Reference no: EM133272565

Chapter 5

1. (a.) What is the difference between a price setter and a price taker from a HOSPITAL stance?

(b.) Can most providers be classified strictly as price settlers or price takers?

2. What are the essential differences between full cost and marginal cost pricing strategies?

3. What is cross-subsidization (price shifting)?

4. (a). What is profit (CVP) analysis?

(b). Why is it so useful to healthcare managers?

(c.) What is a profit and loss (P & L) statement?

5. (a). Write out and explain the equation for volume breakeven.

(b). What is the difference between accounting and economic breakdown?

6. What are the critical differences in profit analysis when conducted in a capitated environment versus a fee-for-service environment?

7. How does a provider's incentive differ when it moves from a fee-for-service to a capitated environment?

Chapter 4

1. Identify and briefly describe the major third-party payers.

2. (a.) What are the primary characteristics of managed care organizations (MCO'S)?

(b.) Describe two different types of MCOs.

3. What is the difference between fee-for-service reimbursement and capitation?

4. What is pay for performance?

5. What are provider incentives and risks under each of the following reimbursement methods:

a.) Cost- based

b.) Charge-based, including discounted charges

c.) Prospective payments

d.) Capitation

6. Describe the coding systems for diseases (diagnoses) and procedures.

7. How does Medicare reimburse hospitals for inpatient stays?

8. How does Medicare reimburse physician's services?