Discussion: Employee covered Health Plans

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Discussion: Employee covered Health Plans essay assignment

Question 1.1. (TCO 7) Employee covered health plans are most likely to be? (Points : 5)

Question 2.2. (TCO 7) Capitation plans are more common for physician payment because: (Points : 5)

Question 3.3. (TCO 7) The James Clinic is an organization of 100 physicians in a variety of specialties. They recently contracted with Prudential Health Plan on a capitated basis to provide all medical services to Prudential’s members for the next three years. This HMO model would be defined as a: (Points : 5)

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Question 4.4. (TCO 7) Suppose that AT&T had made an offer to acquire Merck Pharmaceuticals. Ignoring potential antitrust problems, this merger would be classified as a: (Points : 5)

Question 5. 5. (TCO 7) An HMO has a Point of Service (POS) option for its members, but will pay only 80 percent of approved charges. If a member goes out of network for a medical procedure with a charge of $2,000, of which $1,200 is approved, how much must the member pay? (Points : 10)

Question 6. 6. (TCO 7) A hospital incurs $10 million of cost to treat Medicaid patients and receives $7 million in payment. Actual charges for these Medicaid patients were $20 million. The net community benefit expense that would be reported in Schedule H of IRS Form 990 would be? (Points : 10)

Question 7. 7. (TCO 7) How is charity care usually defined? (Points : 10)