NEBC EXAM 2025 |GUARANTEED
ACCURATE ANSWERS |VERIFIED
For Profit Organizations - ACCURATE ANSWERS✔✔ Can lawfully
release a patient who does not have the ability to pay for services (after
EMTALA). Serve lower income populations. Owned by investors or
shareholders. Large portion of budget allocated to marketing and
advertising.
not-for-profit organizations - ACCURATE ANSWERS✔✔ Must treat all
conditions or people regardless of insurance or ability to pay. Considered
charities by IRS. Do not pay federal or state/local property taxes.
Obligation to the community.
Medicare - ACCURATE ANSWERS✔✔ National Health Insurance
program for people 65 and older, disabled, and any age with ESRD.
Medicare A - ACCURATE ANSWERS✔✔ Covers inpatient hospital
stays, some hospice and home health care, no monthly premium
Medicare B - ACCURATE ANSWERS✔✔ Medical insurance, pays for
doctor services and outpatient services, PT/OT services. Monthly
premium.
,Medicare C - ACCURATE ANSWERS✔✔ Often called the advantage
plan or choice plan. Includes A and B, most include D. May offer dental,
vision, and wellness
Medicare D - ACCURATE ANSWERS✔✔ Prescription drug coverage.
Monthly premium. Available to everyone, must join Medicare plan that
includes part D
Medicaid - ACCURATE ANSWERS✔✔ A federal and state assistance
program that pays for health care services for people who cannot afford
them. Low-income children, pregnant women, and elderly. Pays long
term care.
Affordable Care Act - ACCURATE ANSWERS✔✔ An expansion of
medicaid, most of employers must provide health insurance, have
insurance or face surtax, prevents rejection based on pre-existing
condition. Also referred to as "Obamacare", signed into law in 2010.
Make affordable health insurance available to more people.
Payors - ACCURATE ANSWERS✔✔ Employers, government,
insurance companies, people who pay for healthcare services
Charity Pay - ACCURATE ANSWERS✔✔ Healthcare system received
no reimbursement for services
,Health Maintenance Organization (HMO) - ACCURATE
ANSWERS✔✔ an organization that provides comprehensive medical
care to subscribers for a fixed fee. Cost effective care focused on
preventative care. Network, group, staff and independent practice
associations.
Preferred Provider Organization (PPO) - ACCURATE ANSWERS✔✔
Group of healthcare providers that provide services to a specific group,
often at a reduced rate. Cost is higher to use out of network provider.
Help negotiate cost of services between the providers and purchasers.
Diagnosis Related Group (DRGs) - ACCURATE ANSWERS✔✔
classifies patients by age, diagnosis, surgical procedure, and other
information with hundreds of different categories to predict the use of
hospital resources, including length of stay, resulting in a fixed payment
amount
Prospective Payment Systems (PPS) - ACCURATE ANSWERS✔✔
Required facilities providing services to Medicare clients to be
reimbursed using a fixed-rate system and included monetary incentives
to reduce the length of hospital stays.
(Based on diagnosis-related group (DRG) categories)
Social Health Maintenance Organization (SHMO) - ACCURATE
ANSWERS✔✔ special type of health plan that provides the full range
, of Medicare benefits offered by standard Medicare HMOs, plus other
services that include the following: prescription drug and chronic care
benefits, respite care, and short-term nursing home care; homemaker,
personal care services, and medical transportation; eyeglasses, hearing
aids, and dental benefits
Pay for Performance (P4P) - ACCURATE ANSWERS✔✔ performance-
oriented incentives for hospitals and physicians to improve the quality of
patient healthcare. 4 quality measures - performance, outcomes, patient
satisfaction/experience, structures and technologies (EHR)
Value Based Purchasing - ACCURATE ANSWERS✔✔ A pay for
performance methodology used to reimburse hospitals based on
outcomes. Provided by Centers for Medicare and Medicaid Services.
