Fundamentals of Health Care Management Domain Questions

When attempting to collect a debt, it is NOT legally considered harassment to call the individual after 9:00 pm or before 8:00 am. a. True B. False

B. False

Which of the following formulas will tell you how many months of work are outstanding accounts receivables? a. Accounts Receivable/Average monthly revenue b. Average monthly revenue/Accounts Receivable c. Average Monthly Collections/Average Monthly Expenses d. Accounts Receivable/Average Monthly Expenses

a. Accounts Receivable/Average monthly revenue

Which of the following would most likely be covered by professional liability insurance? a. An orthopedic surgeon is sued for malpractice by a patient the developed a complication after hip surgery b. A pulmonologist is sued for malpractice by a patient that he treated for a respiratory condition but who asked him at the same time to remove a skin lesion from their chest that turned out to be a malignant melanoma with metastasis c. An orthopedic surgeon who gets into a car wreck and administers first aid to the driver of the other car who subsequently has a seizure and sues for malpractice d. A pulmonologist is sued for malpractice as the physician on duty at a hospital where a nurse administered the wrong medicine to a patient with an acute exacerbation of COPD

a. An orthopedic surgeon is sued for malpractice by a patient the developed a complication after hip surgery

Licensing terms, training of staff and providers, system maintenance, integration with existing practice management systems and customer service are a few of the items that need to be addressed in: a. Any contract with an HIT system vendor such as an EHR contract b. Any CMS EHR incentive plan c. Any managed care plan HIT incentive plan d. Any contract with a e-marketing consultant

a. Any contract with an HIT system vendor such as an EHR contract

The order of the steps in building a marketing plan are: a. Assessing the practice, marketing objectives, marketing strategies, an action plan and measuring results b. Marketing objectives, marketing strategies, assessing the practice, action plan and measuring results c. Action plan, objective, strategies, assessing the practice and measuring results d. Assessing the practice, action plan, marketing strategies, marketing objectives and measuring results

a. Assessing the practice, marketing objectives, marketing strategies, an action plan and measuring results

Which provision allows a licensed provider to access a patient's health information, without consent, when the practitioner judges that it is an emergency? a. Break the glass b. Privacy Override c. Emergency Access d. Emergency Override

a. Break the glass

What is the final step in the implementation of a new EHR system? a. Continual quality assessment and improvement of the system b. Connect to a local HIE c. Demonstrate Meaningful Use (MU) through legal attestation d. Maintain and continue reporting to CMS' PQRS Program

a. Continual quality assessment and improvement of the system

Which Act designates exempt versus non-exempt employees for purposes of overtime pay?: a. Fair Labor Standards Act b. Civil Rights Act c. Equal Employment Opportunity Act d. Consolidated Omnibus Budget Reconciliation Act

a. Fair Labor Standards Act

The compliance program authorizes an employee to report suspected offenses to ______________ unless the employee feels uncomfortable in doing so. a. Immediate supervisor b. Compliance officer c. Practice manager d. Physician director

a. Immediate supervisor

What is a continuing medical education (CME) hour? a. It is a method of measuring the hours of continuing education that are required to maintain a physician or nurse practitioner's credential (e.g. M.D., ARNP) b. It is a method of measuring the hours of continuing education that are required to maintain any credential or professional license (e.g., M.D, RN, LPN, CMM) c. It is a method of distinguishing between approved continuing education for any licensed or credentialed employee and continuing education that doesn't qualify toward credential maintenance d. It is a method of distinguishing between approved continuing education for any licensed or credentialed employee and continuing education that doesn't qualify toward credential maintenance

a. It is a method of measuring the hours of continuing education that are required to maintain a physician or nurse practitioner's credential (e.g. M.D., ARNP)

Relative Value Units (RVUs) are the sum of which three components? a. Physician's work, practice expense/overhead, and malpractice costs b. Insurance fees, physician's work, and indirect expenses c. Physician's work, practice expense/overhead, and accounting costs d. Office manager salary, office overhead, and insurance fees

a. Physician's work, practice expense/overhead, and malpractice costs

What is PECOS? a. Provider Enrollment, Chain and Ownership System and is a requirement to receive Medicare or Medicaid Payments b. Provider Eligibility, Credentialing and Ownership System and is a requirement to receive Medicare or Medicaid Payments c. Provider Enrollment, Chain and Ownership System and is a requirement for privileges at any hospital d. Provider Eligibility, Credentialing and Ownership System and is a requirement for privileges at any hospital

a. Provider Enrollment, Chain and Ownership System and is a requirement to receive Medicare or Medicaid Payments

