Healthcare Finance MHA 706 – Questions & Answers
Individuals at greater risk of needing health care are more likely to
purchase insurance Correct Ans - Adverse selection
Healthcare Finance Correct Ans - the practice of finance, including
both accounting AND financial management
Accounting Correct Ans - the measurement, in financial (dollar)
terms of events that reflect the resources, operations, and financing of an
organization
Financial Management Correct Ans - provides the theory, concepts,
an tools necessary to help managers make better financial decisions
Characteristics of a business Correct Ans - -obtains financing from
the marketplace
-uses the funds to buy assets
-operates the assets to provide goods or services
-sells the goods or services to create revenue
role of finance Correct Ans - to plan for, acquire, and use resources
to maximize the efficiency of the enterprise
Financing activities can be summarized by the FOUR C's which are:
Correct Ans - -Cost minimization
-cash sufficiency
-capital access
-control of financial resources
deductibles Correct Ans - The amount that must be paid out of
pocket by the policyholder before an insurance provider will pay any
expenses
Coinsurance Correct Ans - requires an individual to pay for a
certain percentage of the eligible medical expenses
Moral Hazard Correct Ans - the risk of overuse of health services
because the insured does not bear the full cost of the consequences
, copayments Correct Ans - the fixed amount for a covered service
that the insurer mandates that the patient pay to the provider before the
patient receives services from the provider
Medicare Part A Correct Ans - covers hospital and some skilled
nursing home coverage
Medicare Part B Correct Ans - Covers physician services, outpatient
care and other miscellaneous services.
Medicare Part C Correct Ans - Often called Medicare Advantage,
managed care benefits of A &B
Medicare Part D Correct Ans - Covers prescription drugs
Medigap Correct Ans - health insurance plans that help pay
expenses not covered by Medicare
Underwriting provisions Correct Ans - Community rating and
Experience rating
Private 3rd party Correct Ans - BCBS "The Blues"
Commercial insurers
self-insurers
Medicaid Correct Ans - -low-income mothers and children
elderly, blind and disabled who receive supplemental income
-takes up a very large portion of a state's budget
Types of Managed Care Plans Correct Ans - HMO, PPO, POS
HMO Correct Ans - strong incentive to prevent illness
PPO Correct Ans - hybrid of HMO and traditional health insurance
plan, encourage their "illusion of choice"
POS (point of service) Correct Ans - "in network" provider, outside
pays a higher rate
Individuals at greater risk of needing health care are more likely to
purchase insurance Correct Ans - Adverse selection
Healthcare Finance Correct Ans - the practice of finance, including
both accounting AND financial management
Accounting Correct Ans - the measurement, in financial (dollar)
terms of events that reflect the resources, operations, and financing of an
organization
Financial Management Correct Ans - provides the theory, concepts,
an tools necessary to help managers make better financial decisions
Characteristics of a business Correct Ans - -obtains financing from
the marketplace
-uses the funds to buy assets
-operates the assets to provide goods or services
-sells the goods or services to create revenue
role of finance Correct Ans - to plan for, acquire, and use resources
to maximize the efficiency of the enterprise
Financing activities can be summarized by the FOUR C's which are:
Correct Ans - -Cost minimization
-cash sufficiency
-capital access
-control of financial resources
deductibles Correct Ans - The amount that must be paid out of
pocket by the policyholder before an insurance provider will pay any
expenses
Coinsurance Correct Ans - requires an individual to pay for a
certain percentage of the eligible medical expenses
Moral Hazard Correct Ans - the risk of overuse of health services
because the insured does not bear the full cost of the consequences
, copayments Correct Ans - the fixed amount for a covered service
that the insurer mandates that the patient pay to the provider before the
patient receives services from the provider
Medicare Part A Correct Ans - covers hospital and some skilled
nursing home coverage
Medicare Part B Correct Ans - Covers physician services, outpatient
care and other miscellaneous services.
Medicare Part C Correct Ans - Often called Medicare Advantage,
managed care benefits of A &B
Medicare Part D Correct Ans - Covers prescription drugs
Medigap Correct Ans - health insurance plans that help pay
expenses not covered by Medicare
Underwriting provisions Correct Ans - Community rating and
Experience rating
Private 3rd party Correct Ans - BCBS "The Blues"
Commercial insurers
self-insurers
Medicaid Correct Ans - -low-income mothers and children
elderly, blind and disabled who receive supplemental income
-takes up a very large portion of a state's budget
Types of Managed Care Plans Correct Ans - HMO, PPO, POS
HMO Correct Ans - strong incentive to prevent illness
PPO Correct Ans - hybrid of HMO and traditional health insurance
plan, encourage their "illusion of choice"
POS (point of service) Correct Ans - "in network" provider, outside
pays a higher rate
