MHA Healthcare Economics and Reimbursement

Question 1

What is the primary purpose of Diagnosis-Related Groups (DRGs) in hospital reimbursement?

Accepted Answer

To reimburse hospitals a fixed amount based on patient diagnosis

Answer

To pay hospitals based on actual services rendered

Answer

To calculate physician salaries

Answer

To determine outpatient copayments

Question 2

Which reimbursement model pays providers a set amount per patient per month regardless of services used?

Accepted Answer

Capitation

Answer

Fee-for-service

Answer

Per diem

Answer

Case rate

Question 3

The Medicare Prospective Payment System (PPS) was introduced in 1983 primarily to address which problem?

Accepted Answer

Rapid escalation of hospital costs under cost-based reimbursement

Answer

Lack of physician specialists

Answer

Shortage of inpatient beds

Answer

Inadequate coverage for outpatient services

Question 4

In healthcare economics, the term 'moral hazard' most closely refers to:

Accepted Answer

Overconsumption of healthcare when insured because the patient does not bear the full cost

Answer

Fraudulent billing by providers

Answer

Underinsurance leading to delayed care

Answer

Ethical violations in clinical decision-making

Question 5

A hospital's 'charge master' (chargemaster) is best described as:

Accepted Answer

The master schedule of list prices for all hospital services and supplies

Answer

The list of negotiated rates with commercial payers

Answer

A summary of Medicare cost reports

Answer

A coding reference for ICD-10 diagnoses

Question 6

Which federal program provides healthcare coverage primarily for low-income individuals and is jointly funded by state and federal governments?

Accepted Answer

Medicaid

Answer

Medicare

Answer

CHIP only

Answer

TRICARE

Question 7

The concept of 'adverse selection' in health insurance markets refers to:

Accepted Answer

Sicker individuals being more likely to seek and purchase insurance, raising average costs

Answer

Insurers intentionally excluding high-risk patients from coverage

Answer

Physicians selecting only well-paying patients

Answer

Employers choosing cheaper but inferior benefit plans