HSA 400 Exam 2 With complete solu on RATED NEW
EDITION 2026
payment basis - Ans describes the manner by which a payer determines the amount to be paid
for a specific healthcare claim
cost-payment basis - Ans the underlying method for payment is the provider's cost
fee-schedule basis - Ans the actual payment is predetermined and is unrelated to either the
provider's cost or the provider's actual prices
price-related payment basis - Ans the provider is paid for services based on some rela onship
to its total charges or price for the services delivered to the pa ent
bundled services - Ans aggregate services provided to a pa ent in an encounter of care into
one payment unit
specific services payment - Ans payment method in which the individual services provided to a
pa ent in an encounter of care are not aggregated
price se ng - Ans the process of establishing specific prices for the services provided by the
healthcare provider
underwri ng - Ans a firm that brings our new securi es issues, agreeing to purchase and resell
them; paying for a procedure that is not certain will occur
u liza on review - Ans health plans employ doctors and nurses to review and approve the
delivery of nonemergent medical care for necessity and appropriateness
, case management - Ans the coordina on of services provided to a pa ent by a specific en ty
claims administra on - Ans health plan must verify that coverage for the services exists and
that the services were in fact performed
coordina on of benefits - Ans the process of assigning payment responsibility when mul ple
insurers exist
point of services (POS) - Ans a hybrid between an HMO and PPO in which pa ents are given
the incen ve to see providers par cipa ng in a defined network by may see non-network
providers, though usually at some addi onal cost
health maintenance organiza ons (HMOs) - Ans en es that receive premium payments from
enrollees with the understanding that the ___ will be financially responsible for all predefined
healthcare required by its enrollees for a specified period of me
staff model HMO - Ans an HMO in which the providers are employees of the HMO
group model HMO - Ans the HMO contracts with one or more medical groups to provide all
necessary services to HMO members
IPA model HMO - Ans loose affilia on of providers who agree to cover the healthcare needs of
a covered popula on on a capitated basis, usually through a per member per month payment
arrangement
network model HMO - Ans a hybrid of all three HMOs; may contract with both medical groups
and IPAs and employe individual physicians
EDITION 2026
payment basis - Ans describes the manner by which a payer determines the amount to be paid
for a specific healthcare claim
cost-payment basis - Ans the underlying method for payment is the provider's cost
fee-schedule basis - Ans the actual payment is predetermined and is unrelated to either the
provider's cost or the provider's actual prices
price-related payment basis - Ans the provider is paid for services based on some rela onship
to its total charges or price for the services delivered to the pa ent
bundled services - Ans aggregate services provided to a pa ent in an encounter of care into
one payment unit
specific services payment - Ans payment method in which the individual services provided to a
pa ent in an encounter of care are not aggregated
price se ng - Ans the process of establishing specific prices for the services provided by the
healthcare provider
underwri ng - Ans a firm that brings our new securi es issues, agreeing to purchase and resell
them; paying for a procedure that is not certain will occur
u liza on review - Ans health plans employ doctors and nurses to review and approve the
delivery of nonemergent medical care for necessity and appropriateness
, case management - Ans the coordina on of services provided to a pa ent by a specific en ty
claims administra on - Ans health plan must verify that coverage for the services exists and
that the services were in fact performed
coordina on of benefits - Ans the process of assigning payment responsibility when mul ple
insurers exist
point of services (POS) - Ans a hybrid between an HMO and PPO in which pa ents are given
the incen ve to see providers par cipa ng in a defined network by may see non-network
providers, though usually at some addi onal cost
health maintenance organiza ons (HMOs) - Ans en es that receive premium payments from
enrollees with the understanding that the ___ will be financially responsible for all predefined
healthcare required by its enrollees for a specified period of me
staff model HMO - Ans an HMO in which the providers are employees of the HMO
group model HMO - Ans the HMO contracts with one or more medical groups to provide all
necessary services to HMO members
IPA model HMO - Ans loose affilia on of providers who agree to cover the healthcare needs of
a covered popula on on a capitated basis, usually through a per member per month payment
arrangement
network model HMO - Ans a hybrid of all three HMOs; may contract with both medical groups
and IPAs and employe individual physicians
