Exam Prep Financing The Provision Of Care Chapter 3

Chapter 3: Financing the Provision of Care

1. All of the following budget elements are categorized as expenditures except:

a. Costs.

b. Taxes.

c. Revenue.

d. Overhead.

Page Ref: 62

2. By law, for-profit organizations can use “extra” money to:

a. Pay bonuses to personnel.

b. Pay dividends to stockholders.

c. Fund improvements.

d. All of the above

Page Ref: 49

3. When revenue and expenditures are equal, this is known as:

a. Breaking even.

b. Making a profit.

c. Taking a loss.

d. Reinvestment.

Page Ref: 64

4. Which of the following is an example of a public health care facility?

a. A for-profit hospital

b. A community-based free clinic

c. A physician’s office

d. A hospital-based walk-in clinic

Page Ref: 49

5. Which of the following is an example of a third-party payer?

a. The patient paying a co-pay

b. The physician getting reimbursement for services provided

c. The parents of a minor patient

d. Prudential health insurance

Page Ref: 52

6. Which statement about Medicare is true?

a. Medicare is a health insurance company.

b. Medicare covers health care services to indigent patients.

c. Medicare covers health care services to those 65 years and older.

d. Medicare covers only those serving in the military.

Page Ref: 50

7. When a patient has an injury or illness shown to be a result of employment, health services are usually paid for by:

a. The patient’s health care coverage.

b. Workers’ compensation insurance.

c. Medicaid.

d. TriCare.

Page Ref: 50

8. Which of the following is the term used for the limitation placed on the amount a third-party payer will reimburse for a service?

a. Co-insurance

b. Deductible

c. Allowed amount

d. Co-payment

Page Ref: 51/52

9. A balance among various types of payers to one health care facility is known as:

a. Case mix.

b. Payer balance.

c. Reimbursement coverage.

d. Revenue sourcing.

Page Ref: 52

10. The general rule in business is that no single customer should ever represent more than ________ of the facility’s total revenue.

a. 10%

b. 25%

c. 30%

d. 60%

Page Ref: 52

11. When a predetermined amount of money is paid for each covered procedure, service, and treatment, this reimbursement method is known as:

a. Capitation.

b. Fee-for-service.

c. Episodic care.

d. Reasonable.

Page Ref: 53

12. The reimbursement method RBRVS uses RVUs to determine how much the allowed amounts are for each procedure or service. RVU stands for:

a. Reasonable Variable Unit.

b. Reliable Variations and Uniformity.

c. Resources Valuation Unity.

d. Relative Value Unit.

Page Ref: 53

13. The RBRVS formula includes weighted value for:

a. Malpractice expense.

b. Cost of training to perform the procedure.

c. Number of years the physician has been practicing.

d. Age of the patient.

Page Ref: 53

14. In order to provide a dollar value to the total of the RBRVS formula, the total number of RVUs is multiplied by the ________ as determined by Congress for that calendar year.

a. capitation factor

b. UCR

c. geographical practice cost indices

d. conversion factor

Page Ref: 53

15. Diagnosis-related groups (DRGs) are an example of which type of reimbursement plan?

a. Capitation

b. Episodic care

c. Fee-for-service

d. UCR

Page Ref: 55

16. Resource utilization factors which of the following into the payment amount?

a. Age of patient

b. Risk of mortality

c. Quantity of diagnostic services

d. Gender of patient

Page Ref: 55

17. Which of the following is included in Medicare Severity DRG (MS-DRG) calculations to determine amount of reimbursement?

a. A geographic location adjustment

b. Date of admission

c. Physician specialty

d. Patient prognosis

Page Ref: 55

18. An enhanced payment for services can be received by a physician participating in CMS’s:

a. TriCare.

b. Primary Care Incentive Payment Program (PCIP).

c. STTR grant program.

d. Medicaid.

Page Ref: 57

19. Which of the following is considered a capital expense?

a. Payroll

b. Utility payments

c. Telephone payments

d. Purchase of an MRI unit

Page Ref: 57

20. Which of the following is a type of government financing that provides money that does not have to be paid back?

a. Commercial loan

b. Grant

c. Secured bond issuance

d. Claims submitted to Medicare

Page Ref: 58

21. Physicians and hospitals that need financial help paying for the conversion to electronic health records could get incentive payments through:

a. CMS.

b. CDC.

c. EPA.

d. PQRS.

Page Ref: 59

22. For-profit health care facilities can raise money by:

a. Raising taxes on area residents.

b. Hiring more support staff.

c. Issuing and selling shares of stock.

d. Expanding the size of their offices.

Page Ref: 61

23. A secured bond issuance is:

a. Used to raise small amounts of money (less than $1,000).

b. Also known as a debenture.

c. The same as selling stock in the company.

d. Backed with some type of asset.

Page Ref: 61

24. Which of the following is an example of accounts receivable?

a. Telephone bill

b. Claims submitted to third-party payer

c. Payroll

d. Dividends to stockholders

Page Ref: 62

25. The money paid out for bandages and exam table covers are considered:

a. Fixed costs.

b. Reimbursement from third-party payers.

c. Variable expenditures.

d. Payroll.

Page Ref: 62