Miscellaneous

Question 1

Who does medicare provide medical coverage to?

Answer 1

1. individuals > 65 y/o
2. disabled
3. those with ESRD

Question 2

What is Medicare’s prospective payment system based on?

Answer 2

Diagnostic-related groups (DRGs)

Places patients into disease categories or groups

Question 3

(true/false) Medicare A covers all medical expenses of long-term or custodial care.

Answer 3

True

Question 4

(true/false) Medicaid benefits are the same in all states

Answer 4

False

individual states determine the scope, duration, and amount of services provided

Question 5

(true/false) preauthorization is needed for medicare and not medicaid.

Answer 5

FALSE (required for medicaid)

Question 6

What must a person pay for medicare A?

Answer 6

Annual deductible fee

Question 7

What must a person pay for medicare B?

Answer 7

Monthly premium

Question 8

(true/false) With medicare, PT provided by a PT aide is reimbersable regardless of supervision

Answer 8

FALSE

Only SPTs

Question 9

Insurance type that includes commercial insurance, fee-for-service / traditional indemnity plans, or employers who are self-insured

Answer 9

private health insurance

Question 10

What is a HMO?

Answer 10

Form of managed care that provides a broad spectrum of health services for a preset amount of money

Allow members to seek healthcare outside of the network but at a higher or additional cost to the patient

Has a small copay for members using providers within the network

Question 11

(true/false) With a HMO, a patient that is seeking additional care (such as PT), must have authorization through their PCP (“gatekeeper”)

Answer 11

true

Question 12

(true/false) The numer of PT visits when a person is part of an HMO is unlimited

Answer 12

FALSE - limited number of visits

Question 13

What are the two types of HMOs?

Answer 13

1. **Individual practice associations (IPA) **- contract independently with the HMO and work out of their own office
2. Prepaid Group plan (PGP) - physicians practice in a central facility

Question 14

What is a PPO?

Answer 14

Group of providers that offer healthcare services as an entity to their employers - discount their fees to attract patients

Pts are not locked into the PPO providers but receive financial incentives to use services through that network

Preauthorization is needed before services can be provided

Question 15

Definition:

A flat bundled reimbursement rate that is established based on the diagnosis- predetermined dollar amount:
- per diem / per day
- per visit
- per episode of service

Answer 15

Case-based rate

Question 16

Definition:

Tax-free savings account that can be used to pay for health-related expenses and reiree health expenses

Answer 16

Health Savings Account

Question 17

(true/false) Those who have a health savings account must have a high-deductible health plan

–> insurance product that covers catastrophic health occurrences

Answer 17

true