Which of the following statements about retrospective reimbursement is false?

Which of the following statements about retrospective reimbursement is false? Question 1 options: The total reimbursement amount is determined after the services are provided The fewer services performed, the greater the potential for increased total reimbursement Types of retrospective reimbursement include fee schedule and per diem Reimbursement is based on the actual resources expended to deliver the services Question 2 (1 point) Dr. Jones is a podiatrist who performs more than 100 bunionectomies a year. Several of Dr. Jones’ patients are insured by Super Payer. Super Payer reimburses Dr. Jones one amount for the preoperative visit, surgery, and routine post-operative follow-up visits. Which reimbursement methodology does Super Payer use to reimburse Dr. Jones? Question 2 options: Fee schedule Case-rate methodology Bundled payment methodology Global payment method Question 3 (1 point) Dr. Ward is an endocrinologist who is part of the City Endocrinologist Specialists practice. Super Payer reimburses City Endocrinologist Specialists $450 per month for each of the 250 beneficiaries assigned to their care. Which type of reimbursement methodology is Super Payer using to reimburse City Endocrinologist Specialists? Question 3 options: Percent of billed charges Capitation Case-rate methodology Global payment method Question 4 (1 point) Dr. McGee is a primary care physician. Several of Dr. McGee’s patients are insured by Super Payer. Super Payer reimburses Dr. McGee for each service she provides during a clinic visit. Which reimbursement methodology does Super Payer use to reimburse Dr. McGee? Question 4 options: Global payment method Fee schedule Bundled payment methodology Case-rate methodology Question 5 (1 point) Dayna is analyst at Community Hospital. She is examining inpatient cases for Super Payer. She notices that all pneumonia cases have a reimbursement amount of $4,000 and that all CHF cases have a reimbursement rate of $4,200. The reimbursement is consistent for the entire year. Which methodology is Super Payer using to reimburse Community Hospital for inpatient admissions? Question 5 options: Per diem Fee schedule Case-rate methodology Global payment method Question 6 (1 point) CMS uses the ___________ reimbursement methodology when they contract with Medicare Advantage Payers to care for Medicare beneficiaries under Medicare Part C. Question 6 options: Per diem Bundled payment method Percent of billed charges Capitation Question 7 (1 point) CMS uses the __________ reimbursement methodology for inpatient psychiatric facility services payment system because a specific payment rate is established for each day of the admission. Question 7 options: Capitation Percent of billed charges Bundled payment method Per diem Question 8 (1 point) Use the following contract matrix to answer this question Payer Inpatient Services Outpatient Services A 62% billed charges 56% of billed charges B $6,500 obstetric delivery case rate Fee Schedule $70 per clinic visit $85 per initial OT evaluation $50 per OT visit (non-eval) C $2,100 obstetric delivery per diem $75 per clinic visit $45 per OT visit D $6,350 obstetric delivery case rate $65 per clinic visit $55 per initial OT evaluation $35 per OT visit (non-eval) Patient 72341 was admitted as an inpatient for delivery. The patient’s length of stay was three days. The charges for the encounter are $10,425.00. The cost of the encounter is $5,848.45. Which payer will reimburse the hospital the highest amount? Question 8 options: Payer A Payer C There is not enough information in the contract matrix to determine reimbursement for this encounter Payer B Question 9 (1 point) Use the following contract matrix to answer this question. Payer Inpatient Services Outpatient Services A 62% billed charges 56% of billed charges B $6,500 obstetric delivery case rate Fee Schedule $70 per clinic visit $85 per initial OT evaluation $50 per OT visit (non-eval) C $2,100 obstetric delivery per diem $75 per clinic visit $45 per OT visit D $6,350 obstetric delivery case rate $65 per clinic visit $55 per initial OT evaluation $35 per OT visit (non-eval) Patient 89423 was seen in the outpatient clinic at Happy Hospital for a pneumonia follow-up visit. The charges for the encounter total $135. Which payer will reimburse the hospital the lowest amount? Question 9 options: Payer B Payer D Payer C There is not enough information in the contract matrix to determine reimbursement for this encounter Question 10 (1 point) Use the following contract matrix to answer questions 8 through 11. Payer Inpatient Services Outpatient Services A 62% billed charges 56% of billed charges B $6,500 obstetric delivery case rate Fee Schedule $70 per clinic visit $85 per initial OT evaluation $50 per OT visit (non-eval) C $2,100 obstetric delivery per diem $75 per clinic visit $45 per OT visit D $6,350 obstetric delivery case rate $65 per clinic visit $55 per initial OT evaluation $35 per OT visit (non-eval) Patient 24571 was seen in the occupational therapy clinic for an initial evaluation of her carpal tunnel surgery recovery. The charges for the visit total $150. Which payer will reimburse the facility the highest amount? Question 10 options: Payer A Payer B Payer C There is not enough information in the contract matrix to determine reimbursement for this encounter Question 11 (1 point) Use the following contract matrix to answer questions 8 through 11. Payer Inpatient Services Outpatient Services A 62% billed charges 56% of billed charges B $6,500 