Discussion Board Unit 2
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Out of the 48 insurance companies that offer coverage for Indiana only 26 of those are accredited. The highest rated insurance companies were Atena Life Insurance Company, Anthem Insurance Companies (Anthem Blue Cross and Blue Shield Indiana), Sierra Heath and Life Insurance Company, and UnitedHealthcare of the Midlands. All of which had a four-star rating. What was most shocking to me was that Anthem (Blue Cross Blue Shield), Aetna, Sierra, and UnitedHealthcare of the Midlands are all Medicare. While Anthem did offer a commercial HMO/POS combined option that was rated four stars as well. Cigna Health and Life Insurance Company came in with the worst rating of two and half stars and is a commercial PPO option. Cigna received a low score of prevention and equity with only a one and half star given. While treatment was given a two and half star, and patient experience was given a three-star rating. Since Medicare and Medicaid plans seemed to be the highest rated options in Indiana, I researched my own health insurance company of CareSource. This is a state funded Medicaid program and I have had a few struggles with them over the years, versus my daughter who is on Medicaid through Blue Cross Blue Shield, and I have had no problems with. CareSource ranked in with three and half stars. CareSource was given three and half stars for patient experience, three stars for prevention and equity, and three stars for treatment. According to RAND “
consumers' choice of hospitals relied more on anecdotal press reports of adverse events than on the comparative assessments that were available”. RAND also seems to think that major corporate health plans are no more likely to use these report cards than the average person is when finding a healthcare plan and that the only ones using the data are health provider organizations such as hospitals. Brook, R., McGlynn, E., Shekelle, P., Marshall, M., Leatherman, S., Adams, J., Hicks, J., & Klein, D.
(2002).
Report cards for health care: Is anyone checking them?
RAND Corp.
https://www.rand.org/pubs/research_briefs/RB4544.html
NCQA. (2023).
Health plans
. National Committee for Quality Assurance.
https://reportcards.ncqa.org/health-plans?dropdown-state=Indiana&filter-state=Indiana&filter-
accreditation=Accredited&pg=1
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Parktown Medical Center, Inc.. is a small health care provider owned by a publicly heldcorporation. It employs 7 salaried physicians, I0 nurses, 3 support stafl, and 3 clericalworkers. The clerical workers perform such tasks as reception, correspondence, cashreceipIs,billing, and appointment scheduling. All are adequately bonded. Most patients pay for services rendered by cash or check on the day of their visit.Sometimes.however, the physician who is to performservices apprcredit based on an interview. When credit is approved, the physician files a memo vone of the clerks to set up the receivable using data the physician generates.The servicing physician prepares a charge sup that 1s given to one or the clerKs IorDicing and preparation of the patient S bill. At the end of the dav.one of the clerks usesthe bills to preparea revenue summarv and. in cases of credit sales. to update thecounts receivable subsidiary ledger.The frontoffice clerks receive cash and checksdirectly from patients…
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VIP-MD is a health maintenance organization (HMO) located in North Carolina. Unlike the traditional fee-for-service model that determines the payment according to the actual services used or costs incurred, VIP-MD receives a fixed, prepaid amount from subscribers. The per member, per month rate (PMPM) is determined by estimating the health care cost per enrollee within a geographic location. The average health care coverage in North Carolina costs $376 per month, which is the same amount irrespective of the subscriber’s age. Because individuals are demanding quality care at reasonable rates, VIP-MD must contain its costs to remain competitive. A major competitor, National Physicians, entered the North Carolina market early in the current year with a monthly premium of $333. VIP-MD wants to maintain its current market penetration and hopes to increase its enrollees in the current year. The latest data on the number of enrollees and the associated costs follow:
Age
Enrollment in…
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Assume that the entity is a private not-for-profit hospital. During Year 2, the hospital has two portfolios: patients with insurance and
patients without insurance. Work with a standard charge of $2 million is done for the first group and work with a standard charge of $1
million is done for the second group. Insurance companies have contracts that create explicit price concessions. The hospital believes
it has a 60 percent chance of collecting $1.5 million and a 40 percent chance of collecting $1.3 million. Because of the high cost of
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Assume the hospital wants to use the most likely amount where…
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City Bus Corporation provides school bus transportation to
public schools in Lancaster County. City Bus owns 50 buses
that are garaged in three different cities within the county.
