BUSI 323 Quiz Revenue Determination

BUSI 323 Quiz: Revenue Determination

1. True or False? Prosecution under the FCA requires that specific intent to defraud the government was present.
2. True or False? FCA charges against providers can be brought by individuals under a qui tam
3. True or False? Providing medically unnecessary care to a patient and then billing Medicare for it is an example of Medicare fraud.
4. True or False? EMTALA allows a hospital to transfer an emergency patient to another hospital because of the patient’s inability to pay.
5. Which of the following is the main source of financing for long- term care, paying 40% or the nation’s bill for both nursing home care and long-term care?
6. Assume that a long-term care facility provides inadequate nutrition, wound care, and medication administration to its residents. It provides this substandard care to residents for which it bills government programs. Under which healthcare law or regulation is it at risk of being prosecuted?
7. Which parts of Medicare are commonly referred to as the “original Medicare plan”?
8. What component of internal control sets the tone of an organization, influencing the control consciousness of its people?
9. What type of hospitals show the worst overall CVI scores compared to the U.S. median?
10. Outcome quality measurement is conducted through which of the following, which is established for each facility by Medicare?
11. The purpose of which of the following is to provide greater parity to relative charge structures at U.S. hospitals?
12. Which of the five policy groups include bad debts as an element of community benefit?
13. Which of the following can a healthcare provider vary across different payers?
14. Which of the following is directly affected by three key areas: pricing, health plan contract negotiation, and billing and coding?
15. Which of the following is the best way to compare hospital costs?
16. 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 receive. What PMPM rate should you set?
17. Employer premium costs for healthcare coverage are often lowest in which type of health plan?
18. Capitation plans are more common for physician payment because:
19. What is the primary provision of EMTALA?
20. How does the Stark Law impact physicians?
21. What is the False Claims Act (FCA) and how does it impact providers of healthcare services?
22. How is charity care usually defined?
23. What firms must file an IRS Form 990 on an annual basis?
24. List and discuss the three payment-determination bases.
25. What are the three major ways that healthcare providers can control their revenue function?
26. What are the four major activities of a health plan?
27. 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?
28. Explain why there has been a dramatic shift from inpatient to outpatient services.