Quiz part 1 Flashcards

1
Q

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?

A

Favorable selection

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2
Q

Reforms to PDPM primarily impacts what setting

A

Skilled Nursing facilities

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3
Q

Part B medicare co-insurance for physical therapy is what % of the medicare fee schedule (also known as medicare allowable charges?

A

20%

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4
Q

medicaid spend down refers to

A

an individual will have to cash pay for their custodial care until they qualify for medicaid

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5
Q

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?

A

The hospital is paid based on DRG

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6
Q

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

a person with a supportive family who undergoes total joint replacement

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7
Q

the shared responsibility payment can be satisfied by all of the following except

A

a non-ACA compliant private insurance plan

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8
Q

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

A

ongoing health management

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9
Q

at what point did US private health insurance premiums and deductibles begin rising

A

before the ACA was passed

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