4188097
Pregunta 1
Pregunta
Price setters vs price takers. When a provider has market dominance, and hence can set its own prices, it is said to be a _____?
Respuesta
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price setter
-
price taker
Pregunta 2
Pregunta
Providers are ___?
Perfectly competitive markets
Payer dominance
Government programs
Respuesta
-
price taker
-
price setter
Pregunta 3
Pregunta
When a provider is a price setter there are two most common theoretical bases
Respuesta
-
full cost pricing and marginal cost pricing
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low pricing and no marginal cost pricing
Pregunta 4
Pregunta
Full cost pricing, prices for a service are set to cover all costs: (3)
Respuesta
-
direct variable costs
-
indirect overhead costs
-
direct fixed costs
-
no fixed costs
Pregunta 5
Pregunta
Price takers uses
Respuesta
-
project costing
-
target costing
Pregunta 6
Pregunta
Scenario Analysis, to break even, revenues must
Respuesta
-
equal net profit
-
equal total costs
Pregunta 7
Pregunta
total costs = ___ + ____
Respuesta
-
total cost = total mc + total fc
-
total cost = total visits + total vc
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total costs = total variable costs + total fixed cost
Pregunta 8
Pregunta
the value of scenario analysis,
focused on:
Respuesta
-
It is obvious that scenario analysis gives decision makers more insights into the decision at hand.
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The minimum PMPM rate necessary to break even.
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The maximum PMPM rate necessary to break even.
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The ability to accept a lower PMPM rate when cost control is possible.
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The ability to accept a higher PMPM rate when cost control is possible.
Pregunta 9
Pregunta
Setting Managed Care Plan Rates,
Respuesta
-
Managed care plans must not set the rates they charge to employers on the basis of their costs of providing healthcare services.
-
Managed care plans must set the rates they charge to employers on the basis of their costs of providing healthcare services.
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the rates for different services are estimated and then aggregated.
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the rates for same services are estimated and then aggregated.
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This is usually done on a PMPM basis regardless of the actual reimbursement methods used to pay providers.
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This is usually done with something else besides PMPM basis regardless of the actual reimbursement methods used to pay providers.
Pregunta 10
Pregunta
Setting Managed Care Plan Rates (Cont.),
There are three techniques used to set the rates for individual providers:
Respuesta
-
Fee-for-service (FFS) approach
-
Face-to-face approach
-
Random approach
-
Cost approach
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Demographic approach
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Ethnicity approach
Pregunta 11
Pregunta
To illustrate the FFS method, assume that BetterCare HMO targets 350 inpatient days for each 1,000 members of an employee group, or 350 ÷ 1,000 = ____ per member
Respuesta
-
.392
-
.328
-
.432
-
.323
-
.523
-
.350
Pregunta 12
Pregunta
FFS approach cont,
inpatient cost = (pm utilization rate x ffs) / 12
= (_____ x 1,000$)/12
= ___ PMPM
Respuesta
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23.39$
-
84.24$
-
29.17$
-
17.34$
-
23.42$
Pregunta 13
Pregunta
Cost approach is commonly used to estimate _____ costs for the ____ population. Assume each enrollee will make 3 visits per year to a PCP (primary care physician).
-each PCP can handle 4,000 patients visit per year
-pcps are compensated at an annual rate of $175k per year
each member will require __ visits divided by __ patients = _____ pcps ~
the annual per member pcp cost is ___ pcps x ____compensation annual rate = ____ $
$ __ divided by 12 = ___ $
Respuesta
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employers
-
physicians
-
covered
-
uncovered
-
0.00075
-
0.00038
-
0.00043
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$131.25
-
$134.32
-
$10.94
Pregunta 14
Pregunta
What is RVU?
Respuesta
-
related variable units
-
relative value units
-
relative variable unknown
Pregunta 15
Pregunta
Relative value units measure the _____ amount of resources consumed to provide a _____ service.
they form the basis for ___ for physician reimbursement
Respuesta
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relative
-
related
-
particular
-
different
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medical
-
medicare
Pregunta 16
Pregunta
a variance is the difference between the ___ results and the budgeted ( ___ ) value
Respuesta
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fake results, budgeted (standard) value
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actual results, budgeted (standard) value
Pregunta 17
Pregunta
variance analysis is a technique applied to budget data to
Respuesta
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identify problem areas
-
not enhance control
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enhance control
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