MHA Healthcare Economics and Reimbursement 3

Question 1

In healthcare finance, the difference between a hospital's charges and the actual payments received from payers is called:

Accepted Answer

Contractual adjustment (or allowance)

Answer

Net revenue

Answer

Uncompensated care

Answer

Bad debt expense

Question 2

Which coding system is used in the United States to classify diagnoses and inpatient procedures for billing and data purposes?

Accepted Answer

ICD-10-CM/PCS

Answer

CPT-4

Answer

HCPCS Level II

Answer

APC codes

Question 3

Medicare Part A primarily covers:

Accepted Answer

Inpatient hospital stays, skilled nursing facilities, hospice, and some home health care

Answer

Physician office visits and outpatient services

Answer

Prescription drugs

Answer

Preventive services and lab tests only

Question 4

A Federally Qualified Health Center (FQHC) receives what type of enhanced reimbursement from Medicare and Medicaid?

Accepted Answer

A Prospective Payment System (PPS) rate based on encounter type

Answer

Cost-based prospective payment

Answer

Standard fee-for-service with no enhancement

Answer

Capitation only

Question 5

The medical loss ratio (MLR) rule under the Affordable Care Act requires that health insurers spend what minimum percentage of premiums on clinical care and quality improvement?

Accepted Answer

80% for individual/small group and 85% for large group markets

Answer

50% for all markets

Answer

70% for large group markets

Answer

90% for all fully-insured plans

Question 6

Which payment arrangement places the greatest financial risk on the provider organization?

Accepted Answer

Global capitation with full risk for all services

Answer

Fee-for-service with no performance adjustment

Answer

Shared savings only (upside risk)

Answer

Per diem inpatient rates

Question 7

The Centers for Medicare & Medicaid Services (CMS) uses the Medicare Cost Report primarily to:

Accepted Answer

Determine cost-based reimbursement for critical access hospitals and calculate various payment adjustments

Answer

Audit physician billing practices

Answer

Set negotiated rates for commercial insurers

Answer

Approve new hospital construction projects