Dr Leona Koenig Removed the Appendix of a Plan Member

question 49

Multiple Choice

Dr. Leona Koenig removed the appendix of a plan member of the Helium health plan. In order to increase the level of reimbursement that she would receive from Helium, Dr. Koenig submitted to the health plan separate charges for the preoperative physical examination, the surgical procedure, and postoperative care. All of these charges should have been included in the code for the surgical procedure itself. Dr. Koenig's submission is a misuse of the coding system used by health plans and is an example of:

• A) Upcoding
• B) A wrap-around
• C) Churning
• D) Unbundling

Examine the influence of expectations about future prices on current supply.

Comprehend the role of substitute goods in shaping supply decisions.

Grasp the concept of market equilibrium and the forces that drive towards it.

Understand the effects of demand changes on market equilibrium.

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Definitions:

Market Orientation

A business philosophy where the focus is on identifying and meeting the needs and desires of customers through the product mix.

Dual-process model

A theory explaining human thought and behavior as the outcome of two distinct systems: one automatic and unconscious, and the other deliberate and conscious.

Restoration focused

Relates to efforts or methodologies aimed at restoring or revitalizing something to its original or a better state.