MHAghn706ghnMidterm-ghnLord
Proprietorshipsghn&ghnPartnerships:ghnProsghn&ghnConsghn-
ghnCORRECTghnANSWER✔Pros:ghnEaseghnofghnInformation, ghnSubjectghntoghn
aghnfewghnregulations,ghnnoghncorporationghnincomeghntaxes.
Cons:ghnLimitedghnlife,ghndifficultghntoghntransfer,ghnunlimitedghnlife,ghndifficultghnt
oghnraiseghncapital.
Corporations:ghnProsghn&ghnConsghn-
ghnCORRECTghnANSWER✔Pros:ghnUnlimited ghnlife,ghneasyghntransfer ghnofghno
wnership,ghnlimitedghnliability,ghneaseghnofghnraisingghncapital.
Cons:ghnCostghnofghnformationghnandghnreporting,ghndoubleghnorghntripleghntaxesghn
mustghnbeghnpaid.
Non-profitghnOrganizationghn-
ghnCORRECTghnANSWER✔Exemptghnfromghntaxes.ghnGoalghnisghntoghnimprov
eghncommunity.
For-profitghnOrganizationsghn-
ghnCORRECTghnANSWER✔(InvestorghnOwned)ghnGoalghnisghntoghnmaximize g
hnshareholderghnreturn.ghnOweghntaxes.
AgencyghnProblemghn-
ghnCORRECTghnANSWER✔theghnpossibilityghnofghnconflictghnofghninterestghnb
etweenghntheghnstockholdersghnandghnmanagementghnofghnaghnfirm.
,Example:ghnHireghnsomeoneghntoghncarryghnoutghnaghnjobghnfunction,ghnbutghntheyghn
goghnoutghnofghntheirghninterestsghninsteadghnofghnbestghninterestsghnofghncompany/
organization.
Third-partyghnpayorghnsystemghninghntheghnUSghn(i.e.ghnprivateghnvsghnpublic)ghn-
ghnCORRECTghnANSWER✔Private:ghnBlueghnCrossghnBlueghnShield,ghnCom
mercialghnInsurers,ghnSelf-Insurers.ghn(AETNA)
Public:ghnMedicareghnandghnMedicaid-
bothghnofferghnservicesghntoghndifferentghnlevels.ghn"Safetyghnnet"ghnLowestghnreim
bursementghnrates.
Reimbursementghnmethodsghn(fee-for-serviceghnvs.ghncapitation)ghn-
ghnCORRECTghnANSWER✔FeeghnforghnService:ghnpaymentghnisghntiedghntoghna
mountghnofghnservicesghnprovided.ghn(Decadesghnago)ghn*Dentalghnindustry*
Capitation:ghnpaymentghnisghntiedghntoghntheghnsizeghnofghntheghncoveredghnpopulatio
nghn(numberghnofghnenrollees)ghnPaymentghnisghnbasedghnonghnperghn#ghnperghnmonth.
ghn*Decreasingghnutilization*ghnPopulation ghnisghnhealthier.
Medicareghnreimbursementghnforghndifferentghntypesghnofghnprovidersghn-
ghnCORRECTghnANSWER✔MedicareghnpartsghnA,ghnBghn&ghnC.
MedicareghnPartghnAghn(akaghnHospitalghnInsuranceghnorghnHI)ghn-
ghnCORRECTghnANSWER✔Providesghnhospitalghninsuranceghnautomaticall
yghnatghnageghn65ghn(ifghnFICAghnqualified)ghnatghnnoghnfeeghnbutghnmayghnhaveghndedu
ctibleghn&ghnco-pay.
, MedicareghnPartghnBghn-
ghnCORRECTghnANSWER✔TheghnpartghnofghntheghnMedicareghnprogramghnthat
ghnpaysghnforghnphysicianghnservices,ghnoutpatientghnhospitalghnservices,ghndurable
ghnmedicalghnequipment,ghnandghnotherghnservicesghnandghnsupplies.
MedicareghnPartghnCghn(MedicareghnAdvantage)ghn-
ghnCORRECTghnANSWER✔•Replacesghnandghncoversghnexpensesghnfoundghni
nghnPartghnAghnandghnB
•Medicareghnprivateghnfee-for-serviceghnplansghn(PFFS)
•Medicareghnmanagedghncareghnplansghn(HMOsghnandghnPPOs)
•Medicareghnspecialtyghnplans
Medicare—PartghnDghnPrescriptionghnDrugghnCoverageghn-
ghnCORRECTghnANSWER✔aghnUnitedghnStatesghnfederal-
governmentghnprogramghntoghnsubsidizeghntheghncostsghnofghnprescriptionghndrugsg
hnandghnprescriptionghndrugghninsuranceghnpremiumsghnforghnMedicareghnbenefici
aries.
ImpactghnofghntheghnAffordableghnCareghnActghn(whatghntheghnbillghnchangedghnabou
tghntheghnhealthcareghnenvironment)ghn-
ghnCORRECTghnANSWER✔Createdghnnewghnstandards,ghnindividualghnmand
ates,ghnexchanges,ghnandghnMedicaidghnexpansion.
Focusedghnonghnqualityghnthroughghnclinicalghncompensation,ghnbundledghnpaym
ent,ghnvalue-basedghnpurchasing.
