Quiz
Chapter 7
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Questions in this quiz (17)
1Price setters vs price takers. When a provider has market dominance, and hence can set its own prices, it is said to be a _____?
- Aprice setter
- Bprice taker
2Providers are ___?
Perfectly competitive markets
Payer dominance
Government programs- Aprice taker
- Bprice setter
3When a provider is a price setter there are two most common theoretical bases
- Afull cost pricing and marginal cost pricing
- Blow pricing and no marginal cost pricing
4Full cost pricing, prices for a service are set to cover all costs: (3)
- Adirect variable costs
- Bindirect overhead costs
- Cdirect fixed costs
- Dno fixed costs
5Price takers uses
- Aproject costing
- Btarget costing
6Scenario Analysis, to break even, revenues must
- Aequal net profit
- Bequal total costs
7total costs = ___ + ____
- Atotal cost = total mc + total fc
- Btotal cost = total visits + total vc
- Ctotal costs = total variable costs + total fixed cost
8the value of scenario analysis,
focused on:- AIt is obvious that scenario analysis gives decision makers more insights into the decision at hand.
- BThe minimum PMPM rate necessary to break even.
- CThe maximum PMPM rate necessary to break even.
- DThe ability to accept a lower PMPM rate when cost control is possible.
- EThe ability to accept a higher PMPM rate when cost control is possible.
9Setting Managed Care Plan Rates,
- AManaged care plans must not set the rates they charge to employers on the basis of their costs of providing healthcare services.
- BManaged care plans must set the rates they charge to employers on the basis of their costs of providing healthcare services.
- Cthe rates for different services are estimated and then aggregated.
- Dthe rates for same services are estimated and then aggregated.
- EThis is usually done on a PMPM basis regardless of the actual reimbursement methods used to pay providers.
- FThis is usually done with something else besides PMPM basis regardless of the actual reimbursement methods used to pay providers.
10Setting Managed Care Plan Rates (Cont.),
There are three techniques used to set the rates for individual providers:- AFee-for-service (FFS) approach
- BFace-to-face approach
- CRandom approach
- DCost approach
- EDemographic approach
- FEthnicity approach
11To 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
- A.392
- B.328
- C.432
- D.323
- E.523
- F.350
12FFS approach cont,
inpatient cost = (pm utilization rate x ffs) / 12
= (_____ x 1,000$)/12
= ___ PMPM- A23.39$
- B84.24$
- C29.17$
- D17.34$
- E23.42$
13Cost 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 = ___ $- Aemployers
- Bphysicians
- Ccovered
- Duncovered
- E0.00075
- F0.00038
- G0.00043
- H$131.25
- I$134.32
- J$10.94
14What is RVU?
- Arelated variable units
- Brelative value units
- Crelative variable unknown
15Relative value units measure the _____ amount of resources consumed to provide a _____ service.
they form the basis for ___ for physician reimbursement- Arelative
- Brelated
- Cparticular
- Ddifferent
- Emedical
- Fmedicare
16a variance is the difference between the ___ results and the budgeted ( ___ ) value
- Afake results, budgeted (standard) value
- Bactual results, budgeted (standard) value
17variance analysis is a technique applied to budget data to
- Aidentify problem areas
- Bnot enhance control
- Cenhance control
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