MHA 706 Midterm Exam (Lord) – Q&A (Graded A+)
Alternative forms of business organization ✔️Ans - 1. proprietorships
and partnerships
2. corporations
3. hybrid forms
proprietorships and partnerships ✔️Ans - pros: ease of information,
subject to a few regulations, no corporation income taxes.
cons: limited life, difficult to transfer, unlimited liability, difficult to raise
capital.
corporations ✔️Ans - pros: unlimited life, easy transfer of ownership,
limited liability, ease of raising capital.
cons: cost of formation and reporting, double or triple tax must be paid.
Hybrid forms of business organizations ✔️Ans - LLP, LLC,PC, PA
Non-profit organization ✔️Ans - exempt from taxes - goal is to improve
community
For-profit organization ✔️Ans - investor owned
goal is to maximize shareholder return - owes taxes
agency problem ✔️Ans - hire someone to carry out a job function, but
they go out of their interests instead of best interest of company
Third party payor system ✔️Ans - private vs public insurance
private insurance ✔️Ans - blue cross blue shield, commercial insurers,
self-insurers
public insurance ✔️Ans - Medicare and Medicaid both offer services to
different levels
safety net
lowest reimbursement rates
, reimbursement methods ✔️Ans - fee for service
cost based
charged base
prospective payment
capitation
fee for service ✔️Ans - payment is tied to amount of services provided
(decades ago)
dental industry
cost based ✔️Ans - payer pays all allowable cost
ex. payment to critical access hospitals
charged based ✔️Ans - payer pays billed charges
ex. payment on a rate schedule
prospective payment ✔️Ans - have fixed payments per diagnosis basis
capitation ✔️Ans - payment is tied to size of covered populations
(Number of enrollees) payment is based on per number per month
decreasing utilization
population healthier
Medicare reimbursement for different types of providers ✔️Ans - IPPS
OPPS
Physician Fee Services
Inpatient Prospective Payment System (IPPS) ✔️Ans - each DC is
assigned to a Medicare severity diagnosis
Outpatient Prospective Payment System (OPPS) ✔️Ans - each DC is
assigned to ambulatory classifications (APC)
Physician fee services ✔️Ans - each service has a relative value unit
(RVU) services are standardized
Impact of the ACA on healthcare ✔️Ans - created new standards,
individual mandates, exchanges and Medicaid expansion,
Alternative forms of business organization ✔️Ans - 1. proprietorships
and partnerships
2. corporations
3. hybrid forms
proprietorships and partnerships ✔️Ans - pros: ease of information,
subject to a few regulations, no corporation income taxes.
cons: limited life, difficult to transfer, unlimited liability, difficult to raise
capital.
corporations ✔️Ans - pros: unlimited life, easy transfer of ownership,
limited liability, ease of raising capital.
cons: cost of formation and reporting, double or triple tax must be paid.
Hybrid forms of business organizations ✔️Ans - LLP, LLC,PC, PA
Non-profit organization ✔️Ans - exempt from taxes - goal is to improve
community
For-profit organization ✔️Ans - investor owned
goal is to maximize shareholder return - owes taxes
agency problem ✔️Ans - hire someone to carry out a job function, but
they go out of their interests instead of best interest of company
Third party payor system ✔️Ans - private vs public insurance
private insurance ✔️Ans - blue cross blue shield, commercial insurers,
self-insurers
public insurance ✔️Ans - Medicare and Medicaid both offer services to
different levels
safety net
lowest reimbursement rates
, reimbursement methods ✔️Ans - fee for service
cost based
charged base
prospective payment
capitation
fee for service ✔️Ans - payment is tied to amount of services provided
(decades ago)
dental industry
cost based ✔️Ans - payer pays all allowable cost
ex. payment to critical access hospitals
charged based ✔️Ans - payer pays billed charges
ex. payment on a rate schedule
prospective payment ✔️Ans - have fixed payments per diagnosis basis
capitation ✔️Ans - payment is tied to size of covered populations
(Number of enrollees) payment is based on per number per month
decreasing utilization
population healthier
Medicare reimbursement for different types of providers ✔️Ans - IPPS
OPPS
Physician Fee Services
Inpatient Prospective Payment System (IPPS) ✔️Ans - each DC is
assigned to a Medicare severity diagnosis
Outpatient Prospective Payment System (OPPS) ✔️Ans - each DC is
assigned to ambulatory classifications (APC)
Physician fee services ✔️Ans - each service has a relative value unit
(RVU) services are standardized
Impact of the ACA on healthcare ✔️Ans - created new standards,
individual mandates, exchanges and Medicaid expansion,