Proprietorshipsghn&ghnPartnerships:ghnProsghn&ghnConsghn-
ghnCORRECTghnANSWER✔Pros:ghnEaseghnofghnInformation, ghnSubjectghntoghn
aghnfewghnregulations,ghnnoghncorporationghnincomeghntaxes.
Cons:ghnLimitedghnlife,ghndifficultghntoghntransfer,ghnunlimitedghnlife,ghndifficultghnt
oghnraiseghncapital.
Corporations:ghnProsghn&ghnConsghn-
ghnCORRECTghnANSWER✔Pros:ghnUnlimited ghnlife,ghneasyghntransfer ghnofghno
wnership,ghnlimitedghnliability,ghneaseghnofghnraisingghncapital.
Cons:ghnCostghnofghnformationghnandghnreporting,ghndoubleghnorghntripleghntaxesghn
mustghnbeghnpaid.
Non-profitghnOrganizationghn-
ghnCORRECTghnANSWER✔Exemptghnfromghntaxes.ghnGoalghnisghntoghnimprov
eghncommunity.
For-profitghnOrganizationsghn-
ghnCORRECTghnANSWER✔(InvestorghnOwned)ghnGoalghnisghntoghnmaximize g
hnshareholderghnreturn.ghnOweghntaxes.
AgencyghnProblemghn-
ghnCORRECTghnANSWER✔theghnpossibilityghnofghnconflictghnofghninterestghnb
etweenghntheghnstockholdersghnandghnmanagementghnofghnaghnfirm.
,Example:ghnHireghnsomeoneghntoghncarryghnoutghnaghnjobghnfunction,ghnbutghntheyghn
goghnoutghnofghntheirghninterestsghninsteadghnofghnbestghninterestsghnofghncompany/
organization.
Third-partyghnpayorghnsystemghninghntheghnUSghn(i.e.ghnprivateghnvsghnpublic)ghn-
ghnCORRECTghnANSWER✔Private:ghnBlueghnCrossghnBlueghnShield,ghnCom
mercialghnInsurers,ghnSelf-Insurers.ghn(AETNA)
Public:ghnMedicareghnandghnMedicaid-
bothghnofferghnservicesghntoghndifferentghnlevels.ghn"Safetyghnnet"ghnLowestghnreim
bursementghnrates.
Reimbursementghnmethodsghn(fee-for-serviceghnvs.ghncapitation)ghn-
ghnCORRECTghnANSWER✔FeeghnforghnService:ghnpaymentghnisghntiedghntoghna
mountghnofghnservicesghnprovided.ghn(Decadesghnago)ghn*Dentalghnindustry*
Capitation:ghnpaymentghnisghntiedghntoghntheghnsizeghnofghntheghncoveredghnpopulatio
nghn(numberghnofghnenrollees)ghnPaymentghnisghnbasedghnonghnperghn#ghnperghnmonth.
ghn*Decreasingghnutilization*ghnPopulation ghnisghnhealthier.
Medicareghnreimbursementghnforghndifferentghntypesghnofghnprovidersghn-
ghnCORRECTghnANSWER✔MedicareghnpartsghnA,ghnBghn&ghnC.
MedicareghnPartghnAghn(akaghnHospitalghnInsuranceghnorghnHI)ghn-
ghnCORRECTghnANSWER✔Providesghnhospitalghninsuranceghnautomaticall
yghnatghnageghn65ghn(ifghnFICAghnqualified)ghnatghnnoghnfeeghnbutghnmayghnhaveghndedu
ctibleghn&ghnco-pay.
, MedicareghnPartghnBghn-
ghnCORRECTghnANSWER✔TheghnpartghnofghntheghnMedicareghnprogramghnthat
ghnpaysghnforghnphysicianghnservices,ghnoutpatientghnhospitalghnservices,ghndurable
ghnmedicalghnequipment,ghnandghnotherghnservicesghnandghnsupplies.
MedicareghnPartghnCghn(MedicareghnAdvantage)ghn-
ghnCORRECTghnANSWER✔•Replacesghnandghncoversghnexpensesghnfoundghni
nghnPartghnAghnandghnB
•Medicareghnprivateghnfee-for-serviceghnplansghn(PFFS)
•Medicareghnmanagedghncareghnplansghn(HMOsghnandghnPPOs)
•Medicareghnspecialtyghnplans
Medicare—PartghnDghnPrescriptionghnDrugghnCoverageghn-
ghnCORRECTghnANSWER✔aghnUnitedghnStatesghnfederal-
governmentghnprogramghntoghnsubsidizeghntheghncostsghnofghnprescriptionghndrugsg
hnandghnprescriptionghndrugghninsuranceghnpremiumsghnforghnMedicareghnbenefici
aries.
ImpactghnofghntheghnAffordableghnCareghnActghn(whatghntheghnbillghnchangedghnabou
tghntheghnhealthcareghnenvironment)ghn-
ghnCORRECTghnANSWER✔Createdghnnewghnstandards,ghnindividualghnmand
ates,ghnexchanges,ghnandghnMedicaidghnexpansion.
Focusedghnonghnqualityghnthroughghnclinicalghncompensation,ghnbundledghnpaym
ent,ghnvalue-basedghnpurchasing.
