Chapter 1 Quiz

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School

University of Kansas *

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1000

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Health Science

Date

Dec 6, 2023

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docx

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2

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1. Which one of the three models of healthcare delivery is used in the US? Private health insurance 2. Compare the social insurance model and the national health service model. Describe their similarities and differences. The social insurance model is universal healthcare. National health insurance model is government ran facilities. Similar in the sense that social insurance and national insurance provide insurance benefits that is defined by the nation’s government. Workers pay into social insurance at an affordable percentage. National health insurance is paid in by taxes. When having social insurance if unemployment were to occur you would still have medical coverage. National health insurance does not account for when you become unemployed. 3. Describe the healthcare spending trend in the US over the past decade. Over the past decade a trend of increased spending has been consistent. At a rate of 4.6% from 2017 to 2018. 4. Provide two examples of transactions that occur between the provider and third-party payer. Transactions from services the patient received is submitted by the provider to third party payers. Transactions submitted on behalf of the patient to provider. 5. Define risk pool as used in health insurance. Risk pool in health insurance is defined as cost of healthcare that is unknown by a group of individuals who have a similar risk of loss. 6. In the US, healthcare is most often connected to employment. Provide a downfall of this approach. When an individual loses a job, health benefits are then also lost. Insurance can be continued but out of pocket cost would be expensive. Insurance can also be expensive because employers require workers to pay a percentage of coverage provided by them. Some employers have no insurance benefit policies to offer, and individuals must source their own health insurance. Which again can be very expensive. 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 mother 8. What is a benefit of a multidisciplinary approach to RCM? Multidisciplinary approach promotes clinical departments to collaborate. This creates a revenue cycle management team that is run by representatives from each department in the healthcare organization. 9. What are the goals of revenue integrity? Revenue integrity is to produce a claim that is clean. Let it be free of errors, complete and have all services and supplies accounted for. A claim that adheres to contract requirements, regulations, and laws. pg. 1 CHAPTER 1 QUIZ
10. Describe how a healthcare organization benefits from an IRC. Healthcare organization benefits from IRC because can help reduce cost across board for revenue/expenses. Object is to collect, perform consistency and coordinate strategic goals. pg. 2 CHAPTER 1 QUIZ
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