After a major flu vaccination campaign, an agency bills a private insurance company for allowable ...

Answer to #1

ANS: A
Because the agency is submitting costs after the campaign is completed and in accordance with an established schedule of allowable costs, a retrospective, cost-based reimbursement payment method is being utilized. If a desire for profit was indicated, then the answer would be charges.

Answer to #2

ANS: A
Total healthcare costs are a function of prices that are established for various services and the volume or quantity of services used. Utilization of high-tech diagnostic services and lowering of copayments have been implicated in increasing total healthcare costs (thus C and D would not be correct), as well as attitudes and behaviors of consumers of health care. In general, consumers prefer to be fixed when something goes wrong rather than to practice prevention. Many consumers still believe that the physician knows best, so they do not seek much information related to costs and effectiveness of different healthcare options. When information is sought, it is not readily available or understandable. Also, consumers are not accustomed to using other, less costly healthcare providers, such as nurse practitioners.

Answer to #3

ANS: B
Assuming that a full-time RN works 2080 hours/year (40 hours  52 weeks), the nurse works (24 hours  52 weeks + 8 hours  26 weeks)/2080, which is 0.7 FTE.

Answer to #4

ANS: C
The operating budget includes a personnel budget, which takes into account productive and nonproductive paid work hours. Education hours are covered under nonproductive paid work hours in the operating budget.

Answer to #5

ANS: B
Variance reflects the difference between what was projected and the actual performance in a budget. When the variance is negative or unfavorable, the amount spent is more than what was budgeted (expenses exceed revenue); this may be a result of higher acuity. To help managers interpret and use variance information better, some institutions use flexible budgets that automatically account for census variances.

Answer to #6

ANS: B
In a capitated environment, a single fee is paid for all services provided. To be financially viable under this reimbursement model, organizations would be interested in decreasing the volume of services used and increasing the volume of patients. High-technology treatments and second opinions may increase the number of services used.

Answer to #7

ANS: B
Because staffing constitutes the largest portion of any healthcare budget, managing the mix and numbers of staff required for patient care to meet identified outcomes will have the largest impact on budgets.

Answer to #8

ANS: D
An integrated clinical information system draws on specific knowledge from many involved disciplines that interface at the patient. Successful integration of clinical information systems requires that the various disciplines work together collaboratively to transform the data into meaningful knowledge.

All of these are right, thanks!