The medical model includes all of the following except: Third-party payers are covered by both state and federal regulations. Two of the federal regulations are ________ and _________.

The medical model includes all of the following except: Third-party payers are covered by both state and federal regulations. Two of the federal regulations are ________ and _________.

a. illness and disease require treatment.

b. focus is diagnosis.

c. focus is on disease prevention.

d. focus is on treatment.

2. The ability to stay in business for a health care facility is based on the facility’s _________.

a. sustainable competitive advantage

b. reimbursement rates

c. business plan

d. business viability

3. Focus areas of Healthy People 2020 and patterns of disease in the population direct research efforts. Research can be directed at all of the following except _________.

a. cure

b. control

c. prevention

d. the study of rural road traffic patterns

4. The Patient Protection and Affordable Care Act _________.

a. helps increase the number of people who are uninsured

b. allows the market to drive costs up

c. seeks to improve health care delivery performance

d. is surveying Americans about their health care utilization patterns

5. Sustainable competitive advantage is described by all of the following except:

a. varies from business to business.

b. depends on the objectives the firm is trying to achieve.

c. helps a business maintain its position in the marketplace.

d. allows the market to drive costs up.

6. All of the following are categories of health occupations except:

a. service occupations.

b. professional and related occupations.

c. management, business, and financial occupations.

d. labor union officials.

7. Accounting __________.

a. creates the product or service

b. tracks the flow of money in and out of a business

c. uses technology to manage information

d. includes the product, price, promotion, and distribution to the customer

8. Information technology __________.

a. creates the product or service

b. tracks the flow of money in and out of a business

c. includes the product, price, promotion, and distribution to the customer

d. uses technology to manage information

9. Shareholders may exist in which business ownership configuration?

a. corporation

b. partnership

c. sole proprietorship

d. collaboration

10. A decrease in unemployment and interest rates occurs during the following portion of the economic cycle __________.

a. prosperity

b. recession

c. depression

d. recovery

11. Profit is __________.

a. money collected from patients and insurance companies for health care services rendered.

b. the price paid when an individual or business borrows money.

c. revenue minus costs.

d. lacking during times of prosperity.

12. The Hill Burton Act __________.

a. is part of the Social Security Act

b. prohibits referrals to clinical lab services where the provider has a financial interest

c. involved the federal government funding construction of private facilities pursuant to a Certificate of Need

d. provides for health insurance portability and protects the privacy of health records5

13. The Stark I law __________.

a. contains special provisions to protect laid-off workers and to encourage electronic records technology

b. prohibits referrals to clinical lab services where the provider has a financial interest

c. involved the federal government funding construction of private facilities pursuant to a Certificate of Need

d. provides for health insurance portability and protects the privacy of health records

14. A market economy is described by all of the following except which of the following?

a. It is also called a private system.

b. It is called a free enterprise system.

c. It has competition as its central feature.

d. It is not concerned with profit.

15. Third-party payers are covered by both state and federal regulations. Two of the federal regulations are ________ and _________.

a. COBRA; PPO

b. ERISA; HIPAA

c. COBRA; EPO

d. ERICA; HIPAA

16. An enrollment period is a _________.

a. binding contract between the payer and the employee

b. binding contract between the payer and employer

c. time when employees can utilize benefits

d. time when employees can change providers

17. If an employee decides to take advantage of an insurance benefit being offered to them they are known as a/an _________.

a. actuary

b. enrollee

c. subscriber

d. policy holderFinal Examination

18. With EPOs all of the following are true except:

a. patients must select their care providers from those in the network.

b. patients may choose their physician or hospital.

c. if the patient chooses to go outside the network the services are not covered.

d. they are regulated by state insurance law.

19. All of the following are true except:

a. 22 states insist on mental health parity.

b. all 50 states mandate breast cancer screening.

c. 16 states mandate payment of prenatal care.

d. 44 states require external review of health plan decisions.

20. HIPAA regulates all of the following except:

a. portability.

b. coverage on a family plan until 26 years old.

c. access.

d. mandated benefits.

21. Prepaid health plans _________.

a. are attractive to employers because they know in advance what the cost of providing health care will be

b. all involve an IPO

c. are attractive to the service provider because the number of patients is fixed and a certain revenue level is guaranteed

d. Both a and c are correct.

22. Office of Personnel Management administers this program __________.

a. Medicare

b. FEHBP

c. Medicaid

d. SCHIP

23. Which of the following people may be eligible for workers’ compensation?

a. Julie has an accident on her way to work.

b. Jan hurt herself while vacationing at the resort where she works as a cook.

c. Steve fell in the restaurant parking lot on his lunch break.

d. Scott heard an odd popping noise as he transferred a patient from the bed to the chair

24. Which of the following are likely eligible for Medicaid?

a. the indigent

b. children

c. the elderly

d. the wealthy

25. Medicaid eligibility is __________.

a. decided on a federal level

b. decided on a state level

c. the same for all states

d. determined based on education

26. All of the following are true about compliance programs except:

a. all claims submitted for payment must have appropriate documentation.

b. providers should receive regular training to stay current with Medicare and Medicaid regulations.

c. they are mandatory under the Patient Protection and Affordable Care Act.

d. upcoding is encouraged.

27. All of the following describe the 2010 Patient Protection and Affordable Care Act regarding fraud and abuse except:

a. there will be enhanced oversight of new providers.

b. there will be provider screening.

c. a database to share information across states and federal programs is being developed.

d. penalties for false claims will be decreased.

28. When providers feel that financial incentives are inadequate, they may opt out of _________.

a. CHAMPUS


 

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