Question: 16. A member, covered under an HMO plan, had a 7 day non-emergent inpatient stay at a hospital not in the health plans network. The

16. A member, covered under an HMO plan, had a 7 day non-emergent inpatient stay at a hospital not in the health plans network. The total charges for the stay were $42,000. The inpatient rate at in-network hospitals is a per diem of $1,000. What payment is the hospital entitled to?

A. $10,000

B. $7,000

C. $42,000

D. $25,000

21. Which of the following payment types is least advantageous to a payer:

A. Fee Schedule

B. DRG Payment

C. Capitation

D. Discount off Billed Charges

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