HEALTHCARE FINANCE MHA 706 EXAM QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
Individuals at greater risk of needing health care are more likely to purchase
insurance
Adverse selection
Healthcare Finance
the practice of finance, including both accounting AND financial management
Accounting
the measurement, in financial (dollar) terms of events that reflect the resources,
operations, and financing of an organization
Financial Management
provides the theory, concepts, an tools necessary to help managers make better
financial decisions
Characteristics of a business
-obtains financing from the marketplace
-uses the funds to buy assets
-operates the assets to provide goods or services
-sells the goods or services to create revenue
role of finance
to plan for, acquire, and use resources to maximize the efficiency of the enterprise
Financing activities can be summarized by the FOUR C's which are:
,-Cost minimization
-cash sufficiency
-capital access
-control of financial resources
deductibles
The amount that must be paid out of pocket by the policyholder before an insurance
provider will pay any expenses
Coinsurance
requires an individual to pay for a certain percentage of the eligible medical expenses
Moral Hazard
the risk of overuse of health services because the insured does not bear the full cost of
the consequences
copayments
the fixed amount for a covered service that the insurer mandates that the patient pay to
the provider before the patient receives services from the provider
Medicare Part A
covers hospital and some skilled nursing home coverage
Medicare Part B
Covers physician services, outpatient care and other miscellaneous services.
Medicare Part C
Often called Medicare Advantage, managed care benefits of A &B
Medicare Part D
Covers prescription drugs
, Medigap
health insurance plans that help pay expenses not covered by Medicare
Underwriting provisions
Community rating and Experience rating
Private 3rd party
BCBS "The Blues"
Commercial insurers
self-insurers
Medicaid
-low-income mothers and children
elderly, blind and disabled who receive supplemental income
-takes up a very large portion of a state's budget
Types of Managed Care Plans
HMO, PPO, POS
HMO
strong incentive to prevent illness
PPO
hybrid of HMO and traditional health insurance plan, encourage their "illusion of choice"
POS (point of service)
"in network" provider, outside pays a higher rate
Fee-for-service (FFS)
payment tied to amount of services provided
Capitation
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
Individuals at greater risk of needing health care are more likely to purchase
insurance
Adverse selection
Healthcare Finance
the practice of finance, including both accounting AND financial management
Accounting
the measurement, in financial (dollar) terms of events that reflect the resources,
operations, and financing of an organization
Financial Management
provides the theory, concepts, an tools necessary to help managers make better
financial decisions
Characteristics of a business
-obtains financing from the marketplace
-uses the funds to buy assets
-operates the assets to provide goods or services
-sells the goods or services to create revenue
role of finance
to plan for, acquire, and use resources to maximize the efficiency of the enterprise
Financing activities can be summarized by the FOUR C's which are:
,-Cost minimization
-cash sufficiency
-capital access
-control of financial resources
deductibles
The amount that must be paid out of pocket by the policyholder before an insurance
provider will pay any expenses
Coinsurance
requires an individual to pay for a certain percentage of the eligible medical expenses
Moral Hazard
the risk of overuse of health services because the insured does not bear the full cost of
the consequences
copayments
the fixed amount for a covered service that the insurer mandates that the patient pay to
the provider before the patient receives services from the provider
Medicare Part A
covers hospital and some skilled nursing home coverage
Medicare Part B
Covers physician services, outpatient care and other miscellaneous services.
Medicare Part C
Often called Medicare Advantage, managed care benefits of A &B
Medicare Part D
Covers prescription drugs
, Medigap
health insurance plans that help pay expenses not covered by Medicare
Underwriting provisions
Community rating and Experience rating
Private 3rd party
BCBS "The Blues"
Commercial insurers
self-insurers
Medicaid
-low-income mothers and children
elderly, blind and disabled who receive supplemental income
-takes up a very large portion of a state's budget
Types of Managed Care Plans
HMO, PPO, POS
HMO
strong incentive to prevent illness
PPO
hybrid of HMO and traditional health insurance plan, encourage their "illusion of choice"
POS (point of service)
"in network" provider, outside pays a higher rate
Fee-for-service (FFS)
payment tied to amount of services provided
Capitation
