H320 Final review

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H320 Final review
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2013-12-15 19:10:47
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  1. Heath care inflation typically exceeds general inflation because of:
    • FEE FOR SERVICE
    • REIMBURSEMENT
  2. Major
    payment / reimbursement methods for healthcare services include:
    GLOBAL PAYMENT
  3. Reasons
    cited for health care market inefficiencies include:
    • THE PREVEALENCE OF
    • THIRD PARTY PAYERS
  4. The insurer
    is the:
    INSURANCE CARRIER
  5. A method of
    determining health insurance reimbursement rates based upon charges by other
    area providers for comparable services is called:
    USUAL AND CUSTOMARY
  6. Which of
    the following are basic components of the “Revenue Cycle”?
    • PATIENT
    • REGISTRATION
  7. Which of
    the following is an example of managed care:
    • INDEPENDENT
    • PRACTICE ASSOCIATION (IPA)
  8. The
    greatest source of funding that finances US Health services is:
    PRIVATE INSURANCE
  9. Which of
    the following is used to transfer some of the risk from an employer sponsored
    partially self-funded health plan?
    REINSURNACE
  10. The
    tendency of individuals to choose the health insurance plan or other benefit
    they anticipate using is called:
    SELECTION BIAS
  11. Services
    provided by a TPA include:
    • BENEFIT ELIGIBILITY
    • DETERMINATION, CLAIN ADJUDICATION, CODE EDITING, CLAIM PAYMENT (all of the above)
  12. Assessing
    the health risks and possible claim expenditures to determine the insurability
    of a person or group is called:
    UNDERWRITING
  13. The
    fundamental basis of health insurance is to:
    • SPREAD RISKS,
    • TRANSFER RISKS, PREVENT CATASTROPHIC FINANCIAL SITUATIONS, MAKE PAYMENTS MORE
    • PREDICTABLE (all of the
    • above)
  14. Methods of
    cost-sharing that employer-sponsored self-funded health plans use to reduce
    their portion of health plan costs include:
    DEDUCTABLES
  15. An
    organization that contracts with self-funded employers to administer its
    employee health plan and pay health claims is called:
    • THIRD PARTY
    • ADMINISTRATOR
  16. “Administrative
    Services Only” or “ASO” refers to
    • HEATH INSURANCE
    • CARRIERS’ ADMINISTERING A HEALTH PLAN WITHOUT UNDERWRITING RISKS
  17. Reasons why
    an employer would self-fund it's employee health plan include:
    • CONTROLLING HEALTH
    • PLAN BENEFIT DESIGN OPTIONS
  18. The ratio
    of premium received to benefit paid out by an insurer is the:
    RETENTION RATE
  19. The portion
    of preium an insurer charges to cover the actual cost of insuring risk
    assessment, marketing and claims processing is called:
    ADMINISTRATIVE LOAD
  20. A hybrid
    managed care plan that offers consumers a choice of options at the time they
    seek services-rather than at the ttime they choose to enroll-is called:
    • POINT-OF-SERVICE
    • PLAN
  21. An example
    of an alternative delivery system includes:
    • GROUP MODEL HMO,
    • STAFF MODEL HMO, POINT-OF-SERVICE PLAN, INDEPENDENT PRACTICE MODEL HMO (all of the above)
  22. A medical
    condition that may preclude coverage by a new health insurance plan for a
    period of time is called:
    • A PRE-EXISTING
    • CONDITION
  23. Strategies that
    employer sponsored health plans use to contain health plan expenditures
    include:
    • PRESCRIPTION DRUG
    • FORMULARY
  24. Experience
    rating includes:
    • ANALYZING PRIOR
    • PLAN YEAR EXPENDITURES
  25. The 2 basic
    types of health insurance policies are:
    • INDIVIDUAL &
    • GROUP POLICIES
  26. The
    deductible is a set amount one health plan member pays each time they access
    specialty care
    FALSE
  27. Third Party
    Administrators typically charge self-funded groups by employee per month basis
    TRUE
  28. The
    majority of employers in the US have between 150 and 500 employees
    FALSE
  29. Managed
    care is an umbrella term for a variety of health care plans that at some point
    integrates delivery and finance
    TRUE
  30. Medicaid is
    financed 75 percent by the states, and 25 percent by the federal government
    FALSE
  31. "Cost"
    and "Charge" mean the same thing:
    FALSE
  32. The term
    "Stop Loss" can apply to reinsurance amounts on a specific and
    aggregate basis, as well as the annual out-of-pocket maximum amount a
    beneficiary would pay under a group health plan
    TRUE
  33. Medicare
    Part "B" provides coverage for hospitalization and is financed
    through both an employer tax and a payroll tax on employee earnings
    FALSE
  34. When
    physicians send a bill to a payer (carrier or TPA) for professional services
    rendered, they use a UB-04 claim.
