Medicaid plans facing several operational challenges
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Medicaid plans facing several operational challenges
QUESTION 1
Medicaid plans face several operational challenges, including challenging populations and an uncertain policy and payment environment.
A True
B False
4.5 points
QUESTION 2
Sandy is the new practice manager of Precise Physicians group. Part of her new role is to explain the goal of managed care, in order to educate staff on its purpose and how it impacts the business’ activities and reimbursement strategies. If you were Sandy you would explain that the goal of managed care activities include all but the following?
1. A, manage the cost of health care B, provide free healthcare service to the uninsured C. influence the quality of that health care B, provide better access to that care 4.5 points
QUESTION 3
Data analysis is a powerful asset to businesses and individuals, to be able to compare information for decision making. But in order to be considered useful for data analysis purposes, data must be all of the following except:
1. A, Be clean and valid B, Encompass a specific and short time period C, Link appropriately if it comes from multiple sources D, Be consistent and mean the same thing from provider to provider 4.5 points
QUESTION 4
Which of the following scenarios BEST describes how capitation works in regard to physician reimbursement?
1. A, A physician is paid the same amount regardless of how many members receive services in a given month or how expensive those services are. B, A physician is paid based on use of services by members or race or gender. C, A physician rate can vary depending on such factors as age, gender, current health status, geography, and practice type. D. None are correct 4.5 points
QUESTION 5
Administrative claims data can serve many different uses for reporting and analysis in managed care. Which of the following examples BEST describes possible uses of this data:
1. A, Monitor utilization patterns and the cost of health care B, Conduct clinical investigations C, Patient profiling D, None are correct 4.5 points
QUESTION 6
Which of the following calculation scenarios describe capitation in regard to physician reimbursement?
1. A, If a physician receives $100 per month per member and the plan has 20 members, then the physician will receive $2000/month. B, Even if no members seek services in a given month, the physician is still compensated $2000. C, On the other hand, if all 20 members seek services in a given month, the physician is still only paid $2000. D, All are correct 4.5 points
QUESTION 7
In most situations, providers have the option whether or not to participate in P4P programs though involuntary participation is possible. This may be a reflection of the idea that most of pay-for-performance (P4P) incentives are financial.
A, True
B, False
4.5 points
QUESTION 8
Which of the following is NOT a descriptive element of a P4P program?
1. A, A variety of measures can be used; measures may be simple or complex; it is recommended that measures be straightforward, understandable, and valid. B, Rewards include the following: tiering, reimbursement adjustments, and bonus payments C, A common method of per diem is straight per diem; this method is a negotiated single charge for a day in the hospital regardless of any actual charges or costs incurred. D, None are correct 4.5 points
QUESTION 9
Managed care organizations have a wide array of tools to promote prevention through the use of activities, such as case management. To achieve maximum impact, managed care organizations need to make use of the entire set of tools available to them. Components of a strong managed care prevention program include the following.
1. A, immunizations and screenings included in benefits B, health risk assessments for select populations only C, free fitness center memberships D, none are correct 4.5 points
QUESTION 10
- The following should be considered when designing and implementing technology and information systems:
2. A, Visibility, because only external customers should be considered. B, Security and privacy, because employees should be individually responsible for security audits. C, Usability, because users’ needs should not be met. D, Flexibility, because systems should have the capability to be easily modified to meet changing requests.
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). 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