HOM 5307 Exam 1 Set 3 Exam
Questions and Answers
T or F: In markets with high levels of managed care penetration, hospitals
are usually paid using a sliding scale discount on charges method. - -False
- T or F: The same methodology used to pay a hospital for inpatient care is
usually also use to pay for outpatient care. - -False
- T or F: Fee-for-service payment is the most common method used by
HMOs to pay specialists. - -True
- T or F: Consolidation in the payer industry has resulted in most hospitals
being unable to obtain adequate rate increases. - -False
- The following term refers to an all-inclusive rate paid by the HMO for both
institutional and professional services: - -bundled payment
- Which of the following forms of hospital payment contain no elements of
risk sharing by the hospital? - -sliding scale FFS
- What are the basic ways to compensate open-panel PCPs? - -FFS
- Capitation is a physician payment method preferred by many HMOs
because it: - -Costs are predictable
Is less costly to administer than FFS
Eliminates the FFS incentive to overutilize
- How are outlier cases determined by a hospital? - -through the
chargemaster
- Payment to a facility for outpatient procedures may be increased on a
case-by-case basis through which of the following? - -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 - -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
Questions and Answers
T or F: In markets with high levels of managed care penetration, hospitals
are usually paid using a sliding scale discount on charges method. - -False
- T or F: The same methodology used to pay a hospital for inpatient care is
usually also use to pay for outpatient care. - -False
- T or F: Fee-for-service payment is the most common method used by
HMOs to pay specialists. - -True
- T or F: Consolidation in the payer industry has resulted in most hospitals
being unable to obtain adequate rate increases. - -False
- The following term refers to an all-inclusive rate paid by the HMO for both
institutional and professional services: - -bundled payment
- Which of the following forms of hospital payment contain no elements of
risk sharing by the hospital? - -sliding scale FFS
- What are the basic ways to compensate open-panel PCPs? - -FFS
- Capitation is a physician payment method preferred by many HMOs
because it: - -Costs are predictable
Is less costly to administer than FFS
Eliminates the FFS incentive to overutilize
- How are outlier cases determined by a hospital? - -through the
chargemaster
- Payment to a facility for outpatient procedures may be increased on a
case-by-case basis through which of the following? - -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 - -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