Incentive payments to acute-care hospitals yearly based on total
performance score (TPS)
Budget Cycle - ACCURATE ANSWERS✔✔ Includes development,
monitoring, reporting, justifying and variance analysis. Four types of
budget - revenue, expense, capital, and operating
Revenue - ACCURATE ANSWERS✔✔ anticipated amount of income
during the budget period
ACCURATE ANSWERS |VERIFIED
For Profit Organizations - ACCURATE ANSWERS✔✔ Can lawfully
release a patient who does not have the ability to pay for services (after
EMTALA). Serve lower income populations. Owned by investors or
shareholders. Large portion of budget allocated to marketing and
advertising.
not-for-profit organizations - ACCURATE ANSWERS✔✔ Must treat all
conditions or people regardless of insurance or ability to pay. Considered
charities by IRS. Do not pay federal or state/local property taxes.
Obligation to the community.
Medicare - ACCURATE ANSWERS✔✔ National Health Insurance
program for people 65 and older, disabled, and any age with ESRD.
Medicare A - ACCURATE ANSWERS✔✔ Covers inpatient hospital
stays, some hospice and home health care, no monthly premium
Medicare B - ACCURATE ANSWERS✔✔ Medical insurance, pays for
doctor services and outpatient services, PT/OT services. Monthly
premium.
,Medicare C - ACCURATE ANSWERS✔✔ Often called the advantage
plan or choice plan. Includes A and B, most include D. May offer dental,
vision, and wellness
Medicare D - ACCURATE ANSWERS✔✔ Prescription drug coverage.
Monthly premium. Available to everyone, must join Medicare plan that
includes part D
Medicaid - ACCURATE ANSWERS✔✔ A federal and state assistance
program that pays for health care services for people who cannot afford
them. Low-income children, pregnant women, and elderly. Pays long
term care.
Affordable Care Act - ACCURATE ANSWERS✔✔ An expansion of
medicaid, most of employers must provide health insurance, have
insurance or face surtax, prevents rejection based on pre-existing
condition. Also referred to as "Obamacare", signed into law in 2010.
Make affordable health insurance available to more people.
Payors - ACCURATE ANSWERS✔✔ Employers, government,
insurance companies, people who pay for healthcare services
Charity Pay - ACCURATE ANSWERS✔✔ Healthcare system received
no reimbursement for services
,Health Maintenance Organization (HMO) - ACCURATE
ANSWERS✔✔ an organization that provides comprehensive medical
care to subscribers for a fixed fee. Cost effective care focused on
preventative care. Network, group, staff and independent practice
associations.
Preferred Provider Organization (PPO) - ACCURATE ANSWERS✔✔
Group of healthcare providers that provide services to a specific group,
often at a reduced rate. Cost is higher to use out of network provider.
Help negotiate cost of services between the providers and purchasers.
Diagnosis Related Group (DRGs) - ACCURATE ANSWERS✔✔
classifies patients by age, diagnosis, surgical procedure, and other
information with hundreds of different categories to predict the use of
hospital resources, including length of stay, resulting in a fixed payment
amount
Prospective Payment Systems (PPS) - ACCURATE ANSWERS✔✔
Required facilities providing services to Medicare clients to be
reimbursed using a fixed-rate system and included monetary incentives
to reduce the length of hospital stays.
(Based on diagnosis-related group (DRG) categories)
Social Health Maintenance Organization (SHMO) - ACCURATE
ANSWERS✔✔ special type of health plan that provides the full range
, of Medicare benefits offered by standard Medicare HMOs, plus other
services that include the following: prescription drug and chronic care
benefits, respite care, and short-term nursing home care; homemaker,
personal care services, and medical transportation; eyeglasses, hearing
aids, and dental benefits
Pay for Performance (P4P) - ACCURATE ANSWERS✔✔ performance-
oriented incentives for hospitals and physicians to improve the quality of
patient healthcare. 4 quality measures - performance, outcomes, patient
satisfaction/experience, structures and technologies (EHR)
Value Based Purchasing - ACCURATE ANSWERS✔✔ A pay for
performance methodology used to reimburse hospitals based on
outcomes. Provided by Centers for Medicare and Medicaid Services.
Incentive payments to acute-care hospitals yearly based on total
performance score (TPS)
Budget Cycle - ACCURATE ANSWERS✔✔ Includes development,
monitoring, reporting, justifying and variance analysis. Four types of
budget - revenue, expense, capital, and operating
Revenue - ACCURATE ANSWERS✔✔ anticipated amount of income
during the budget period
