TEST BANK Chapter 4

Fundamentals of U.S. Health Care Chapter 4 – Health care financing and payment for services Test Bank Multiple Choice Which of the following defines “fee-for-service reimbursement”? Fixed prospective payment for services provided during a specified time period Retroactive payment made after services are provided Payment at the time of service Various payments for specific services provided during a specified time period Which of the following defines capitation? Payment at the time of service Fixed prospective payment for services provided Fixed payment made for each enrolled patient rather than reimbursement based on the type and number of services provided Various payments for specific services provided during a specified time period Which of the following Medicare programs covers hospital charges? Part A Part B Part C Part D Which of the following Medicare parts is also called “Medicare Advantage”? Part A Part B Part C Part D Which of the following items is NOT covered by Medicare Part B? Physician office visits Outpatient X-rays Diagnostic laboratory services Hospitalization TRICARE is a health care benefit program for all of the following, EXCEPT: The Coast Guard The Navy Families of veterans with service-related disabilities Families of uniformed personnel Which of the following allows employees to continue health care coverage after the termination date of their benefits? COBRA CHAMPVA The Snyder Act TRICARE Which of the following organizations oversees the Children’s Health Insurance Program (CHIP)? FDA CMS PPO HMO Which of the following is true about BlueCross–BlueShield? It offers prepaid health services. It helps Medicare to determine covered health services. It offers free health services for low income people. It helps Medicaid to determine covered health services. Which of the following health plans was created during World War II, and provided inpatient and outpatient care for shipyard workers? TRICARE Medicare BlueCross–BlueShield Kaiser Foundation Which of the following is a third-party health plan that is funded by the federal government? TRICARE Aetna Starmark BlueCross–BlueShield Which of the following laws protects employers in the working environment by limiting the amount an injured employee can receive? COBRA Affordable Care Act HIPAA Workers’ compensation Which of the following is NOT an example of related federal workers’ compensation programs? FECA ACA OSHA FELA Which of the following terms describes tax-deferred amounts from a person’s income that can be deposited? Contributions Distributions Withdrawals Reimbursements Which of the following is the primary difference between an HMO and a PPO? HMOs pay for all services completely, except for preventive check-ups, whereas PPOs do not pay for services completely, but do partially cover preventive medicine. In an HMO, patients may select specialists, whereas in a PPO, patients must see specialists to whom they were referred. An HMO locks patients into receiving services from providers with whom it has contracts, whereas a PPO allows patients to choose among providers in return for higher deductibles and copayments. All of the above. Which of the following is a large component of utilization review? Cost of care Quality of care Distributions Copayments In the group network model: The HMO has capitation contracts with multispecialty groups. Providers are employees of the HMO. Providers are paid on a fee-for-service basis. Plan members can see out-of-network providers for additional fees. Which of the following parts of Medicare includes managed care and private fee-for-service plans, which provide contracted care to Medicare patients? Part A Part B Part C Part D Medicaid provides medical and health-related services to individuals and families with low incomes and limited resources; these individuals and families are known as Medically needy Medically indigent TRICARE HMO Which of the following is a daily determination of length of hospitalization and appropriateness of medical treatments? Concurrent utilization review Prospective utilization review Drug utilization review Retrospective utilization review Which of the following was the most significant change in health legislation? Medicare Affordable Care Act Medicaid TRICARE Which of the following parts of Medicare was previously called Medicare + Choice? Medicare Part D Medicare Part B Medicare Part A Medicare Part C Which of the following parts of Medicare covers prescription drugs? Part C Part D Part B Part A Which of the following is the largest source of public funding related to family planning services? Medicaid plans Medicare Indian Health Service Children’s Health Insurance Program Which of the following are NOT included in private health plans? Comprehensiveness of benefits Premiums Medicare beneficiaries Copays True or False _____ 1. Fee-for-service pays for particular services that are itemized at a specific time. _____ 2. Medicaid was first designed to insure medium-income children. _____ 3. President Nixon signed into law the bill that led to the development of Medicare and Medicaid. _____ 4. Medicare Part A is funded through a tax paid by working individuals on all of their earned income. _____ 5. Part C or Medication Prescription Drug Plans add prescription drug coverage. _____ 6. Most Medicaid expenditures are for acute care, and also cover nursing home or long-term care. _____ 7. TRICARE supports active-duty uniformed military members and their families. _____ 8. TRICARE Standard is a preferred provider organization (PPO) option. _____ 9. Health services for Native Americans were established by the Snyder Act. _____ 10. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), allows employees to continue health care coverage after the termination date of their benefits. _____ 11. The Children’s Health Insurance Program (CHIP) covers uninsured children and teenagers for routine physician visits, prescriptions, dental visits, immunizations, and mental health visits. _____ 12. BlueCross covers hospital bills and certain physician services. _____ 13. BlueShield covers only hospital bills. _____ 14. Workers’ compensation insurance provides weekly cash payments and reimbursements of health care costs. _____ 15. In the United States, medical savings accounts are usually associated with self-employed individuals. _____ 16. The first Health Maintenance Organizations (HMOs) were developed as a result of the Health Maintenance Organization Assistance Act of 1973. _____ 17. HMOs are easily recognized as BCBS plans, but all BCBS organizations do not offer any HMO plan. _____ 18. A preferred provider organization (PPO) is also known as a participating provider organization. _____ 19. HMOs are usually more flexible in their health care coverage than PPOs. _____ 20. Patients who lack health insurance must pay cash for health services. Matching ERISA COBRA FELA OSHA TRICARE Medigap _____ 1. Provides military medical care for families of active-duty members _____ 2. Helps to cover costs not reimbursed by the original Medicare plan _____ 3. Responsible for ensuring safety at work and a healthful work environment _____ 4. Includes provisions for health care coverage continuation, applying to group health plans of employers with two or more employees _____ 5. An example of a federal workers’ compensation program _____ 6. Allows employees to continue health care coverage after the termination date of their benefits CHAMPVA Capitation Medicaid Fixed premiums Underwriting Prepaid health plan _____ 7. Not paid to health insurance payers by employers _____ 8. To sign and accept liability, and guarantee payment, if loss or damage occurs _____ 9. The Kaiser Permanente Program is an example _____ 10. Health care program for low-income pregnant women _____ 11. Shares costs of covered health care services and supplies with eligible beneficiaries for veterans _____ 12. Pays a fixed amount per person for health services without regard to the volume of services provided Medicare Part A Medicare Part B Medicare Part C Medicare Part D Medical savings account Health maintenance organization _____ 13. Tax-deferred amounts from a person’s income can be deposited _____ 14. The goal is to control costs while improving preventive care _____ 15. Also called Medicare Advantage _____ 16. Former federal employees who received federal employee pensions rather than Social Security are not covered _____ 17. Covers durable medical equipment and certain medical services _____ 18. Medicare prescription drug plans Answer Key – Test Bank Chapter 4 Multiple Choice 1. B 2. C 3. A 4. C 5. D 6. C 7. A 8. B 9. A 10. D 11. A 12. D 13. B 14. A 15. C 16. B 17. A 18. C 19. B 20. A 21. B 22. D 23. B 24. A 25. C True or False 1. T 2. F 3. F 4. T 5. F 6. T 7. T 8. F 9. T 10. T 11. T 12. F 13. F 14. T 15. T 16. T 17. F 18. T 19. F 20. T Matching 1. E 2. F 3. D 4. A 5. C 6. B 7. D 8. E 9. F 10. C 11. A 12. B 13. E 14. F 15. C 16. A 17. B 18. D