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