The firm faces competition from two larger bus companies
that operate in the same area. Public school boards gener-
ally award contracts to the lowest bidder, but the level of
service and overall performance are also considered.
b. Identify the major loss exposures faced by City Bus.
c. For each of the loss exposures identified in (b),
identify a risk management technique or combina-
tion of techniques that could be used to handle the
exposure.
d. Describe several sources of funds for paying
losses if retention is used in the risk management
a. Briefly describe the steps in the risk management
process that should be followed by the risk manager
of City Bus.
program.
e. Identify other departments in City Bus that would
also be involved in the risk management program.
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The effects of climate related risks on insurance companies.
- Identify the climate related risks which may affect insurance companies in St. Kitts and Nevis and the region on a whole.
- State the mitigating measures registered insurance companies should have in place to minimize the impact of identified risks.
- Include the steps the regulatory authority should take to ensure that this is monitored effectively.
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Delaware Medical Center operates a general hospital. The medical center also rents space and beds to separately owned entities
rendering specialized services, such as Pediatrics and Psychiatric Care. Delaware charges each separate entity for common services,
such as patients' meals and laundry, and for administrative services, such as billings and collections. Space and bed rentals are fixed
charges for the year, based on bed capacity rented to each entity. Delaware Medical Center charged the following costs to Pediatrics
for the year ended June 30, 20x1:
Dietary
Janitorial
Laundry
Laboratory
Pharmacy
Repairs and maintenance
General and administrative
Rent
Billings and collections.
Total
Annual Patient Days
Up to 22,000
22,001 to 26,000
26,001 to 29, 200
Aides
20
25
31
Patient Days
(variable)
$ 580,000
270,000
440,000
320,000
Nurses
10
14
16
220,000
$1,830,000
During the year ended June 30, 20x1, Pediatrics charged each patient an average of $300 per day, had a capacity of 50 beds, and…
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Delaware Medical Center operates a general hospital. The medical center also rents space and beds to separately owned entities rendering specialized services, such as Pediatrics and Psychiatric Care. Delaware charges each separate entity for common services, such as patients’ meals and laundry, and for administrative services, such as billings and collections. Space and bed rentals are fixed charges for the year, based on bed capacity rented to each entity. Delaware Medical Center charged the following costs to Pediatrics for the year ended June 30, 20x1:
Patient Days (variable)
Bed Capacity (fixed)
Dietary
$
540,000
—
Janitorial
—
$
71,000
Laundry
240,000
—
Laboratory
400,000
—
Pharmacy
320,000
—
Repairs and maintenance
—
33,000
General and administrative
—
1,320,000
Rent
—
1,570,000
Billings and collections
230,000
—
Total
$
1,730,000
$
2,994,000…
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A business-type government hospital.
A not-for-profit hospital.
A for-profit hospital.
All of the above.
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Delaware Medical Center operates a general hospital. The medical center also rents space and beds to separately owned entities rendering specialized services, such as Pediatrics and Psychiatric Care. Dela-ware charges each separate entity for common services, such as patients’ meals and laundry, and for administrative services, such as billings and collections. Space and bed rentals are fixed charges for the year, based on bed capacity rented to each entity. Delaware Medical Center charged the following costs to Pediatrics for the year ended June 30, 20x1"
Patient Days Bed Capacity
Dietary ....................................................................... $600,000 —
Janitorial .......................................................................— $70,000
Laundry…
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17. In Year 1, Better Sleep Company began to receive complaints from physicians that patients were experiencing unexpected side
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b. CPA Mackenzie Palin practices public accounting and is a director of Comedy Company. Palin’s firm performs consulting and tax services for Comedy. Palin prepared unaudited financial statements on Comedy’s letterhead and submitted them to First National Bank in support of a loan application. Palin’s accounting firm received a fee for this service.c. CPA Ellery Idle audited the financial statements of Monty…
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Read the following cases.
