MHA Healthcare Economics and Reimbursement 2

Question 1

Accountable Care Organizations (ACOs) under Medicare primarily aim to:

Accepted Answer

Coordinate care among providers to improve quality and reduce costs, sharing savings with CMS

Answer

Replace private insurance with government coverage

Answer

Eliminate fee-for-service payment entirely

Answer

Require all providers to accept capitation rates

Question 2

In a bundled payment model, reimbursement is structured as:

Accepted Answer

A single payment covering all services from multiple providers for a defined episode of care

Answer

A single payment to the hospital only for an episode of care

Answer

Monthly capitated payments to primary care physicians

Answer

Daily payments based on ICU census

Question 3

The Resource-Based Relative Value Scale (RBRVS) is used by Medicare to determine payments for:

Accepted Answer

Physician professional services

Answer

Hospital inpatient stays

Answer

Prescription drugs under Part D

Answer

Skilled nursing facility care

Question 4

Under value-based purchasing (VBP) programs, hospitals that perform poorly on quality metrics face:

Accepted Answer

A reduction in their Medicare base payment rates

Answer

Automatic loss of Medicare certification

Answer

Mandatory participation in a remediation program only

Answer

No financial penalty — only public reporting

Question 5

Which metric is most commonly used to evaluate the financial health of a hospital's revenue cycle?

Accepted Answer

Days in accounts receivable (DAR)

Answer

Length of stay

Answer

Nurse-to-patient ratio

Answer

Operating margin only

Question 6

The 'two-midnight rule' issued by CMS is relevant to which aspect of hospital reimbursement?

Accepted Answer

Determining when a patient qualifies for inpatient admission status versus observation

Answer

Setting maximum length-of-stay limits for DRG payments

Answer

Calculating overtime for nursing staff

Answer

Defining readmission windows for penalty calculations

Question 7

The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for excess readmissions primarily to:

Accepted Answer

Incentivize better discharge planning and post-acute care coordination

Answer

Reward hospitals with high surgical volume

Answer

Eliminate short-stay admissions

Answer

Increase use of skilled nursing facilities