Financing and Reimbursement

Question 1

How is Medicare funded?

Answer 1

Federal funded

Income tax maintained

Question 2

Medicare covers all of the below besides for:

Must be 65 or older

Must have disability and receive cash from SSI for 2 years and over.

Patient with cancer

Patient with ESRD (end stage renal disease)

Answer 2

Patient with cancer

Question 3

What does Medicare part A cover?

Answer 3

• Pays institutions
• DRG: diagnosis related group
• Lump sum payment
• Covers employee costs, overhead and supply costs

Question 4

If the hospital cost is less than the DRG with Medicare part A who keeps the difference?

Answer 4

The hospital.

Question 5

Is home health care covered by Part A or Part B?

Answer 5

Part A

Question 6

Which part of Medicare covers Hospice care?

Answer 6

Part A

Question 7

Who does Medicare Part B contract with?

Answer 7

private insurance companies

Question 8

What does Medicare Part B cover?

Answer 8

Private office visits
Nursing homes
Patient homes

Question 9

What does Fee-for-service mean?

Answer 9

It is resource based relative value scale.

It gives the most flexibility in selecting a practitioner of choice.

Question 10

What is the most frequent method of payment with Medicare?

Answer 10

Part B- Fee for service

Question 11

How much does Medicare pay for fee for service?

Answer 11

80% after the annual deductible.

Question 12

What is HMO?

Answer 12

health maintenance

Question 13

What parts of Medicare does HMO cover?

Answer 13

Part A and B

Question 14

What is Medicare Part C?

Answer 14

Medicare Choice

• paid predetermined capitation monthly fee
• offers enhanced benefits

Question 15

How many Medicare beneficiaries were enrolled in Medicare Part C in 2002?

Answer 15

10%

Question 16

How is Medicaid funded?

Answer 16

Jointly by federal and state gvt

Question 17

Who does Medicaid provide for?

Answer 17

• Low income individuals
• Families with dependent children
• Aged and disabled

Question 18

What is the Balanced Budget Act of 1997?

Answer 18

Affected Medicaid

• Greater flexibility in utilizing managed care
• funds for child health care
• PAs may be covered by the state

Question 19

What are the three options with managed care?

Answer 19

Capitation

HMO

PPO

Question 20

What type of managed care is the practitioner or hospital paid a certain amount per patient to provide medical?

Answer 20

Capitation

Question 21

What type of managed care is when members pay a specified fee and receive all their healthcare?

Answer 21

HMO

Question 22

What is Preferred provider organization?

Answer 22

PPO

- discounted fee for a group of practitioners.