Required:
For each case, select whether the action or situation shows a violation of the AICPA Code of Professional Conduct, and select the
relevant rule.
a. CPA Jerry Cheese became the new auditor for Python Insurance Company. Cheese knew a great deal about insurance
accounting but had never conducted an audit of an insurance company. Consequently, Cheese hired CPA Tate Gilliam, who
had six years of experience with the State Department of Insurance Audit. Gilliam managed the audit, and Cheese was the
partner in charge.
b. CPA Mackenzie Palin practices public accounting and is a director of Comedy Company. Palin's firm performs consulting and
tax services for Comedy. Palin prepared unaudited financial statements on Comedy's letterhead and submitted them to First
National Bank in support of a loan application. Palin's accounting firm received a fee for this service.
c. CPA Ellery Idle audited the financial statements of Monty Corporation and gave an unmodified…
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The president of the American Insurance Institute wants to compare the yearly costs of auto insurance offered by two leading
companies. He selects a sample of 15 families, some with only a single insured driver, others with several teenage drivers, and pays
each family a stipend to contact the two companies and ask for a price quote. To make the data comparable, certain features, such as
the deductible amount and limits of liability, are standardized. The data for the sample of families and their two insurance quotes are
reported in the table.
Family
Becker
Berry
Cobb
Debuck
Midstates Car
Insurance
$ 2,090
Gecko Mutual
Insurance
$ 1,610
1,683
1,247
1,402
2,327
1,830
1,367
DuBrul
930
1,461
Eckroate
697
1,789
German
1,741
1,621
Glasson
1,129
1,914
King
1,018
1,956
Kucic
1,881
1,772
Meredith
1,571
1,375
Obeid
874
1,527
Price
1,579
1,767
Phillips
1,577
Tresize
860
1,636
1,188
Click here for the Excel Data File
At the 0.10 significance level, can we conclude that there is a difference in…
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It is hypothesized that, of the students completing their degree in physical therapy in
the state of Georgia, 35% of them take a job in Georgia, 38% take a job in a
neighboring state, while the rest take a job further away. A random sample of 86
students graduating with a degree in physical therapy in Georgia over the last 10
years are selected and 40 of them took a job in-state, 22 of them took a job in a
neighboring state, and the rest of them took a job in a state further away.
What value represents the expected frequency for PT graduates who took a job in a
neighboring state?
If needed, round your answer to two decimal places.
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True or false
12) The brokers' motivation is measured in five levels: Great, Good, Regular, Bad, and Awful.
13) The regulatory agency defines the minimum and maximum premiums to be charged for each type of insurance.
14) Reinsurance can be conducted, without limits, for Auto, Property, and Life insurance.
15) The combined index does not measure the insurer's operational efficiency.
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A county medical agency is considering two mutually exclusive options for treatment of a chronic
illness in a population ot elderly patients. For cach option the agency has initial outlays (for
equipment and initial training) and annual expenses. Patient benefits are measured in terms of
quality of life, and patient costs are measured in terms of lost income due to treatment. Estimates
have been made of the dollar value of both. Each option has a lifetime of 5 years, after which new
options will be considered based on the technology available then. MARR is 5%.
A
$165,000
55,000
Investment (t O)
$120,000
Annual expense
Annual patient benefits
Annual patient costs
35.000
175,000
12,000
200,000
18,000
What is the incremental BC when the two are compared? Select the answer closest to this value.
