MHA 706 Midterm- Lord

Proprietorships & Partnerships: Pros & Cons - Answer-Pros: Ease of Information, Subject to a few regulations, no corporation income taxes. Cons: Limited life, difficult to transfer, unlimited life, difficult to raise capital. Corporations: Pros & Cons - Answer-Pros: Unlimited life, easy transfer of ownership, limited liability, ease of raising capital. Cons: Cost of formation and reporting, double or triple taxes must be paid. Non-profit Organization - Answer-Exempt from taxes. Goal is to improve community. For-profit Organizations - Answer-(Investor Owned) Goal is to maximize shareholder return. Owe taxes. Agency Problem - Answer-the possibility of conflict of interest between the stockholders and management of a firm. Example: Hire someone to carry out a job function, but they go out of their interests instead of best interests of company/organization. Third-party payor system in the US (i.e. private vs public) - Answer-Private: Blue Cross Blue Shield, Commercial Insurers, Self-Insurers. (AETNA) Public: Medicare and Medicaid-both offer services to different levels. "Safety net" Lowest reimbursement rates. Reimbursement methods (fee-for-service vs. capitation) - Answer-Fee for Service: payment is tied to amount of services provided. (Decades ago) *Dental industry* Capitation: payment is tied to the size of the covered population (number of enrollees) Payment is based on per # per month. *Decreasing utilization* Population is healthier. Medicare reimbursement for different types of providers - Answer-Medicare parts A, B & C. Medicare Part A (aka Hospital Insurance or HI) - Answer-Provides hospital insurance automatically at age 65 (if FICA qualified) at no fee but may have deductible & co-pay. Medicare Part B - Answer-The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies. Medicare Part C (Medicare Advantage) - Answer-•Replaces and covers expenses found in Part A and B •Medicare private fee-for-service plans (PFFS) •Medicare managed care plans (HMOs and PPOs)