed care? A and B only (To reduce the costs of healthcare services and To improve the quality of care for patients Which of the following phrases mean "per head"? per capita Which of the following payment methods are global? All of the above (block grants, surgical packages, bundling) All of the following methods are types of episode-of-care reimbursement except: Self-insured plan Payers that use per-diem payment rates reimburse the provider a fixed rate for each day a covered member is hospitalized. True The federal government funds significant portions of which groups' healthcare? All of the above (Seniors, people with disabilities, and people with end-stage renal disease, Low-income persons on state medicaid, Active-duty and retired military personnel and their families and veterans, native americans) The constant trend of increased national spending on healthcare is a concern because as spending on healthcare increases, the money available for other sectors of the economy decreases. True In the U.S., what is healthcare insurance? Reduction of a person's or a group's exposure to risk for unknown healthcare costs by the