ACCREDITED TEST BANK SOLUTION FOR
GAPENSKIS FUNDAMENTALS OF HEALTHCARE
FINANCE EXAM 2026
◉ Provider Panel. Answer: The group of providers - say doctors and
hospitals - designated as preferred by a managed care plan. Services
delivered by providers outside of the panel may be only partially
covered, or not covered at all, by the plan
◉ gatekeeper. Answer: The primary care provider, who can approve
or deny when the patient seeks additional care via a referral to a
specialist or further medical tests.
◉ Fee-for-service (FFS). Answer: an insurance payment system
where providers are paid for each service, also called indemnity plan
◉ chargemaster. Answer: a provider's official list of charges (prices)
for goods and services rendered. Also called a rate schedule
◉ Prospective Payment System (PPS). Answer: Reimbursement
payment is made based on a predetermined, fixed amount. Motivate
providers to deliver pt care in a cost effective, efficient manner
without over utilization of services. Providers know how much they
will be reimbursed in advance; can made or lose money on the
,reimbursement. Encourages efficiency: lead to faster dx and tx,
shorter LOS, ultimately lower costs.
◉ Bundled reimbursement. Answer: The prospective payment of a
single amount for several procedures.
◉ Capitation. Answer: System of payment used by managed care
plans in which physicians and hospitals are paid a fixed, per capita
amount for each patient enrolled over a stated period regardless of
the type and number of services provided; reimbursement to the
hospital on a per-member/per-month basis to cover costs for the
members of the plan.
◉ Pay for Performance (P4P). Answer: performance-oriented
incentives for hospitals and physicians to improve the quality of
patient healthcare
◉ utilization risk. Answer: the risk that patients, often members of a
managed care plan, will use more healthcare services than initially
assumed
◉ ICD codes. Answer: The international standard diagnostic
classification for all medical data concerning the incidence and
prevalence of disease in large populations and for other health
management purposes.
, ◉ CPT codes. Answer: Current procedural terminology: billing codes
for medical, surgical and diagnostic services
◉ Healthcare Common Procedure Coding System (HCPCS). Answer:
A group of codes and descriptors used to represent health care
procedures, supplies, products, and services.
◉ Healthcare Reform. Answer: The actions taken by congress in
2009 and 2010 to transform the US healthcare system. Patient
Protection and Affordable Care Act (ACA). It aims to increase the
quality and decrease the costs of healthcare services.
◉ Accountable Care Organization (ACO). Answer: An organizaiton
that integrates physicians and other healthcare providers with the
goal of controlling csots and improving quality.
◉ Medical home. Answer: A team-based model of care led by a
personal physician who provides continuous and coordinated care
throughout a patient's lifetime to maximize health outcomes.
◉ Managerial accounting. Answer: accounting used to provide
information and analyses to managers inside the organization to
assist them in decision making
GAPENSKIS FUNDAMENTALS OF HEALTHCARE
FINANCE EXAM 2026
◉ Provider Panel. Answer: The group of providers - say doctors and
hospitals - designated as preferred by a managed care plan. Services
delivered by providers outside of the panel may be only partially
covered, or not covered at all, by the plan
◉ gatekeeper. Answer: The primary care provider, who can approve
or deny when the patient seeks additional care via a referral to a
specialist or further medical tests.
◉ Fee-for-service (FFS). Answer: an insurance payment system
where providers are paid for each service, also called indemnity plan
◉ chargemaster. Answer: a provider's official list of charges (prices)
for goods and services rendered. Also called a rate schedule
◉ Prospective Payment System (PPS). Answer: Reimbursement
payment is made based on a predetermined, fixed amount. Motivate
providers to deliver pt care in a cost effective, efficient manner
without over utilization of services. Providers know how much they
will be reimbursed in advance; can made or lose money on the
,reimbursement. Encourages efficiency: lead to faster dx and tx,
shorter LOS, ultimately lower costs.
◉ Bundled reimbursement. Answer: The prospective payment of a
single amount for several procedures.
◉ Capitation. Answer: System of payment used by managed care
plans in which physicians and hospitals are paid a fixed, per capita
amount for each patient enrolled over a stated period regardless of
the type and number of services provided; reimbursement to the
hospital on a per-member/per-month basis to cover costs for the
members of the plan.
◉ Pay for Performance (P4P). Answer: performance-oriented
incentives for hospitals and physicians to improve the quality of
patient healthcare
◉ utilization risk. Answer: the risk that patients, often members of a
managed care plan, will use more healthcare services than initially
assumed
◉ ICD codes. Answer: The international standard diagnostic
classification for all medical data concerning the incidence and
prevalence of disease in large populations and for other health
management purposes.
, ◉ CPT codes. Answer: Current procedural terminology: billing codes
for medical, surgical and diagnostic services
◉ Healthcare Common Procedure Coding System (HCPCS). Answer:
A group of codes and descriptors used to represent health care
procedures, supplies, products, and services.
◉ Healthcare Reform. Answer: The actions taken by congress in
2009 and 2010 to transform the US healthcare system. Patient
Protection and Affordable Care Act (ACA). It aims to increase the
quality and decrease the costs of healthcare services.
◉ Accountable Care Organization (ACO). Answer: An organizaiton
that integrates physicians and other healthcare providers with the
goal of controlling csots and improving quality.
◉ Medical home. Answer: A team-based model of care led by a
personal physician who provides continuous and coordinated care
throughout a patient's lifetime to maximize health outcomes.
◉ Managerial accounting. Answer: accounting used to provide
information and analyses to managers inside the organization to
assist them in decision making
