Complete the Multiple Choice:
Question 1.1. Coordination of benefits refers to:
a penalty assessed for going out of network.
assessing payment responsibility when multiple payers exist.
benefit plan list of covered services.
vertical integration of health plans.
Question 2.2. Capitation plans are more common for physician payment because:
they can better control utilization.
physicians want more risk in their payment plans.
they are concerned about adverse selection.
physicians have larger reserves and can assume more risk.
Question 3.3. Employer premium costs for health care coverage are often lowest in which type of health plan:
HMO
PPO.
POS.
High deductible health plans with savings options.
Question 4.4. (Suppose that HCA and Tenet were to merge. Ignoring potential antitrust problems, this merger would be classified as a:
Cross-border merger
Horizontal merger
Conglomerate merger
Vertical merger
Short Essay Questions:
Question 5.5. A nursing home contracts with an HMO for skilled nursing care at $2.00 PMPM. If costs are expected to average $120 per day, what is the maximum utilization of days per 1,000 members that the nursing home can experience before it begins to lose money?
Question 6.6. An uninsured patient receives services with charges of $5,000 from a hospital. The hospital staff bills the patient $1,000 and records $4,000 as charity care. If the hospital's ratio of cost to charges is 50%, what amount would the hospital recognize as charity care in Schedule H of IRS Form 990?
Question 7.7. How is charity care usually defined?