    FALSE
  35. Under
    COBRA, an employee can maintain his/her same health insurance coverage with
    his/her employer after termination for up to 24 months
    FALSE
  36. Risk
    assessment is a term that refers to a health insurance carrier prociding
    coverage to only those health plans/populations that are a good risk
    FALSE
  37. List 3
    factors that contribute to healthcare market inefficiencies
    • -Fee for service,
    • -lack of information given to physician,           -prevalance of 3rd party payers
  38. List 5
    factors that contribute to healthcare inflation exceeding general inflation:
    • -Higher life expectancy,
    • -aging population,
    • -desire for better quality of life,
    • -desire for longevity of life,
    • -growing population
  39. 3 elements
    of revenue cycle
    • -billing,
    • -coding,
    • -patient registration
  40. 3  services that a TPA provides to an
    employer-sponsered health plan
    • -Network care
    • -providers,
    • -stop loss coverage,
  41. The Nurse
    Practice Act refers to:
    • FEDERAL NURSING
    • LICENSURE
  42. Physcian
    Assistants are:
    • CERTIFIED BY THE
    • NATIONAL COMMISSION OF CERTIFICATION OF PHYSICAN ASSOCIATES
  43. Advanced
    Practice Nurses are:
    • LICENCED BY EACH
    • STATE
  44. The Flexner
    Report on medical education:
    • PUSHED FOR MEDICAL
    • EDUCATION REFORM
  45. Which of
    the following is NOT  acontributing
    factor for the growing shortages of nurses?
    • SIGNIFICANTLY MORE
    • STRINGENT LICENSING REQUIREMENTS
  46. Which of
    the following is an Advanced Practice Nurse?
    None of the above
  47. Phycician
    specialists receive specialty training in:
    RESIDENCY PROGRAM
  48. Which of
    the following factors impact the supply of healthcare manpower today?
    • RETENTION OF STAFF,
    • TRAINING PROGRAM CAPACITY, HEALTHCARE WORKING ENVIRONMENT, INCREASING
    • UTILIZATION (all of the
    • above)
  49. Hospitalists
    have grown as a profession /specialty because:
    • WAY FOR PRIMARY
    • CARE PHYSICIANS TO AVOID COVERING THEIR HOSPITAL INPATIENTS
  50. The US is
    dependent on International Medical Graduates (IMGs) because:
    • THERE ARE MORE US
    • RESIDENCIES THAT US MEDICAL SCHOOL GRADUATES
  51. Which of
    the following is considered an entry level nursing positions
    • CERTIFIES NURSE
    • ASSISTANT (CNA)
  52. AN
    oversupply of physicians may result in:
    • PHYSICIAN-INDUCED
    • DEMAND
  53. Which of
    the following is NOT a primary care physican:
    OPTOMETERISTS
  54. Which of
    the following represents the largest group of health service providers?
    NURSES
  55. 2/3rds of
    all nurses are employed by:
    HOSPITALS
  56. A
    Registered Nurse may receive his/her education & training through:
    ALL OF THE ABOVE
  57. The
    voluntary process by which physician specialists are examined and determined to
    have met the academic and clinical standards of their specialty is called:
    • BOARD OF
    • CERTIFICATION
  58. Complimentary
    or alternative (nontraditional) providers of health care services include:
    CHIROPRACTORS
  59. Which of
    the following is an example of an Allied Health Provider?
    PHYSICAL THERAPIST
  60. The
    physician plays a cental role in health service deliver because:
    ALL OF THE ABOVE
  61. Which of
    the following is NOT  a physician?
    OPTOMETRIST
  62. Which
    statement about physician specialists is true?
    • SPECIALISTS MAY BE
    • SELF-DECLARED
  63. The supply
    of phycicians today is centrally controlled by the:
    NONE OF THE ABOVE
  64. Which of
    the following is an alternative /complimentary provider?
    ACUPUNTURIST
  65. Physcician-to-population
    ratios can identify the following:
    NONE OF THE ABOVE
  66. A physician
    assistant does not have prescriptive powers.
    FALSE
  67. A
    registered nurse is an advanced practice nurse
    FALSE
  68. The degree
    is supervision required for a Nurse Practitioner is governed by the National
    Nurse Licensure Program:
    FALSE
  69. There are
    more physcians specialists in the US than any other health care worker
    FALSE
  70. Medical
    licensing is the process by which physician specialists are examined and
    determined to have met the academic and clinical standards of their specialty
    • FALSE-BOARD OF
    • EDUCATION
  71. Historically,
    allopathic physcians have been trained in spinal manipulations (like
    chiropractors)
    FALSE
  72. Just
    slightly more than half of all physicians in the US are primary care physicians
    FALSE
  73. A physician
    is eligible for state licensure when he/she successfully completes medical
    school, a national licensing examination, and a one year internship or
    residency program.
