ATI PN FUNDAMENTALS PROCTORED
2024-2025 EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS
ALREADY GRADED A+>100% PASS
GUARANTEED!
Which of the following statements regarding employer-based health
insurance in the United States is true? - Ans>The real advent of
employer-based insurance came through Blue Cross, which was
started by hospital associations during the Depression.
The Health Maintenance Organization (HMO) Act of 1973 gave
qualified HMOs the right to "mandate" an employer under certain
conditions, meaning employers: - Ans>Would have to offer HMO plans
along side traditional fee-for-service medical plans.
Which of the following is an anticipated change in the relationships
between consumers and providers? - Ans>Providers will face many new
service demands and consumers will have virtually unfettered access
to those services
What transition began as a result of the March 2010 healthcare
reform legislation? - Ans>A transition toward new models of health care
delivery with corresponding changes system financing and provider
reimbursement.
,Which statement is false concerning ABNs? - Ans>ABN began
establishing new requirements for managed care plans participating
in the Medicare program.
Which Statement is TRUE concerning ABNs? - Ans>-ABNs are not
required for services that are never covered by Medicare.
-An ABN form notifies the patient before he or she receives the
service that it may not be
covered by Medicare and that he or she will need to pay out of
pocket.
-Although ABNs can have significant financial implications for the
physician, they also
serve an important fraud and abuse compliance function.
What is the overall function of Medicaid? - Ans>The pay for medical
assistance for certain individuals and low-income families
Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is defined as: -
Ans>Total Medical Expenses divided by Total Premiums
Provider service organizations (PSOs) function like health
maintenance organizations (HMOs) in all of the following ways,
EXCEPT: - Ans>Ties to the healthcare delivery industry rather than the
insurance industry
,Provider service organizations (PSOs) function like health
maintenance organizations (HMOs) in all of the following ways: - Ans>-
Risk pooling
-Capitalization
-Network management
Which of the following is a service provided by a well-managed third-
party administrator (TPA)? - Ans>-Administrative
-Utilization review (UR)
-Claims processing
What is tiering? - Ans>The ranking or classifying of one or more of the
provider delivery system components
Which option is a practice used to control costs of managed care? -
Ans>-Making advance payment to providers for all services needed to
care for a member
-Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment
for each service.
Which option is a risk involved in per diem payments? - Ans>-The risk to
the insurance company or health plan
-The risk to the hospital
-The risk when embracing per diem payments in complex case
, Diagnosis-related group (DRG) is: - Ans>A payment category
How is the term carve-out used when discussing managed care? -
Ans>To refer to specific benefits or services
What is the term Coordination of Benefits (COB)? - Ans>A term used to
describe how payment is coordinated for patients who have coverage
through two insurance policies
Which three components are used to determine the total RVU value
for a service? - Ans>-Malpractice expense
-Lowest market price for services used
-Medicare discounts
A fixed payment amount based upon the number of members
assigned to a provider, and does not vary based upon the number of
services rendered, is known as: - Ans>Capitation
Aligning incentives has come to mean _________. - Ans>The
appropriate addition of some risk in the exchange of health care to a
patient for some form of remuneration.
According to MedPAC, which option is a benefit or undesirable
consequence of bundling
payments? - Ans>-It allows Medicare to pay a set fee per hospitalization
episode.
-It would provide the potential to improve efficiency and quality
2024-2025 EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS
ALREADY GRADED A+>100% PASS
GUARANTEED!
Which of the following statements regarding employer-based health
insurance in the United States is true? - Ans>The real advent of
employer-based insurance came through Blue Cross, which was
started by hospital associations during the Depression.
The Health Maintenance Organization (HMO) Act of 1973 gave
qualified HMOs the right to "mandate" an employer under certain
conditions, meaning employers: - Ans>Would have to offer HMO plans
along side traditional fee-for-service medical plans.
Which of the following is an anticipated change in the relationships
between consumers and providers? - Ans>Providers will face many new
service demands and consumers will have virtually unfettered access
to those services
What transition began as a result of the March 2010 healthcare
reform legislation? - Ans>A transition toward new models of health care
delivery with corresponding changes system financing and provider
reimbursement.
,Which statement is false concerning ABNs? - Ans>ABN began
establishing new requirements for managed care plans participating
in the Medicare program.
Which Statement is TRUE concerning ABNs? - Ans>-ABNs are not
required for services that are never covered by Medicare.
-An ABN form notifies the patient before he or she receives the
service that it may not be
covered by Medicare and that he or she will need to pay out of
pocket.
-Although ABNs can have significant financial implications for the
physician, they also
serve an important fraud and abuse compliance function.
What is the overall function of Medicaid? - Ans>The pay for medical
assistance for certain individuals and low-income families
Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is defined as: -
Ans>Total Medical Expenses divided by Total Premiums
Provider service organizations (PSOs) function like health
maintenance organizations (HMOs) in all of the following ways,
EXCEPT: - Ans>Ties to the healthcare delivery industry rather than the
insurance industry
,Provider service organizations (PSOs) function like health
maintenance organizations (HMOs) in all of the following ways: - Ans>-
Risk pooling
-Capitalization
-Network management
Which of the following is a service provided by a well-managed third-
party administrator (TPA)? - Ans>-Administrative
-Utilization review (UR)
-Claims processing
What is tiering? - Ans>The ranking or classifying of one or more of the
provider delivery system components
Which option is a practice used to control costs of managed care? -
Ans>-Making advance payment to providers for all services needed to
care for a member
-Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment
for each service.
Which option is a risk involved in per diem payments? - Ans>-The risk to
the insurance company or health plan
-The risk to the hospital
-The risk when embracing per diem payments in complex case
, Diagnosis-related group (DRG) is: - Ans>A payment category
How is the term carve-out used when discussing managed care? -
Ans>To refer to specific benefits or services
What is the term Coordination of Benefits (COB)? - Ans>A term used to
describe how payment is coordinated for patients who have coverage
through two insurance policies
Which three components are used to determine the total RVU value
for a service? - Ans>-Malpractice expense
-Lowest market price for services used
-Medicare discounts
A fixed payment amount based upon the number of members
assigned to a provider, and does not vary based upon the number of
services rendered, is known as: - Ans>Capitation
Aligning incentives has come to mean _________. - Ans>The
appropriate addition of some risk in the exchange of health care to a
patient for some form of remuneration.
According to MedPAC, which option is a benefit or undesirable
consequence of bundling
payments? - Ans>-It allows Medicare to pay a set fee per hospitalization
episode.
-It would provide the potential to improve efficiency and quality
