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An important distinction in health insurance is between the list price (PL) and out-of-pocket price (PP) of a medical good or service. The list price is the official price that the provider charges the insurance company, while the out-of-pocket price is the price that the insurance customer faces. Sometimes, the out-of-pocket price depends on the list price.   Now assume the consumer is part of a partial insurance plan with a coinsurance provision. Her insurance pays 50% of all medical expenses. Consider again the relationship between PL and PP and plot a coinsurance plan demand curve in PL - Q space. Label this curve D3. Finally, assume the consumer is part of a partial insurance plan with a copayment provision. Her insurance pays all expenses above and beyond her copayment of $25 for each unit of Q. Consider again the relationship between PL and PP and plot a copayment-plan demand curve in PL - Q space. Label this curve D4.

Students may wish to refer to the chapters on the introduction to the revenue cycle and patient encounter and billing information in this workbook for a review of math for the following problems. Dr. Augustino is a Medicare participating provider. Dr. Brunner is a Medicare nonparticipating provider who accepts assignment. Dr. Charles is a Medicare nonparticipating provider who does not accept the assignment. The following table shows the fees each doctor charges as well as the Medicare Fee.   Dr. A Dr. B Dr. C Medicare 99201 OV New 45.00 42.50 48.00 36.00 99204 OV New 60.00 57.50 65.00 48.25 99212 OV Established 40.00 38.00 45.00 32.00 99213 OV Established 45.00 40.00 48.00 35.75 71046 Chest X-ray 165.00 162.50 174,00 73.25 36415 Venipuncture 17.00 12.00 20.00 8.00 Audrey Appel who is covered by Medicare, as well as a Medigap policy, is a new patient of Dr. Augustino. She is seen in the office for…

Which of the following statements regarding the Patient Protection and Affordable Care Act (ACA) is true?   Group of answer choices a. The ACA eliminates lifetime limits on total health care insurance payments by insurers. b. The ACA limits the total number of surgeries for the insurers. c. The ACA requires employers to reimburse the cost of hospital stays of the insured. d. The ACA decides the insurance payments for dependents. e. The ACA provides major medical insurance with low deductibles to protect against catastrophic illnesses.

Which of the following are deductible medical expenses? Select all that apply. Nonprescription drugs (i.e., over the counter drugs) Vitamins and other health supplements A gym membership Visiting a dentist for a teeth clearning Prescription Drugs Transportation and lodging related to medical care

With respect to employer-sponsored health insurance plans, the amount of money a covered participant must pay before health insurance benefits become active is known as which of the following? Select one: a. Premium b. Safe harbor c. Deductible d. Coinsurance

What is a contractual adjustment? Choose the correct.a. An increase in a patient’s charges caused by revisions in the billing process utilized by a health care entity.b. A year-end journal entry to recognize all of a health care entity’s remaining receivables.c. A reduction in patient service revenues caused by agreements with third-party payors that allows them to pay a health care entity based on their determination of reasonable costs.d. The results of a cost allocation system that allows a health care entity to determine a patient’s cost by department.

The life Insurance Solicitation regulation requires an insurer to provide which of the following items to an applicant upon request? An Outline of Coverage An insurance consumer handbook A Buyer's Guide A copy of the Illinois insurance regulations

Course Name: Principle of Healthcare Finance How does Medicare reimburse hospitals for inpatient stays?

Instructions: Complete the following. Calculating Medicare Payments, Write-Offs, Limiting Charges, and Allowed Amounts: Calculate the following amounts for a nonphysician practitioner who bills Medicare: Submitted charge (based on provider's regular fee for office visit) $75 ● MPFS allowed amount $60 Nonphysician practitioner allowed amount (100 percent of MPFS allowed amount) $ . ● ● ● Instructions: Complete the following. Calculating Medicare Payments, Write-Offs, Limiting Charges, and Allowed Amounts: Calculate the following amounts for a participating provider who bills Medicare: Medicare payment (80 percent of the MPFS allowed amount) $ • Submitted charge (based on provider's regular fee for office visit) $75 Medicare physician fee schedule (MPFS) allowed amount $60 ● Coinsurance amount (paid by patient or supplemental insurance) $12 • Medicare payment (80 percent of the MPFS allowed amount) $ Medicare write-off (not to be paid by Medicare or the beneficiary) $ Instructions:…

When creating an Income Statement and calculating Net Patient Service Revenue, which of the accounts do you actually record as a line item on the Income Statement? O Discounts Charity Care Accounts Receivable Bad Debt

Anwar Jones has an insurance policy that pays benefits to him in cash when he is hospitalized. What type of insurance would this be?   Comprehensive major medical   Hospital indemnity   Long-term care   Cancer   Disability income

Accounting for postretirement health care benefits is similar, in most respects, to accounting o O Multiple Choice O Payroll taxes. Health insurance costs for current employees. Pension benefits. Sick pay and vacation pay.

Course Name: Principle of Healthcare Finance   How does Medicare reimburse physician services?

You need what type of license to sell Health insurance? OP & C Security Life Health and Life

Which is Idemenity Plan and which is Managed Care Plan? Insureds create contract with an insurer who does not provide health care services       The higher the deductible, the lower the premium       Insured receive health care services from a designated group of providers       May not even involve an insurance company       No annual deduction is incurred, but a small co-payment may be required I most value the freedom of choice and am willing to pay for it.       Cost is my most important consideration.       I’d rather have the flexibility of either having the insurance company reimburse me or directly paying the health care provider.

When MUST the Policy Summary for a life insurance policy be delivered? Prior to the sales presentation With or prior to delivery of the policy Within a year after delivery of the policy Only upon delivery of a replacement policy.

Ronald started his new job as a comrolier with Aerosystems today Carole, the employee benefes clerk, gave Renaid a packet that contained information on the company's health insurance options. Aerosystems offers is employees the choice between a private Insurance compeny plan (Blue Cross or Blue Shield, an HMO, and a PPO Ronald needs to review the packet and make a decision on which health care program best fits his needs. The folowing is an overview of that information The monthly premium cost for Ronald for the Blue Cross or Blue Shield pren will be $48.32. For al doctor's office visits. prescriptions, and major medical charges, Ronald wil be responsible for 20 percent end the insurance company will cover 80 percent of the covered charges. The annual deductible is $500 b. The HMO is provided to employees free of charge. The copayment for doctors office visits and major medical charges is $30. Prescription copayments are $5. The HMD pays 100 percent after Ronald's copayment. There is…

What is Medicaid? Who is eligible for Medicaid? What are the various parts of the Medicaid plan? Who finances the Medicaid plan?

Which of these duties might a financial manager in a healthcare organization be responsible for?     Prepare a year to date trial balance report for the annual tax filing     Conduct data analysis to report to the board of directors on new revenue sources     Complete a medical supply inventory and submit it to the purchasing department     Submitting invoicing to an insurance company for payment