1. a ppo strictly manages the provides that beneficiaries use.
True or false
2. the idea of creating integrated delivery systems is in preparation for the conceptt of covered lives as part of healthcare reform. this concept of getting paid a fixed amount, per covered life, for a period of time is known as capitation.
True or false
3. the system used to reward providers for hitting certain benchmarks is called fee for service.
True or false
4. Medicare pays providers using DRG's. Those are further divided, and payments are adjusted based on complications and comorbidies. medicare has established almost 750 ms-drg's.
True or false
5. under a cost-based reimbursement system, the payers are billed charges according to a fee schedule called a charge master.
True or False
6. The ultimate goal of healthcare reform is to increase access to care to more citizens while the cost of healthcare down.
True or false
7. The cost assiociated with the existence of a certain department would be considered indirect costs.
True false
8. A concept that occurs becuase those individuals and businesses likely to incur losses are most likely to purchase insurance as opposed to those less likely to incur loss.
Random loss
Pooling
Adverse selection
Underwriting
Risk transfer
9. In medical home model, the personal physicians works with the other healthcare professional teams to provide preventative services, treatment of acute and chronic illnesses, and assistance with end of life issues.
True or False
10. with medicaid, each state can set its own rules as long as they follow basic federal guidelines.
True or false
11. moral hazard is a risk to the insured that excess healthcare services are used because individuals do not bear the full cost of the services provided.
True or false