    TRUE
  74. A
    pediatrician is considered a specialist
    FALSE
  75. The
    disgnation "DDM" stands for Doctor of Dental Medicine
    TRUE
  76. A physician who
    specializes in the heart and cardiovascular system
    CARDIOLOGIST
  77. A physcian who
    specializes in disease in the eye
    OPTHOMOLOGIST
  78. A physcian who
    specializes in physieal medicine and rehabilitation
    PERIDONTISTS
  79. A nurse who provides
    prenatal care and delivers babies
    MIDWIFE
  80. Dentist who specializes
    in the extraction of teeth and surgery of the mouth and jaw
    • ORAL &
    • MAXIOFACIAL SURGEON
  81. A physcian who practices
    exclusively in the hospital, managing admissions from primary care physcians
    HOSPITALISTS
  82. A physician who
    practices laboratory medicine
    PATHOLOGIST
  83. A nurse who provides
    anesthesia in a hospital or surgery center
    ANESTHETISTS (CRNA)
  84. A physcian specialist
    who treats diabetic patients
    ENDOCRINOLOGIST
  85. A physcian who
    specializes in deseases and disorders of the digestive system
    GASTROENTEROLOGIST
  86. Specializes in
    manipulattion & physiotherapy
    PHYSIATRIST
  87. Specializes in disease
    & disorders of the foot and ankle
    PODIATRIST
  88. Dentist who specializes
    in treating gums
    PERIDONTISTS
  89. A physcian specializing
    in surgery of the abdomen, colon, and breast
    GENERAL SURGEON
  90. A physican specializing
    in the treatment of patients with arthritis
    RHEUMOTOLOGIST
  91. The Hill
    Burton Act of 1946 provided:
    • FUNDING FOR
    • CONSTRUCTION OF RURAL HOSPITALS
  92. Which of
    the hollowing is not a level of care:
    AMBULATORY CARE
  93. The
    movement of chronic mentally ill patients from state institutions to other care
    settings is called:
    NONE OF THE ABOVE
  94. Long term
    care can be provided in:
    NONE OF THE ABOVE
  95. Approximately 60% of
    intermediate long term care (nursing home care) is financed by
    MEDICAID
  96. Which health
    care service below represents secondary care?
    • OUTPATIENT
    • TONSILLECTOMY
  97. Which is generally not
    considered long term care?
    SHORT TERM, EPISODIC ACUTE CARE
  98. Reasons why physicians
    fail to provide health promotion services include:
    NONE OF THE ABOVE
  99. Which of
    the following statements is false?
    • A "SWING
    • BED" IS ONE THAT CAN BE USED AS EITHER ACURE CARE OR AS AN INTERMEDIATE
    • LONG TERM CARE BED
  100. "Add-on"
    payments provided through Medicaid reimbursement to hospitals that serve a
    large volume of Medicaid beneficiaries is called:
    DISPROPORTIONATE SHARE
  101. For profit hospitals
    must pay:
    ALL OF THE ABOVE
  102. Tertiary care is:
    RESOURSE-INTENSIVE CARE
  103. The largest source of
    funding for home health services is:
    MEDICARE
  104. The primary source of
    capital for major building & construction projects for not-for-profit
    hospitals is:
    TAX EXEMPT BONDS
  105. What is the
    single largest source of funding for hospitals?
    • DEDUCTABLES &
    • CO PAYMENTS
  106. Characteristics
    of Academic Health Centers (AHCs) include:
    PROVIDE NUMEROUS MEDICAL AND SURGICAL TRAINING PROGRAMS.
  107. End-of-Life care
    provided to ease pain and suffering is called:
    NONE OF THE ABOVE
  108. Providing safe living
    and working conditions through pure drinking water, clean air, and safe food
    and drugs, is an example of:
    HEALTH PROTECTION
  109. Integration
    of a variety of health services organizations and providers to deliver a broad
    array of health services is called:
    • AN INTEGRATED
    • DELIVERY SYSTEM
  110. Classification given by
    a hospital to a patient's financial status when it is known at time of admission
    the patient does not have the ability to pay:
    Charity Care
  111. The largest source of
    funding for skilled nursing facilites (SNF) care is:
    MEDICARE
  112. Care provided on a
    relief basis for a disabled person by special caregivers in order to provide a
    relief for that persons full time caregiver is called:
    RESPITE CARE
  113. Eating, bathing, and
    dressing are examples of:
    • ACTIVITIES OF DAILY
    • LIVING (ADLs)
  114. Who has the ultimate
    authority and responsibility for the financial performance, quality of care,
    and service provided by the hospital?
    BOARD OF DIRECTORS
  115. What determines whether
    a hospital is public, private, or non-for-profit, or tax exempt:
    HOW IT IS ORGANIZED AS A LEGAL ENTITY

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