HFMA CHFP MODULE 1 Business of Healthcare Exam Questions and Answers

HFMA CHFP MODULE 1 Business of Healthcare Exam Questions and Answers

1. is a pre-determined amount that the patient pays before the insurer begins to pay for services: deductible 2. a percentage of the insurance payment amount that is paid by the patient, along with the amount paid by the insurer.: coinsurance 3. a flat amount that the patient pays at each time of service: copayment 4. payment also includes amounts for services that are not included in the patient's benefit design and amounts for services balance billed by out-of-net- work providers. Payments typically does not include premium sharing by the patient.: Out-of-pocket payment 5. The amount payable out of pocket for healthcare services, which may in- cludes deductibles, copayments, coinsurance, amounts payable by the patient for services that are not included in the patient's benefit design, and amounts "balance billed" by out-of-network providers. Health insurance premiums con- stitute a separate category of healthcare costs for patients, independent of healthcare utilization.: Cost (to the patient) 6. The expense (direct and indirect) incurred to deliver healthcare services to patients.: Costs (to the provider) 7. The amount payable to the provider (or reimbursable to the patient) for services rendered.: Cost (to the health plan/insurer) 8. The expense related to provided health benefits (premiums or claims paid)- : Cost (to the employer) 9. The dollar amount a provider sets for services rendered before negotiating any discounts.The charge can be different from the amount paid.: Charge 10. The total amount a provider expects to be paid by health plans/payers and patients for healthcare services.: Price 11. An organization that negotiates or sets rates for provider services, col- lects revenue through premium payments or tax dollars, processes provider claims for service, and pays provider claims using collected premium or tax revenues.: Health Plan/Payer 12. An entity, organization, or individual that furnishes a healthcare service.: - Provider 13. Occurs when a healthcare provider bills a patient for charges (other than copayments, coinsurance or any amounts that may remain on the patient's an- nual deductible) that exceed the health plan's payment for a covered service. Innetwork providers are contractually prohibited from balance billing health plan members, but balance billing by out-ofnetwork providers is common.: - Balance Billing 14. In healthcare, readily available information on the price of healthcare ser- vices that, together with other information, helps define the value of those services and enables patients and other care purchasers to identify, compare and choose providers that offer the desired level of value: Price Transparency