HSA 400 Exam 2 Questions with Verified Solutions Latest Update 2025/2026
payment basis - Answers describes the manner by which a payer determines the amount to be
paid for a specific healthcare claim
cost-payment basis - Answers the underlying method for payment is the provider's cost
fee-schedule basis - Answers the actual payment is predetermined and is unrelated to either the
provider's cost or the provider's actual prices
price-related payment basis - Answers the provider is paid for services based on some
relationship to its total charges or price for the services delivered to the patient
bundled services - Answers aggregate services provided to a patient in an encounter of care into
one payment unit
specific services payment - Answers payment method in which the individual services provided
to a patient in an encounter of care are not aggregated
price setting - Answers the process of establishing specific prices for the services provided by
the healthcare provider
underwriting - Answers a firm that brings our new securities issues, agreeing to purchase and
resell them; paying for a procedure that is not certain will occur
utilization review - Answers health plans employ doctors and nurses to review and approve the
delivery of nonemergent medical care for necessity and appropriateness
case management - Answers the coordination of services provided to a patient by a specific
entity
claims administration - Answers health plan must verify that coverage for the services exists
and that the services were in fact performed
coordination of benefits - Answers the process of assigning payment responsibility when
multiple insurers exist
point of services (POS) - Answers a hybrid between an HMO and PPO in which patients are
given the incentive to see providers participating in a defined network by may see non-network
providers, though usually at some additional cost
health maintenance organizations (HMOs) - Answers entities that receive premium payments
from enrollees with the understanding that the ___ will be financially responsible for all
predefined healthcare required by its enrollees for a specified period of time
staff model HMO - Answers an HMO in which the providers are employees of the HMO
, group model HMO - Answers the HMO contracts with one or more medical groups to provide all
necessary services to HMO members
IPA model HMO - Answers loose affiliation of providers who agree to cover the healthcare
needs of a covered population on a capitated basis, usually through a per member per month
payment arrangement
network model HMO - Answers a hybrid of all three HMOs; may contract with both medical
groups and IPAs and employe individual physicians
conventional/idemnity plan - Answers provide members with the greatest access to healthcare
providers, both doctors and hospitals; members are not restricted in terms of whom they can
see for treatment of any medical disorders
preferred provider organization (PPOs) - Answers an independent provider or provider network
preselected by the payer to provide a specific service or range of services at predetermined
rates to the payer's covered members
high deductible health plans with savings option plan - Answers goal is to increase involvement
of patients in selecting cost-effective healthcare services; includes a health savings account
health savings account - Answers accounts that can be created by individuals using pretax
dollars to fund a variety of healthcare expenses, including large deductibles and copayments
financial accounting - Answers the branch of accounting that provides general-purpose financial
statements or reports to aid many decision-making groups, internal and external to the
organization, in making a variety of decisions
generally accepted accounting principles (GAAP) - Answers term often used to describe the
body of rules and requirements that shape the preparation of the four primary financial
statements created by the financial accountants
certified public accountant (CPA) - Answers an independent certified public accountant
accounting entity, money measurement, duality, cost valuation, stable monetary unit - Answers
what are the five principles of accounting
accounting entity - Answers the organization for which financial information is recorded and
reported
economic resources - Answers defined as scarce means, limited in supply but essential to
economic activity
economic obligations - Answers responsibilities to transfer economic resources or provide
services to other entities in the future, usually in return for economic resources received from
other entities in the past through the purchase of assets, the receipt of services, or the
payment basis - Answers describes the manner by which a payer determines the amount to be
paid for a specific healthcare claim
cost-payment basis - Answers the underlying method for payment is the provider's cost
fee-schedule basis - Answers the actual payment is predetermined and is unrelated to either the
provider's cost or the provider's actual prices
price-related payment basis - Answers the provider is paid for services based on some
relationship to its total charges or price for the services delivered to the patient
bundled services - Answers aggregate services provided to a patient in an encounter of care into
one payment unit
specific services payment - Answers payment method in which the individual services provided
to a patient in an encounter of care are not aggregated
price setting - Answers the process of establishing specific prices for the services provided by
the healthcare provider
underwriting - Answers a firm that brings our new securities issues, agreeing to purchase and
resell them; paying for a procedure that is not certain will occur
utilization review - Answers health plans employ doctors and nurses to review and approve the
delivery of nonemergent medical care for necessity and appropriateness
case management - Answers the coordination of services provided to a patient by a specific
entity
claims administration - Answers health plan must verify that coverage for the services exists
and that the services were in fact performed
coordination of benefits - Answers the process of assigning payment responsibility when
multiple insurers exist
point of services (POS) - Answers a hybrid between an HMO and PPO in which patients are
given the incentive to see providers participating in a defined network by may see non-network
providers, though usually at some additional cost
health maintenance organizations (HMOs) - Answers entities that receive premium payments
from enrollees with the understanding that the ___ will be financially responsible for all
predefined healthcare required by its enrollees for a specified period of time
staff model HMO - Answers an HMO in which the providers are employees of the HMO
, group model HMO - Answers the HMO contracts with one or more medical groups to provide all
necessary services to HMO members
IPA model HMO - Answers loose affiliation of providers who agree to cover the healthcare
needs of a covered population on a capitated basis, usually through a per member per month
payment arrangement
network model HMO - Answers a hybrid of all three HMOs; may contract with both medical
groups and IPAs and employe individual physicians
conventional/idemnity plan - Answers provide members with the greatest access to healthcare
providers, both doctors and hospitals; members are not restricted in terms of whom they can
see for treatment of any medical disorders
preferred provider organization (PPOs) - Answers an independent provider or provider network
preselected by the payer to provide a specific service or range of services at predetermined
rates to the payer's covered members
high deductible health plans with savings option plan - Answers goal is to increase involvement
of patients in selecting cost-effective healthcare services; includes a health savings account
health savings account - Answers accounts that can be created by individuals using pretax
dollars to fund a variety of healthcare expenses, including large deductibles and copayments
financial accounting - Answers the branch of accounting that provides general-purpose financial
statements or reports to aid many decision-making groups, internal and external to the
organization, in making a variety of decisions
generally accepted accounting principles (GAAP) - Answers term often used to describe the
body of rules and requirements that shape the preparation of the four primary financial
statements created by the financial accountants
certified public accountant (CPA) - Answers an independent certified public accountant
accounting entity, money measurement, duality, cost valuation, stable monetary unit - Answers
what are the five principles of accounting
accounting entity - Answers the organization for which financial information is recorded and
reported
economic resources - Answers defined as scarce means, limited in supply but essential to
economic activity
economic obligations - Answers responsibilities to transfer economic resources or provide
services to other entities in the future, usually in return for economic resources received from
other entities in the past through the purchase of assets, the receipt of services, or the
