mitc
22
qumc

One of the complaints insurance companies had about the fee-for-service model of reimbursement was that:
it rewarded the provider who prescribed the most services
Correct. The insurance companies were in the position to pay whatever was billed.
patients were discharged from the hospital too quickly
Incorrect. The complaint was that the hospital stays were too lengthy.
too many generic drugs were being prescribed
Incorrect. The complaint was that too many expensive brand-name drugs were being prescribed.

Which of the following is an example of an account receivable for a health care facility?
insurance reimbursement for services rendered
Correct. Payment owed to the facility for services provided is an account receivable.
payment due to pay for a new x-ray machine
Incorrect. This is an account payable.
wages owed to employees
Incorrect. This is an account payable.

Which of the following is the goal of managed care?
to provide good care while practicing efficiency and controlling costs
Correct. This is the goal of managed care.
to limit or delay services
Incorrect. The goal is to provide good care while controlling costs.
to reorganize the industry for a return to fee-for-service
Incorrect. The goal is to provide good care while controlling costs.

Which of the following is true for a person with a preexisting health problem?
He or she may have more difficulty purchasing health insurance.
Correct. Preexisting conditions are frequently excluded.
He or she may have to pay a higher copay for office visits.
Incorrect. Copays are not related to preexisting conditions.
He or she will qualify for Medicare.
Incorrect. Preexisting conditions do not automatically qualify one for Medicare.

What is the most serious consequence for a facility if treatments administered to patients are frequently reported and coded incorrectly?
The facility may be accused of fraud.
Correct. This has serious legal consequences.
The facility may earn lower profits than expected.
Incorrect. This may or may not occur.
The facility may fail to be reimbursed by insurance companies.
Incorrect. The facility would be reimbursed, but perhaps for the wrong item.

A health care worker who is cross-trained may be viewed as having more value to the health care facility because:
he or she has learned to perform additional duties that make his or her assignments more flexible
Correct. Flexibility allows for increased efficiency of time.
he or she has more than one college degree
Incorrect. Additional degrees are not required for cross-training.
he or she is qualified to work in more than one type of health care facility
Incorrect. Cross-training is for flexibility within the facility.

