HSA4109 Study Guide Questions with Correct
Answers
What are prepaid medical groups?
A way of accessing and paying for healthcare services rather than protecting against financial
losses.
What is an HMO?
Health Maintenance Organization; an organization that was captitated (charged a preset amount
per member or per enrollee, or per month) and that provided services directly through its
facilities and personnel, combining the functions of finance and delivery.
Why did prepaid groups continue to form, despite the American Medical Association's
opposition?
-employers' need to attract and retain employees
-providers effort to secure steady incomes
-consumers quest for improved and affordable care health
-efforts by the housing lending agency to reduce the number of foreclosures caused by health
related personal bankruptcies.
Medicare and Medicaid were created ....
-1965
-President JFK proposed what eventually became Part A of Medicare.
-Pres. Lyndon B. Johnson worked aggressively to achieve JKF's domestic goals after his
assassination.
, What is Medicare Part A?
benefits for hospitalization
What is Medicare Part B?
Physician services
What is the third party payment?
third party payers; it severs the financial link between the provider of service and the patient- a
disconnect that fostered increases in both the price of services and utilization.
What did the 1973 Federal HMO act do?
What are the requirements that HMOs must meet to be federally qualified?
HMOs have to satisfy a series of requirements such as:
-meeting minimum benefit package standards,
-demonstrating that their provider networks were adequate,
-having a quality assurance system,
-meeting stands of financial stability
- having an enrollee grievance process.
What is a PPO?
Preferred Provider Organization
-PPOs benefits did not require authorization from patients PCP to access care from specialists or
other providers
-faced lower cost sharing
Answers
What are prepaid medical groups?
A way of accessing and paying for healthcare services rather than protecting against financial
losses.
What is an HMO?
Health Maintenance Organization; an organization that was captitated (charged a preset amount
per member or per enrollee, or per month) and that provided services directly through its
facilities and personnel, combining the functions of finance and delivery.
Why did prepaid groups continue to form, despite the American Medical Association's
opposition?
-employers' need to attract and retain employees
-providers effort to secure steady incomes
-consumers quest for improved and affordable care health
-efforts by the housing lending agency to reduce the number of foreclosures caused by health
related personal bankruptcies.
Medicare and Medicaid were created ....
-1965
-President JFK proposed what eventually became Part A of Medicare.
-Pres. Lyndon B. Johnson worked aggressively to achieve JKF's domestic goals after his
assassination.
, What is Medicare Part A?
benefits for hospitalization
What is Medicare Part B?
Physician services
What is the third party payment?
third party payers; it severs the financial link between the provider of service and the patient- a
disconnect that fostered increases in both the price of services and utilization.
What did the 1973 Federal HMO act do?
What are the requirements that HMOs must meet to be federally qualified?
HMOs have to satisfy a series of requirements such as:
-meeting minimum benefit package standards,
-demonstrating that their provider networks were adequate,
-having a quality assurance system,
-meeting stands of financial stability
- having an enrollee grievance process.
What is a PPO?
Preferred Provider Organization
-PPOs benefits did not require authorization from patients PCP to access care from specialists or
other providers
-faced lower cost sharing
