BUSI 323 Exam 2

BUSI 323 Exam 2 Liberty University

1. True or False? FCA charges against providers can be brought by individuals under a qui tam
2. True or False? Prosecution under the FCA requires that specific intent to defraud the government was
3. True or False? Providing medically unnecessary care to a patient and then billing Medicare for it is an example of Medicare
4. True or False? EMTALA allows a hospital to transfer an emergency patient to another hospital because of the patient’s inability to
5. A medical group includes a provision in its contract with an HMO to receive larger PMPM payments if the HMO members are chronically ill. This type of provision is referred to as a(n):
6. Which of the following can a healthcare provider vary across different payers?
7. Which parts of Medicare are commonly referred to as the “original Medicare plan”?
8. The existence of healthcare plan produced healthcare provider
9. Capitation plans are more common for physician payment because:
10. Which of the following is the best way to compare hospital costs?
11. Which of the five policy groups include bad debts as an element of community benefit?
12. Which of the following typically represents the largest area of charity care?
13. Which of the following is the best way a hospital can minimize the chances of running afoul of healthcare laws and regulations?
14. Employer premium costs for healthcare coverage are often lowest in which type of health plan?
15. You are trying to establish a PMPM rate for primary care physicians. Actuarial estimates project 2,500 visits per 1,000 members per year. You have contracted with a primary care medical group at $45.00 per visit with a $5.00 copayment that you will What PMPM rate should you set?
16. What type of hospitals show the worst overall CVI scores compared to the S. median?
17. What component of internal control sets the tone of an organization, influencing the control consciousness of its people?
18. Contract clauses that permit which of the following should be removed from contract documents?
19. What are the three major ways that healthcare providers can control their revenue function?
20. A nursing home contracts with an HMO for skilled nursing care at $2.00 PMPM. If costs are expected to average $120 per day, what is the maximum utilization of days per 1,000 members that the nursing home can experience before it begins to lose money?
21. Why is the unreimbursed cost of Medicare most often not included as an element of community benefit?
22. How could a hospital legally avoid being covered by EMTALA?
23. How do a high percentage of Medicaid patients influence a hospital’s prices?
24. How is charity care usually defined?
25. How does the Stark Law impact physicians?
26. What firms must file an IRS Form 990 on an annual basis?
27. An HMO has a point-of-service (POS) option for its members but will pay only 80% of approved charges. If a member goes out of network for a medical procedure with a charge of $2,000, of which $1,200 is approved, how much must the member pay?
28. How are Medicaid payments to providers limited by the federal government?