MHA Healthcare Economics and Reimbursement 1

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

DRGs classify hospital cases into groups expected to have similar hospital resource use, allowing Medicare to pay a predetermined fixed rate per discharge.

Question 2

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

Accepted Answer

Capitation

Answer

Capitation pays a fixed monthly amount per enrolled patient, transferring financial risk to the provider to manage utilization efficiently.

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

PPS replaced retrospective cost-based reimbursement to control Medicare spending by giving hospitals a financial incentive to be efficient.

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

Moral hazard occurs when insurance reduces the financial consequence of risky or excessive use of healthcare, leading to higher utilization than would occur without coverage.

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 chargemaster is the hospital's comprehensive price list for every service, procedure, and supply, which serves as the starting point for billing negotiations.

MHA - Master of Healthcare Administration Practice Test

MHA - Master of Healthcare Administration Practice Test

MHA Healthcare Economics and Reimbursement 1