CHAPTER 1 QUIZ
1.
Which one of the three models of healthcare delivery is used in the US?
Private Health Insurance model
2.
Compare the social insurance model and the national health service model. Describe their similarities and differences.
The Bismark model uses an insurance system, the insurers are called “sickness funds” that are financed jointly by employers and employees through payroll deduction. With the Beveridge model, health care is provided and financed by the government through tax payments.
Similarities would be that the government has most of the cost control.
3.
Describe the healthcare spending trend in the US over the past decade.
Increase in real per capita health expenditures, which can be partly due to new technology emerging. 4.
Provide two examples of transactions that occur between the provider and third-party payer.
Claims transactions and encounter information transactions/patient information.
5.
Define risk pool as used in health insurance.
A group of individuals whose medical costs are combined to calculate premiums.
6.
In the US, healthcare is most often connected to employment. Provide a downfall of this approach.
When jobs are lost, so is the health coverage. 7.
Dr. Gilbert sees a 14-year-old male with adolescent scoliosis. During today’s visit, the patient was seen for mononucleosis and was started on prednisone for severe sore throat and difficulty swallowing. The patient was accompanied by his parents, who have health insurance through the mother’s employment at the State Department of Treasury. Who is the first party in this scenario?
The patient.
8.
What is a benefit of a multidisciplinary approach to RCM?
Having access to specialists
9.
What are the goals of revenue integrity?
To prevent revenue issues and compliance risks
10.
Describe how a healthcare organization benefits from an IRC.
They are exempt from paying federal, state and property taxes.
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