O 0.63
O 0.69
0.75
O 0.96
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Nursing Care Incorporated, or NCI, operates both a small nursing home and a retirement home. There is a single kitchen used to provide meals to both the nursing home and retirement home, meaning labor costs and utilities costs of the kitchen are shared by the two homes. There is also a centralized cleaning department that provides the cleaning services for both homes as well as the kitchen. The nursing home serves only indigent patients who are on Medicaid. The state Department of Health and Family Services (DHFS) reimburses NCI at Medicaid-approved cost reimbursement rates. The Medicaid reimbursement rates are based on cost information supplied by NCI. The relevant cost and allocation data for the most recent year appear in the following table.
Annual Operating Cost
Cleaning department
$ 90,000
Central kitchen
$ 120,000
Allocation Base
Kitchen
Nursing Home
Retirement Home
Square feet of space
1,000
2,000
3,000
Number of residents
—
6
4
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Nursing Care Incorporated, or NCI, operates both a small nursing home and a retirement home. There is a single kitchen used to provide meals to both the nursing home and retirement home, meaning labor costs and utilities costs of the kitchen are shared by the two homes. There is also a centralized cleaning department that provides the cleaning services for both homes as well as the kitchen. The nursing home serves only indigent patients who are on Medicaid. The state Department of Health and Family Services (DHFS) reimburses NCI at Medicaid-approved cost reimbursement rates. The Medicaid reimbursement rates are based on cost information supplied by NCI. The relevant cost and allocation data for the most recent year appear in the following table.
Annual Operating Cost
Cleaning department
$ 90,000
Central kitchen
$ 120,000
Allocation Base
Kitchen
Nursing Home
Retirement Home
Square feet of space
1,000
2,000
3,000
Number of residents
—
6
4
Required:
1.…
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- Parktown Medical Center, Inc.. is a small health care provider owned by a publicly heldcorporation. It employs 7 salaried physicians, I0 nurses, 3 support stafl, and 3 clericalworkers. The clerical workers perform such tasks as reception, correspondence, cashreceipIs,billing, and appointment scheduling. All are adequately bonded. Most patients pay for services rendered by cash or check on the day of their visit.Sometimes.however, the physician who is to performservices apprcredit based on an interview. When credit is approved, the physician files a memo vone of the clerks to set up the receivable using data the physician generates.The servicing physician prepares a charge sup that 1s given to one or the clerKs IorDicing and preparation of the patient S bill. At the end of the dav.one of the clerks usesthe bills to preparea revenue summarv and. in cases of credit sales. to update thecounts receivable subsidiary ledger.The frontoffice clerks receive cash and checksdirectly from patients…arrow_forwardVIP-MD is a health maintenance organization (HMO) located in North Carolina. Unlike the traditional fee-for-service model that determines the payment according to the actual services used or costs incurred, VIP-MD receives a fixed, prepaid amount from subscribers. The per member, per month rate (PMPM) is determined by estimating the health care cost per enrollee within a geographic location. The average health care coverage in North Carolina costs $376 per month, which is the same amount irrespective of the subscriber’s age. Because individuals are demanding quality care at reasonable rates, VIP-MD must contain its costs to remain competitive. A major competitor, National Physicians, entered the North Carolina market early in the current year with a monthly premium of $333. VIP-MD wants to maintain its current market penetration and hopes to increase its enrollees in the current year. The latest data on the number of enrollees and the associated costs follow: Age Enrollment in…arrow_forwardAssume that the entity is a private not-for-profit hospital. During Year 2, the hospital has two portfolios: patients with insurance and patients without insurance. Work with a standard charge of $2 million is done for the first group and work with a standard charge of $1 million is done for the second group. Insurance companies have contracts that create explicit price concessions. The hospital believes it has a 60 percent chance of collecting $1.5 million and a 40 percent chance of collecting $1.3 million. Because of the high cost of health care, uninsured patients receive a variety of implicit price concessions. The hospital believes it has a 70 percent chance of collecting $300,000 and a 30 percent chance of collecting $200,000. The hospital reported exchange revenue of $3 million and a provision for bad debt (a contra revenue account) of $1.2 million to drop the reported balance to the expected collection amount. Assume the hospital wants to use the most likely amount where…arrow_forward
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