A physician's work, practice expense (including overhead) and malpractice costs are the components of which of the following? a. Relative Value Units b. The amount the practice charges for a given procedure or service c. A practice's fee schedule d. An insurance company's allowed amount for a given CPT/HCPCS code

a. Relative Value Units

Which marketing formula is calculated by the number of new patients generated by a marketing strategy divided by the cost of that strategy? a. Return on investment b. Source code promotion c. Old dollars versus new dollars d. Average new patient revenue

a. Return on investment

A concise synopsis of a problem and potential solutions that a manager needs to present to the physician should include: a. The manager's opinion of which of the potential best fits the culture, goals, and objectives of the practice. b. Only the one solution the manager feels is best (to avoid wasting physician's time) c. The solution that will maximize the benefits to the manager d. The benefits of the solution the manager prefers and the detriments of any of the other solutions

a. The manager's opinion of which of the potential best fits the culture, goals, and objectives of the practice.

If you subtract the total operating cost from the monthly income and then divided that number by the monthly income, the result would be which of the following: a. The profit margin or profit on each dollar of income for the period being measured b. The profit per patient seen for the period being measured c. The gross profit for the period being measured d. The profit per physician in the practice for the period being measured

a. The profit margin or profit on each dollar of income for the period being measured

Which law prohibits discrimination in employment on account of race or color by private employers regardless of the number of employees? a. Title VII of Civil Rights Act of 1964, as amended by Equal Employment Act of 1972. b. Civil Rights Act of 1866 c. Equal Pay Act of 1963 d. Age Discrimination in Employment Act of 1967 (ADEA)

a. Title VII of Civil Rights Act of 1964, as amended by Equal Employment Act of 1972.

An Independent Physician's Association (IPA) is a corporation formed by physicians who each continue to maintain their independent practices, but participate in the IPA to secure managed care business. a. True b. False

a. True

An alternative to immediate termination of an employee in the midst of a violation is to suspend the employee while facts are being verified. a. True b. False

a. True

Each employer must report any accident resulting in one or more fatalities, or in the hospitalization of five or more employees to the nearest OSHA office within 48 hours of the accident. a. True b. False

a. True

Physicians have the right to accept patients of their choosing and to refuse service to new patients and former patients with new problems, even if another physician is not available. a. True b. False

a. True

Satisfying the needs of your current patients is often much easier, less costly, and less risky than pursuing new patients. a. True b. False

a. True

Scheduling a specific appointment time for each patient with the correct amount of time set aside for each visit is known as stream scheduling: a. True b. False

a. True

The Value Payment Modifier tied quality of care to efficiency (or cost) of care? a. True b. False

a. True

The normal listener understands and retains only about 50 percent of a conversation - that percentage drops to 25 percent within forty-eight hours. a. True b. False

a. True

The physician Quality Reporting System (PQRS) was primarily an incentive program concerned with reporting select quality measures based on disease management a. True b. False

a. True

Which of the following describes the penalties for filing false claims under the civil part of the False Claim Act (FCA)? a. Up to 3 times the program's losses plus $11,000 per claim b. Up to 3 times the program's losses plus imprisonment c. Up to the full amount of the losses plus $11,000 per claim d. Up to the full amount of the losses plus imprisonment

a. Up to 3 times the program's losses plus $11,000 per claim

Expenses that change with the volume of work done in the office each month are known as: a. Variable expenses b. Fixed expenses c. Cash flow expenses d. Petty cash expenses

a. Variable expenses

Dr. Feelgood's charges are $125,000, his write-offs or credit adjustments are $25,000, and the receipts collected for one month are $95,000. His accounts receivable are $458,000 and his average monthly billings are $138,000. What is the collection percentage? a. 1.05% b. 95% c. 75% d. none of the above

b. 95%

The practice employee handbook is an internal document and is: a. Not for use outside of the practice environment b. A legal document subject to court subpoena c. Applicable only to those situations chosen by management d. Not to be used as a reference text

b. A legal document subject to court subpoena

What is the acronym used to designate the hours a clinician is required to demonstrate he or she is staying current with the discipline covered by their credentials/license? a. CEUs b. CMEs c. CPUs d. CPAs

b. CMEs

Compliance program written guidelines must include the practice's: a. Clear commitment to be in compliance with all health insurance organization rules and regulations b. Clear commitment to be in compliance with all federal health insurance rules and regulations c. Clear commitment to be in compliance with all applicable federal, state, county, and municipal laws d. Clear commitment to be in compliance with all government laws as well as managed care rules and regulations

b. Clear commitment to be in compliance with all federal health insurance rules and regulations