obstetric delivery case rate Fee Schedule $70 per clinic visit $85 per initial OT evaluation $50 per OT visit (non-eval) C $2,100 obstetric delivery per diem $75 per clinic visit $45 per OT visit D $6,350 obstetric delivery case rate $65 per clinic visit $55 per initial OT evaluation $35 per OT visit (non-eval) Patient 62316 was admitted as an inpatient for hip replacement following a fall on ice in the parking lot of the school where he works as a teacher. During his admission, the patient received occupational therapy services post-surgery. The length of stay was six days. The charges for the encounter are $135,000. Which payer will reimburse the hospital the highest amount? Question 11 options: Payer C There is not enough information in the contract matrix to determine reimbursement for this encounter Payer B Payer D Question 12 (1 point) The pathologist’s office submitted a $54 bill for a laboratory test. In its payment notice (remittance advice), the healthcare plan lists its payment for the laboratory test as $28. What does the amount of $54 represent? Question 12 options: Allowable charge Billed charge Reimbursement Discounted rate Question 13 (1 point) The CMS-HCC model uses ___________ and __________ to predict the patient’s healthcare costs. Question 13 options: Patient age and functional status Patient demographic characteristics and past surgeries Patient demographic characteristics and health status Patient functional status and health status Question 14 (1 point) In the CMS-HCC model, beneficiaries with a risk score greater than 1 have ___________? Question 14 options: An average Medicare risk score A lower expected cost of care than the average Medicare beneficiary A higher expected cost of care than the average Medicare beneficiary To be reevaluated because no score should be greater than 1 Question 15 (1 point) In the CMS ACO model, what is attribution? Question 15 options: A beneficiary is assignment to multiple ACOs A beneficiary is assigned to a particular ACO A beneficiary rejects using an ACO for healthcare services A beneficiary is given a list of applicable ACOs and may choose which one to use Question 16 (1 point) Giant ACO has agreed to a shared savings rate of 65 percent and a shared loss rate of 40 percent with CMS. Giant ACO participates in a __________ risk agreement. Question 16 options: Two-sided Universal Three-sided One-sided Question 17 (1 point) Giant ACO has agreed to a shared savings rate of 65 percent and a shared loss rate of 40 percent with CMS. The benchmark for the year is $3M. In order to share in the savings Giant ACO must have actual expenses ____________ the benchmark amount. Question 17 options: Equal to Higher than Lower than None of the above Question 18 (1 point) Giant ACO has agreed to a shared savings rate of 65 percent and a shared loss rate of 40 percent with CMS. The benchmark for the year is $3M. The actual expenses for the year are $3.2M. How much money must Giant ACO return to CMS because they did not meet the benchmark amount? Question 18 options: $80,000 $130,000 $0 $200,000 Question 19 (1 point) Community Cancer Hospital provides care for oncology and hematology. They agreed to a contract with Super Payer that uses a percent of billed charges methodology for inpatient admissions. Super Payer will pay 70% of billed charges for oncology services and 65 percent of billed charges for hematology services. If the oncology admission has a total charge of $364,891.00, what reimbursement amount should be paid to Community Cancer Hospital? Question 19 options: $237,179.15 $255,423.70 $364,891.00 $109,467.30 Question 20 (1 point) University Hospital has a contract with Super Payer that uses a case-rate reimbursement methodology for inpatient admissions. For the cardiology admission in question, Super Payer has agreed to reimburse University Hospital $26,000. However, the total cost for the admission is $28,425. University Hospital is able to recoup the remaining $2,425.00 from Super Payer. Question 20 options: True False Question 21 (1 point) Which of the following is not a retrospective reimbursement methodology? Question 21 options: Per diem Fee schedule Percent of billed charges Case-rate methodology Question 22 (1 point) Insurance R’ Us uses a __________ reimbursement methodology for physician office services by reimbursing Johnson’s Clinic $450 per member per month for their 1050 insureds. Question 22 options: Capitation Global payment Case-rate methodology Fee schedule Question 23 (1 point) In 202X, Medicare will provide a monthly fee of $900 to High Hopes Medicare Advantage plan for each Medicare beneficiary with a risk adjustment factor (RAF) score of 1.0. After evaluation, Marcy’s RAF score for this year is 1.32; therefore, Medicare will provide an amount higher than $900 to High Hopes Medicare Advantage plan for Marcy’s care in 202X. Question 23 options: True False Question 24 (1 point) University Hospital has contracted with Medicare to participate in their shared savings program. They have agreed to a target total expenditure value of $300,000,000. The shared saving rate is 50 percent and there is no shared loss rate. University Hospital has chosen the two-sided track. Question 24 options: True False Question 25 (1 point) When Medicare Advantage firms determine the health status risk adjustment factor, they use __________ from claims submitted to Medicare over the past year. Question 25 options: National drug codes ICD-10-CM codes HCPCS codes ICD-10-PCS codes Submit Quiz0 of 25 questions saved

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."