FINAL HSM EXAM questions with verified answers
"donut hole" Ans✓✓✓ the part of Medicare Part D reimbursement
between basic services and full coverage that is the medicare
beneficiaries' responsibility to pay
"flat of the curve" medicine Ans✓✓✓ the point in health treatment
where no additional increases in health status for additional spending
occur
3 quality assessment categories Ans✓✓✓ retrospective
concurrent
prospective
ACA changes to private insurance Ans✓✓✓ health care premiums will
be allowed to vary only based on age, geographic area, tabacco use,
and number of family members
kids can stay on parents plan till 26
required to cover certain preventive services with no cost-sharing
insurers will be required to spend atleast 80% of premiums on medical
costs or pay rebates back to consumers
,cant charge people more based on health status or gender
must have a minimum amount of services and caps annual out of
pocket spending
access Ans✓✓✓ ability to use healthcare services
adverse selection Ans✓✓✓ predisposition of sick people to purchase
health insurance in order to access treatment for their condition
allopathic are Ans✓✓✓ M.D.'s
andersen model Ans✓✓✓ used to predict utilization of all health care
services
arguments against medical malpractice award caps Ans✓✓✓ would
limit those patients who have experienced damages from being
compensated fairly
Assisted Living Facilites Ans✓✓✓ medicare does not cover ALF's
because it is not "skilled" care
bad debt Ans✓✓✓ is incurred from services not being reimbursed that
are provided with the expectation of being reimbursed
, benefits of vertical and horizontal integration Ans✓✓✓ increased
market share
increased efficiency
capitation Ans✓✓✓ a set amount of money given to physicians for
each person who enrolls in their practice prior to the provision of care.
in return, the physician is responsible for providing specified services
for a designated period of time
certificate of need Ans✓✓✓ state board must approve applications for
new facilities, capital improvements, or high-cost equipment
charity care Ans✓✓✓ patient care for which the hospital does not
expect to be reimbursed
closed panel Ans✓✓✓ a managed care plan that contracts with
physicians and other primary care clinicians on an exclusive basis for
services
coinsurance Ans✓✓✓ portion of a bill for health care services that is
the responsibility of the patient, once the patient has met his or her
plan deductible requirements
"donut hole" Ans✓✓✓ the part of Medicare Part D reimbursement
between basic services and full coverage that is the medicare
beneficiaries' responsibility to pay
"flat of the curve" medicine Ans✓✓✓ the point in health treatment
where no additional increases in health status for additional spending
occur
3 quality assessment categories Ans✓✓✓ retrospective
concurrent
prospective
ACA changes to private insurance Ans✓✓✓ health care premiums will
be allowed to vary only based on age, geographic area, tabacco use,
and number of family members
kids can stay on parents plan till 26
required to cover certain preventive services with no cost-sharing
insurers will be required to spend atleast 80% of premiums on medical
costs or pay rebates back to consumers
,cant charge people more based on health status or gender
must have a minimum amount of services and caps annual out of
pocket spending
access Ans✓✓✓ ability to use healthcare services
adverse selection Ans✓✓✓ predisposition of sick people to purchase
health insurance in order to access treatment for their condition
allopathic are Ans✓✓✓ M.D.'s
andersen model Ans✓✓✓ used to predict utilization of all health care
services
arguments against medical malpractice award caps Ans✓✓✓ would
limit those patients who have experienced damages from being
compensated fairly
Assisted Living Facilites Ans✓✓✓ medicare does not cover ALF's
because it is not "skilled" care
bad debt Ans✓✓✓ is incurred from services not being reimbursed that
are provided with the expectation of being reimbursed
, benefits of vertical and horizontal integration Ans✓✓✓ increased
market share
increased efficiency
capitation Ans✓✓✓ a set amount of money given to physicians for
each person who enrolls in their practice prior to the provision of care.
in return, the physician is responsible for providing specified services
for a designated period of time
certificate of need Ans✓✓✓ state board must approve applications for
new facilities, capital improvements, or high-cost equipment
charity care Ans✓✓✓ patient care for which the hospital does not
expect to be reimbursed
closed panel Ans✓✓✓ a managed care plan that contracts with
physicians and other primary care clinicians on an exclusive basis for
services
coinsurance Ans✓✓✓ portion of a bill for health care services that is
the responsibility of the patient, once the patient has met his or her
plan deductible requirements