Which of the following sources of power is described by the other person's perception that you have the ability to punish them if they don't do what you ask them a. Legitimate Power b. Coercive Power c. Referent Power d. Reward Power

b. Coercive Power

Holding an "open house" is a form of: a. Neighborly friendship b. External practice building c. Internal marketing d. Staff party

b. External practice building

Conducting appropriate training and education on practice standards and procedures is not one of the basic components of a voluntary compliance program? a. True b. False

b. False

The differences between clinical and administrative orientations in a physician's practice is fertile ground for expanding personal goals. a. True b. False

b. False

The legal doctrine of "respondent superior" refers to the concept that physicians must accept new patients, regardless of their ability to pay. a. True b. False

b. False

Which ratio most directly impacts whether or not the accounts receivable turnover rate gets out of hand (meaning the AR turnover rate is greater than 3 months' worth of revenue)? a. Cost to gross charges ratio b. Gross collection ratio c. Net income to gross charges d. Net income per employee hour

b. Gross collection ratio

Many Managed Care Organizations (MCOs) require the physician's practice to: a. Reduce costs by eliminating redundant compliance related clerical processes b. Have an effective compliance program c. Do nothing, because payment is per capita rather than fee for service d. Submit claims without regard to the level of care provided

b. Have an effective compliance program

An HMO contract clause that shifts most of the liability for managed care plan liability to the physician is the: a. Liability assumption clause b. Hold harmless clause c. Clinical responsibility clause d. Patient protection clause

b. Hold harmless clause

Which of the individuals listed below are "non-exempt" employees? a. Manager that supervises six other employees b. Manager that works 40% of the time on non-managerial duties c. Registered nurse d. Physical therapists

b. Manager that works 40% of the time on non-managerial duties

Which of the following is not a key tenet of evidence-based medicine? a. Valid clinical research can aid in decision making b. Published clinical research is always valid and useful in developing EBM decisions c. The short life of useful medical research can make some providers out of date which hampers clinical decision making d. A great deal of published clinical research is not valid any may not be helpful

b. Published clinical research is always valid and useful in developing EBM decisions

Which of the following type of managed care plan is described by a plan wherein all premiums are paid directly to the managed care organization and the organization then hires physicians who are paid salary and predetermined bonuses? a. Group Model HMO b. Staff Model HMO c. Independent Practice Association (IPA) d. Exclusive Provider Organization (EPO)

b. Staff Model HMO

A "risk withhold" is: a. A clause used by insurance companies to allow them to charge unspecified fees b. The amount withheld from the physician's payment in a fee-for-service plan specified to cover plan costs that exceed a previously estimated amount c. A service that may be covered under the patient's HMO contract, but not as part of the capitated fee paid to the physician d. A negotiated arrangement between a physician and an

b. The amount withheld from the physician's payment in a fee-for-service plan specified to cover plan costs that exceed a previously estimated amount

Evidence of efforts to comply with a particular compliance related requirements should be retained by: a. The practice manager b. The compliance officer c. The employee making the effort d. The compliance review committee

b. The compliance officer

Who is the responsible payer for a minor of a divorced couple? a. The parent with legal custody b. The parent who first brought the child in and signed the authorization for treatment c. The parent who is paying child support d. The parent who pays the health insurance premium

b. The parent who first brought the child in and signed the authorization for treatment

Part of the practice manager's typical responsibilities is to ensure that every employee has a current credential or license that is required for each type of clinical position and this includes verifying the currency of professional liability insurance. a. True but only for physicians b. True but for all clinical positions that require a license or credential c. False - it is a peer review process d. False - it is the managing physician's responsibility

b. True but for all clinical positions that require a license or credential

The termination of the physician-patient relationship: a. Is the same in every state because the rules are defined as part of federal law b. Varies by state c. Is never necessary because there is no contract between the patient and the physician d. Can only be done by the patient, not the provider

b. Varies by state

Certain patient information must be made public if requested by law. All of the following are situations where legal disclosure of medical information is required, except: a. When demanded by subpoena or court order b. When demanded by the patient's spouse c. When required by statute to protect the welfare of the patient or of a third part. d. When necessary to protect the welfare of the patient or of a third party

b. When demanded by the patient's spouse

One way a physician can increase patient knowledge about specific clinical conditions and, at the same time, make potential new patients aware of that physician's practice is: a. Hand out disease specific flyers to patients as they leave the practice after each visit b. Write health education articles in the local newspaper c. Show each patient how to access Web MD for their specific condition during each visit d. Create a Social Network Page that is only available to patients in your practice

