HSC0003 TEST 3 CH.22, 23, 24 QUESTIONS AND
ANSWERS
Can Insurance company legally refuse the paper of services if they are not
preauthorized? Do you have to preauthorize all your services? - Answers :Yes, It is
legal to refuse if it is not preauthorized. Not all services are necessary for
preauthorizations.
What is the goal of manage care? - Answers :Provide health care that patients can
afford, ensure high-quality care, discourage unnecessary costs, eliminate duplication of
procedures.
Which of the following conditions will qualify you to medicare? - Answers :Ages 65 or
older and others, such as the severely disabled, who qualify for social security.
How does prepaid healthcare encourage efficiency? - Answers :It is a contracted type of
insurance plan in which health care providers are paid a specific amount to provide
certain health benefits. This motivates providers to be more efficient.
What does medicare part A do? - Answers :Helps pay for inpatient care in a hospital or
skilled facility (following a hospital stay), some home health care, and hospice care.
What is the consequence if a facility is consistently coding procedures/treatments
incorrectly? - Answers :Loss of income for the provider to charges of fraud for over-
billing.
What is a diagnostic related group (DRG)? - Answers :It is a classification system of
patients based on their diagnoses to predetermine medicare payments.
How does diagnostic related groups help control medicare cost? - Answers :The
average expected hospital costs of all common diagnoses were determined. The
hospitals are reimbursed for the care medicare patients receive.
What category of expense is the highest for health care organization? What are the
categories and which one is the most expensive? - Answers :Preferred provider
organization is the most expensive.
Point of service plan - Answers :An HMO and Pop hybrid in which members can see an
in-network provider for a reduced rate or out of network provider for a higher rate.
Preferred provider organization - Answers :Health plan in which providers contract on a
fee for service basis with employers, insurance plans, or other third-party
administrators.
ANSWERS
Can Insurance company legally refuse the paper of services if they are not
preauthorized? Do you have to preauthorize all your services? - Answers :Yes, It is
legal to refuse if it is not preauthorized. Not all services are necessary for
preauthorizations.
What is the goal of manage care? - Answers :Provide health care that patients can
afford, ensure high-quality care, discourage unnecessary costs, eliminate duplication of
procedures.
Which of the following conditions will qualify you to medicare? - Answers :Ages 65 or
older and others, such as the severely disabled, who qualify for social security.
How does prepaid healthcare encourage efficiency? - Answers :It is a contracted type of
insurance plan in which health care providers are paid a specific amount to provide
certain health benefits. This motivates providers to be more efficient.
What does medicare part A do? - Answers :Helps pay for inpatient care in a hospital or
skilled facility (following a hospital stay), some home health care, and hospice care.
What is the consequence if a facility is consistently coding procedures/treatments
incorrectly? - Answers :Loss of income for the provider to charges of fraud for over-
billing.
What is a diagnostic related group (DRG)? - Answers :It is a classification system of
patients based on their diagnoses to predetermine medicare payments.
How does diagnostic related groups help control medicare cost? - Answers :The
average expected hospital costs of all common diagnoses were determined. The
hospitals are reimbursed for the care medicare patients receive.
What category of expense is the highest for health care organization? What are the
categories and which one is the most expensive? - Answers :Preferred provider
organization is the most expensive.
Point of service plan - Answers :An HMO and Pop hybrid in which members can see an
in-network provider for a reduced rate or out of network provider for a higher rate.
Preferred provider organization - Answers :Health plan in which providers contract on a
fee for service basis with employers, insurance plans, or other third-party
administrators.
