29.Which of the following payment initiatives are included in healthcare reform legislation (the Affordable Care Act)?
a. Value-based purchasing
b. New models of bundled payment
c. Patient age-based reimbursement
d. Initiatives a. and b. are both correct.
e. Initiatives a., b., and c. are all correct.
28.Which of the following statements about Medicares payment system for physicians services is most correct?
a. Each patient is assigned a Medicare Patient Identification Code (PIC) that reflects the severity of the patients diagnosis.
b. Patients are divided into five groups (A-E) based on diagnosis, with the E group reimbursement being the greatest.
c. Each service performed has a relative value unit (RVU) assigned that reflects the amount of physician work, practice expenses, and liability insurance costs.
d. Physicians are paid using Medicares Outpatient Observation Payment System (OOPS).
e. Physicians are paid using Medicares Ambulatory Patient Payment System (APPS).
27.Which of the following statements about Medicares inpatient prospective payment system (IPPS) is most correct?
a. Each discharge is assigned to a Medicare severity diagnosis-related group (MS-DRG) with a specified relative rate.
b. The relative weight is multiplied by a base dollar payment amount adjusted for local input prices to obtain the reimbursement amount. c. The relative weight is multiplied by a base dollar payment amount adjusted for the size of the hospital to obtain the reimbursement amount.
d. Statements a. and b. are both correct.
e. Statements a., b., and c. are all correct.
21.Which of the following statements about medical coding is incorrect?
a. ICD, CPT, and HCPCS provide a standard set of codes used to transform medical diagnoses and procedures into code numbers that can be universally recognized and interpreted.
b. ICD codes are published by the World Health Organization.
c. CPT codes were developed and are copyrighted by the American Medical Association.
d. HCPCS expands the CPT codes to include nonphysician services and durable medical equipment.
e. Because the coding process is technical and complex, there is little concordance between the information in the medical record and the classifications produced by medical coding.
19.Which of the following reimbursement methods creates the greatest incentive for providers to control the cost of delivering health services?
a. Cost-based reimbursement
b. Charge-based reimbursement
c. Discounted charge based reimbursement
d. Per diagnosis prospective payment
e. Capitation
23.Which of the following statements about capitation is most correct?
a. Capitation creates a delay between providing services and receiving payment.
b. The capitation payment amount to providers varies significantly from month to month and hence is difficult to predict.
c. Capitation encourages providers to focus on prevention and wellness.
d. Capitation places a greater administrative burden on providers than does fee-for-service payment.
e. Capitation uses a per diagnosis methodology to set hospital payment rates.
8.Which of the following tax-related benefits are generally granted to not-for- profit corporations?
a. Exemption from federal and state income taxes
b. Exemption from property taxes c. Ability to issue tax-exempt (municipal) debt
d. Ability to accept contributions that are tax deductible to the donor
e. Answers a., b., c., and d. are correct.
16. True or False: Under current law, the profits of not-for-profit corporations can be distributed to individuals.
14.Which of the following is NOT expected to result from healthcare reform initiatives?
a. Increased formation of accountable care organizations (ACOs)
b. Increased emphasis on population health
c. Decreased need for data analytics
d. Increased provider consolidation
e. Staffing shortages in selected areas
13. True or False: Because the organizational and financial goals of for-profit and not-for-profit provider organizations differ, their financial decision-making processes usually lead to very different decisions.
