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Chapter 7

Question 1 of 17

1

Price setters vs price takers. When a provider has market dominance, and hence can set its own prices, it is said to be a _____?

Select one of the following:

  • price setter

  • price taker

Explanation

Question 2 of 17

1

Providers are ___?
Perfectly competitive markets
Payer dominance
Government programs

Select one of the following:

  • price taker

  • price setter

Explanation

Question 3 of 17

1

When a provider is a price setter there are two most common theoretical bases

Select one of the following:

  • full cost pricing and marginal cost pricing

  • low pricing and no marginal cost pricing

Explanation

Question 4 of 17

1

Full cost pricing, prices for a service are set to cover all costs: (3)

Select one or more of the following:

  • direct variable costs

  • indirect overhead costs

  • direct fixed costs

  • no fixed costs

Explanation

Question 5 of 17

1

Price takers uses

Select one of the following:

  • project costing

  • target costing

Explanation

Question 6 of 17

1

Scenario Analysis, to break even, revenues must

Select one or more of the following:

  • equal net profit

  • equal total costs

Explanation

Question 7 of 17

1

total costs = ___ + ____

Select one of the following:

  • total cost = total mc + total fc

  • total cost = total visits + total vc

  • total costs = total variable costs + total fixed cost

Explanation

Question 8 of 17

1

the value of scenario analysis,

focused on:

Select one or more of the following:

  • It is obvious that scenario analysis gives decision makers more insights into the decision at hand.

  • The minimum PMPM rate necessary to break even.

  • The maximum PMPM rate necessary to break even.

  • The ability to accept a lower PMPM rate when cost control is possible.

  • The ability to accept a higher PMPM rate when cost control is possible.

Explanation

Question 9 of 17

1

Setting Managed Care Plan Rates,

Select one or more of the following:

  • Managed care plans must not set the rates they charge to employers on the basis of their costs of providing healthcare services.

  • Managed care plans must set the rates they charge to employers on the basis of their costs of providing healthcare services.

  • the rates for different services are estimated and then aggregated.

  • the rates for same services are estimated and then aggregated.

  • This is usually done on a PMPM basis regardless of the actual reimbursement methods used to pay providers.

  • This is usually done with something else besides PMPM basis regardless of the actual reimbursement methods used to pay providers.

Explanation

Question 10 of 17

1

Setting Managed Care Plan Rates (Cont.),
There are three techniques used to set the rates for individual providers:

Select one or more of the following:

  • Fee-for-service (FFS) approach

  • Face-to-face approach

  • Random approach

  • Cost approach

  • Demographic approach

  • Ethnicity approach

Explanation

Question 11 of 17

1

To illustrate the FFS method, assume that BetterCare HMO targets 350 inpatient days for each 1,000 members of an employee group, or 350 รท 1,000 = ____ per member

Select one of the following:

  • .392

  • .328

  • .432

  • .323

  • .523

  • .350

Explanation

Question 12 of 17

1

FFS approach cont,
inpatient cost = (pm utilization rate x ffs) / 12
= (_____ x 1,000$)/12
= ___ PMPM

Select one of the following:

  • 23.39$

  • 84.24$

  • 29.17$

  • 17.34$

  • 23.42$

Explanation

Question 13 of 17

1

Cost 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 = ___ $

Select one or more of the following:

  • employers

  • physicians

  • covered

  • uncovered

  • 0.00075

  • 0.00038

  • 0.00043

  • $131.25

  • $134.32

  • $10.94

Explanation

Question 14 of 17

1

What is RVU?

Select one of the following:

  • related variable units

  • relative value units

  • relative variable unknown

Explanation

Question 15 of 17

1

Relative value units measure the _____ amount of resources consumed to provide a _____ service.
they form the basis for ___ for physician reimbursement

Select one or more of the following:

  • relative

  • related

  • particular

  • different

  • medical

  • medicare

Explanation

Question 16 of 17

1

a variance is the difference between the ___ results and the budgeted ( ___ ) value

Select one of the following:

  • fake results, budgeted (standard) value

  • actual results, budgeted (standard) value

Explanation

Question 17 of 17

1

variance analysis is a technique applied to budget data to

Select one or more of the following:

  • identify problem areas

  • not enhance control

  • enhance control

Explanation

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