7. The reimbursement system that places the provider at the greatest financial risk is A. Charges B. Cost C. Per Case D. Per dienm E. Capitation 8. Medicare has three major parts, Part A pays for A. inpatient services outpatient and physician services C. prescription drugs D. long term care 9. Which of the following admissions would receive the lowest reimbursement under the DRG system? A. a surgical case without comorbidities or complications B. a surgical case with comorbidities or complications C. a medical case without comorbidities or complications D. a medical case with comorbidities or complications 10. Which of the following was not used to set physician payment in the RBRVS? A. physician time B. practice cost, non-physician expenses C. cost of malpractice insurance D. patient mix 11. The purpose of withholds and risk pools is to reduce unnecessary medical services by A. placing part of the cost of care on patients B. reducing payments rates to providers C. requiring pre-authorization for services D. placing providers at financial risk for excessive use of specialist and hospital care 12. Health plans have four functions, underwriting involves A. evaluating risk and setting premiums B. communicating available products to perspective customers C. pre-authorization, concurrent review, retrospective review and case management. D. verifying coverage and determining paymentl 13. In what type of HMO are physicians most likely to be employees of the HM)? A. Staff model HMO B. Group model HMC C. IPA model HMO D. Network model HM0