MHA 707 EXAM C 2026 COMPREHENSIVE
STUDY GUIDE SOLUTIONS VERIFIED
◉ Americans Stat on Health Ins Coverage. Answer: 92% of the US
population have some sort of ins (8% or 26.4 M uninsured)
◉ Cost/Cost Plus. Answer: how hospitals/providers describe
payments received for services they have already provided. The
organization tracks all the costs associated with each customer and
then asks to be paid that amount. Contracts specific that the
organization will be reimbursed for actual cost plus an additional
percentage of cost (includes built in profit)
◉ How Money is Paid to Health Care Providers. Answer: Cost/Cost
Plus
Time and Materials
Fee for Service
Fixed Price
Capitation
Value
◉ Time and Materials. Answer: A contract type where the seller
charges the
,buyer for the time and the materials for the
work completed. T&M contracts should have a
not-to-exceed clause (NTE) to contain costs.
◉ fee-for-service. Answer: a system under which doctors and
hospitals receive a payment for each service they provide
◉ Fixed Price. Answer: A price that stays the same; there is no
debate over price
◉ Capitation. Answer: fixed payment per person to the health care
provider for an agreed-on array of services during a contract period
(per member/per month). Payment is the same no matter the
amount or type of service. May put the physician at odds with the
patient
◉ Value. Answer: payment model in which the provider is rewarded
for the value delivered. Value based systems are most often used
when the value is easy to measure and indisputable. Value based
purchasing, bundled payments, and P4P are used by the CMS- top
performers make extra money that is taken from poorer performers
◉ Major Health Care Payers in the US. Answer: -Private Health
Insurance (individual/small business and large)
, -Government (Medicare/Medicaid, CHIP, other government
programs)
-Individual Patient (out of pocket)
-Provider (using discounts, write offs)
-Voluntary charitable organizations
Most obtain insurance via employer or spouses' employer
Less than 2% of employees offered traditional or indemnity health
insurance plans
◉ Employer Managed Care Plans. Answer: HMO
PPO
POS
EPO
Other permutations
◉ HMO (Health Maintenance Organization). Answer: A managed
care organization that provides comprehensive medical services for
a predetermined annual fee per enrollee.
◉ PPO (Preferred Provider Organization). Answer: A type of health
plan that contracts with medical providers, such as hospitals and
STUDY GUIDE SOLUTIONS VERIFIED
◉ Americans Stat on Health Ins Coverage. Answer: 92% of the US
population have some sort of ins (8% or 26.4 M uninsured)
◉ Cost/Cost Plus. Answer: how hospitals/providers describe
payments received for services they have already provided. The
organization tracks all the costs associated with each customer and
then asks to be paid that amount. Contracts specific that the
organization will be reimbursed for actual cost plus an additional
percentage of cost (includes built in profit)
◉ How Money is Paid to Health Care Providers. Answer: Cost/Cost
Plus
Time and Materials
Fee for Service
Fixed Price
Capitation
Value
◉ Time and Materials. Answer: A contract type where the seller
charges the
,buyer for the time and the materials for the
work completed. T&M contracts should have a
not-to-exceed clause (NTE) to contain costs.
◉ fee-for-service. Answer: a system under which doctors and
hospitals receive a payment for each service they provide
◉ Fixed Price. Answer: A price that stays the same; there is no
debate over price
◉ Capitation. Answer: fixed payment per person to the health care
provider for an agreed-on array of services during a contract period
(per member/per month). Payment is the same no matter the
amount or type of service. May put the physician at odds with the
patient
◉ Value. Answer: payment model in which the provider is rewarded
for the value delivered. Value based systems are most often used
when the value is easy to measure and indisputable. Value based
purchasing, bundled payments, and P4P are used by the CMS- top
performers make extra money that is taken from poorer performers
◉ Major Health Care Payers in the US. Answer: -Private Health
Insurance (individual/small business and large)
, -Government (Medicare/Medicaid, CHIP, other government
programs)
-Individual Patient (out of pocket)
-Provider (using discounts, write offs)
-Voluntary charitable organizations
Most obtain insurance via employer or spouses' employer
Less than 2% of employees offered traditional or indemnity health
insurance plans
◉ Employer Managed Care Plans. Answer: HMO
PPO
POS
EPO
Other permutations
◉ HMO (Health Maintenance Organization). Answer: A managed
care organization that provides comprehensive medical services for
a predetermined annual fee per enrollee.
◉ PPO (Preferred Provider Organization). Answer: A type of health
plan that contracts with medical providers, such as hospitals and
