HOM 5307 Exam 1 Set 3 Questions and Answers Solved Correctly Rated A+
T or F: In markets with high levels of managed care penetration, hospitals are usually paid using a sliding
scale discount on charges method. - Answers False
T or F: The same methodology used to pay a hospital for inpatient care is usually also use to pay for
outpatient care. - Answers False
T or F: Fee-for-service payment is the most common method used by HMOs to pay specialists. - Answers
True
T or F: Consolidation in the payer industry has resulted in most hospitals being unable to obtain
adequate rate increases. - Answers False
The following term refers to an all-inclusive rate paid by the HMO for both institutional and professional
services: - Answers bundled payment
Which of the following forms of hospital payment contain no elements of risk sharing by the hospital? -
Answers sliding scale FFS
What are the basic ways to compensate open-panel PCPs? - Answers FFS
Capitation is a physician payment method preferred by many HMOs because it: - Answers Costs are
predictable
Is less costly to administer than FFS
Eliminates the FFS incentive to overutilize
How are outlier cases determined by a hospital? - Answers through the chargemaster
Payment to a facility for outpatient procedures may be increased on a case-by-case basis through which
of the following? - Answers carve-outs
T or F: All of the following are alternatives to acute care hospitalization.
▪ Subacute care
▪ Step-down units
▪ Outpatient facilities/units
▪ Home care
▪ Hospice care - Answers True
T or F: All three methods used to manage utilization during the course of a hospitalization.
Pre-certification that includes the authorized coverage length of stay
T or F: In markets with high levels of managed care penetration, hospitals are usually paid using a sliding
scale discount on charges method. - Answers False
T or F: The same methodology used to pay a hospital for inpatient care is usually also use to pay for
outpatient care. - Answers False
T or F: Fee-for-service payment is the most common method used by HMOs to pay specialists. - Answers
True
T or F: Consolidation in the payer industry has resulted in most hospitals being unable to obtain
adequate rate increases. - Answers False
The following term refers to an all-inclusive rate paid by the HMO for both institutional and professional
services: - Answers bundled payment
Which of the following forms of hospital payment contain no elements of risk sharing by the hospital? -
Answers sliding scale FFS
What are the basic ways to compensate open-panel PCPs? - Answers FFS
Capitation is a physician payment method preferred by many HMOs because it: - Answers Costs are
predictable
Is less costly to administer than FFS
Eliminates the FFS incentive to overutilize
How are outlier cases determined by a hospital? - Answers through the chargemaster
Payment to a facility for outpatient procedures may be increased on a case-by-case basis through which
of the following? - Answers carve-outs
T or F: All of the following are alternatives to acute care hospitalization.
▪ Subacute care
▪ Step-down units
▪ Outpatient facilities/units
▪ Home care
▪ Hospice care - Answers True
T or F: All three methods used to manage utilization during the course of a hospitalization.
Pre-certification that includes the authorized coverage length of stay
