Quiz part 1 Flashcards
An insurer offering a part C plan is most likely to experience which of the following outcomes when there are a high number of enrollees?
Favorable selection
Reforms to PDPM primarily impacts what setting
Skilled Nursing facilities
Part B medicare co-insurance for physical therapy is what % of the medicare fee schedule (also known as medicare allowable charges?
20%
medicaid spend down refers to
an individual will have to cash pay for their custodial care until they qualify for medicaid
most physical therapist generated charges in an acute care hospital are used primarily to determine productivity and may not even leave the building to be billed to Medicare . Why?
The hospital is paid based on DRG
Which of the following populations fits best in the ACO payment model?
-a pt with longstanding DM including LE amputation
-a person experiencing chronic ongoing challenges with homelessness
-a person with a supportive family who undergoes total joint replacement
a person with a supportive family who undergoes total joint replacement
the shared responsibility payment can be satisfied by all of the following except
a non-ACA compliant private insurance plan
which of the following elements reflect the expected future healthcare buisness model
-care provided in office
-fee for service
-ongoing health management
-utilization managed within a care setting
-sick care
ongoing health management
at what point did US private health insurance premiums and deductibles begin rising
before the ACA was passed