Final answer:
CPT codes are used to inform insurance payers about the procedures performed for reimbursement purposes within a fee-for-service health financing system, making the statement True. In HMOs, providers are reimbursed based on patient numbers, not specific services. Adverse selection is an insurance market risk due to information imbalances.
Step-by-step explanation:
CPT codes (Current Procedural Terminology codes) indeed tell the insurance payer what procedures the healthcare provider performed and would like to be reimbursed for. Therefore, the answer to the student's question is a) True. These codes are part of the billing process and are crucial in a fee-for-service health financing system. They allow providers to communicate to payers what services were provided, to ensure accurate and appropriate reimbursement.
In contrast, health maintenance organizations (HMOs) provide a different reimbursement model where providers are paid based on the number of patients they see, rather than the specific services provided. This model requires providers to manage resources to offer care for their panel of patients effectively, regardless of individual service costs.
Lastly, adverse selection is a risk in insurance markets when there is an imbalance of information between buyers and the insurance company, potentially leading to disproportionate enrollment by high-risk individuals, affecting the sustainability of insurance offerings.