HSA 3111 Test 2 | Questions with 100% Correct Answers

HSA 3111 Test 2 | Questions with 100% Correct Answers A health insurance plan pays for medical care only after the insured has first paid $1,000 out of pocket on an annual basis. This $1,000 annual cost is called the _______________________. a) premium b) deductible c) out of pocket service coverage d) coinsurance e) first-thousand coverage In a general sense, what is the primary purpose of insurance? a) Underwriting b) Protection against risk c) Predicting risk d) Risk assessment Which response is NOT one of the four fundamental principles associated with the concept of insurance? a) Insurance protects an individual from catastrophic loss due to major medical bills because their risk can be calculated based on individual behavior and lifestyle factors. b) Insurance mechanism transfers risk from the individual to the group. c) Risk can be predicted with a reasonable accuracy for a large group. d) Risk is unpredictable for the individual insured. e) Members of insured group share actual losses on some equitable basis. The phenomenon called 'moral hazard' results directly from ___________________________. a) inadequate payment to providers b) managed care enrollment c) the uninsured status of a segment of the U.S. population d) guarding individuals against risk e) health insurance coverage A copayment is generally paid___________. a) in form of a deduction from payroll checks b) once a year c) each time the insured receives health care services d) by the employer to purchase health insurance on behalf of each covered employee Typically, tertiary care: a) Is highly specialized b) Does not depend on technology c) Takes place outside of traditional healthcare facilities d) All of the above What does "PPS" stand for? a) Preferred Provider System b) Primary Physician System c) Private Practice System d) Prospective Payment System What is palliation? a) Pain and symptom management b) Psychosocial support c) A surgical intervention d) Bed rest e) A significant problem for PNPs Hospice services are primarily for people with: a) Chronic illnesses b) Rehabilitative needs c) Terminal illnesses d) None of the above Countries whose health systems are oriented more toward primary care achieve: a) Higher satisfaction with health services among their populations b) Higher expenditures in the overall delivery of care c) Worse health outcomes d) None of the above The second BL video after moral hazard in Module 6 and the second BL video after outpatient services in module 7 were a series that focused mainly on the following: a) adverse selection in part one and part two focused on the cost drivers of high-risk individuals b) experience rating based on a groups own medical claims experience and community rating which spreads the risks among members of a larger population c) unethical and illegal practices aimed at getting payouts from a government-funded healthcare program (e.g., Medicare) d) increased utilization of services driven by the fee-for-service (FFS) payment mode and capitation model based on a set amount for each enrolled person e) the high costs associated with the diffusion of technology in part one and part two focused on cost drivers of financing these capital expenditures You should be able to explain "upcoding" or using a particular code for a procedure that is more complex and lengthy than the actual procedure performed to increase the reimbursement paid to the doctor. Or how did the Medicare Fraud Strike Force Teams harness data analytics? Capitation removes the incentive to a) control costs. b) underutilize health care. c) file a reimbursement claim. d) provide unnecessary services. Capitation creates incentives for efficiency, cost control, and preventive care. Under capitation, a doctor, medical group, hospital or integrated health system receives a certain flat fee every month for taking care of an individual enrolled in a managed health care plan. The physician, hospital or health system who is responsible for the enrolled member's health regardless of cost, in theory, capitation motivates the health care provider to provide health screenings (mammograms, pap smears, PSA tests), immunizations, prenatal care, and other preventive care to enrolled members, and to focus on keeping the member healthy through good primary care. Many health plans offer physicians bonuses for efficiency--either for following 'utilization management' guidelines (which try to keep the use of health care services within certain parameters on the part of patients and doctors), or through some other mechanism. So the simple answer is yes capitation removes the incentive to provide unnecessary services. But it is worth noting from the literature that in some markets, there is a danger that, improperly handled and managed, capitation could create some disincentives to care, rather than encouraging the most efficient care possible. The ACA specifies that ______ can be covered under their parents' health insurance plans. a) Children under the age of 26 b) Children who are unemployed c) Children attending college d) Children up to the age of 19 What is the incentive under fee-for-service reimbursement? a) Providers have an incentive to deliver nonessential services b) Insurers have an incentive to reduce premium costs c) Patients have the incentive to consume more services than necessary d) Payers have the incentive to reduce reimbursement In general, inpatient care consists of a) Treatment of acute conditions b) Care delivered in a licensed facility c) Health care delivered in conjunction with an overnight stay in a facility. d) Services delivered by a hospital Average daily census is a measure of a hospital's a) number of inpatients served daily b) average admissions per day c) the average number of patients served per month d) days of care e) daily capacity The Hill-Burton Act was passed to a) relieve shortage of hospitals b) make it mandatory for private insurers to cover hospital services c) have federal control over community hospitals d) curtail the utilization of hospital beds The first hospitals in the United States served mainly a) Those needing surgery b) The poor c) The wealthy d) Government officials Who pioneered the transformation of nursing into a recognized profession? a) Madame Curie b) Joseph Lister c) Florence Nightingale d) Cicely Saunders e) Sylvia Lack What is the backlash for managed care organizations? People needed surgeries and MCO's didn't provide those surgeries and at that point people died; that took MCO's and spun them into PPO's and gave people a way to either negotiate or appeal their cases better & to go to different providers