b. Write health education articles in the local newspaper

How many years after an employee is terminated or leaves the practice; should the practice maintain the personnel file? a. a minimum of one year b. a minimum of three years c. a minimum of five years d. a minimum of thirty years

b. a minimum of three years

Appending modifier 25 to an E&M code billed with a procedure code when the procedure was related to the reason for the E&M service is: a. an example of unbundling b. an example of upcoding c. an example of upcharging d. an example of correct coding

b. an example of upcoding

The parts of the American with Disabilities Act (ADA; Title I) that is specific to preventing discrimination in hiring, retaining and promoting employees who have a disability pertains to practices with: a. Any number of employees b. 10 or more employees c. 15 or more employees d. 20 or more employees

c. 15 or more employees

The Family Medical Leave Act applies to employers with: a. 10 or more employees b. 25 or more employees c. 50 or more employees d. 100 of more employees

c. 50 or more employees

When attempting to collect a debt, it is not considered harassment if making a telephone call to the patient in an effort to collect between which hours? a. 8:00 am - 9:30 pm b. 7:30 am - 9:00 pm c. 8:00 am - 9:00 pm d. 7:30 am - 9:30 pm

c. 8:00 am - 9:00 pm

The practice marketing plan should be assessed at least: a. Quarterly b. Semi-annually c. Annually d. Every five years

c. Annually

Which of the following documents may be kept for less than three years? a. Wages paid b. I-9 forms c. Aptitude tests or any other employee tests d. OSHA required training records

c. Aptitude tests or any other employee tests

Generally the preferred method of making decisions within an organization is the: a. unilateral method b. Bargaining method c. Collaboration method d. Decision-rule method

c. Collaboration method

The goal of annual employee performance appraisals is to: a. Discipline employees for aberrant behavior b. Determine the amount of annual pay raise c. Encourage better job productivity d. Document pre-termination activities

c. Encourage better job productivity

The basic dynamics in managed care contracting are: a. Gambling with the quantity of care that will be provided b. Getting all members to commit to preventive care c. Exchanging a discounted fee for an increased patient load d. Helping the community care for its indigent population

c. Exchanging a discounted fee for an increased patient load

When conducting OSHA Exposure Determination, employees are considered to be: a. Not exposed when wearing personal protective equipment b. Not exposed after receiving appropriate vaccinations c. Exposed even when wearing personal protective equipment d. Exposed if employed in a medical practice

c. Exposed even when wearing personal protective equipment

Which of the following would not be considered a valid reason for terminating an employee? a. Being rude or discourteous to patients b. Repeated rude or discourteous to patients c. Failure to pay personal bills on time; having bad personal credit d. Excessive absenteeism

c. Failure to pay personal bills on time; having bad personal credit

Which of the following information would be inappropriate to include written warning to an employee to document his/her undesirable performance? a. Previous actions you have taken in attempting to correct the deficiency. b. What the employee needs to do to correct the deficiency c. How other staff members feel about the deficiency d. What will happen if the deficiency is not corrected

c. How other staff members feel about the deficiency

An effective managed care tracking system to analyze an MCO plan: a. Is only necessary when the manager is evaluating whether or not to join a new MCO plan b. Is recommended for all MCO plans with which the practice participates at least every three years c. Is recommended as a continuous process to ensure the practice only joins and maintains MCO plans that are financially beneficial to the practice d. Is recommended as part of the evaluation of a potential new MCO plan and for three months after a new plan has been implemented

c. Is recommended as a continuous process to ensure the practice only joins and maintains MCO plans that are financially beneficial to the practice

Which of the following is not a true statement about Meaningful Use? a. MU rolled out in three stages starting in 2011 b. MU identified eligible providers c. MU allowed the same eligible provider to earn incentives under both the Medicare and Medicaid criteria d. MU contained incentives but also penalties

c. MU allowed the same eligible provider to earn incentives under both the Medicare and Medicaid criteria

In a medical practice, what is the primary driver of variable expenses? a. Employee Salaries b. Cost of Malpractice Insurance c. Number of Patients served d. Number of physicians in the practice

c. Number of Patients served

The proper formula used to calculate the collection percentage of a practice is: a. Charges divided by cash plus accounts receivable b. Cash receipts divided by accounts receivable c. Patient fees collected divided by net charges d. Accounts receivable divided by accounts payable

c. Patient fees collected divided by net charges

If a new physician joins the practice and needs to have privileges at the local hospital or be added to the group's managed care contracts, the process is called: a. Provider eligibility verification b. Provider certification c. Provider credentialing d. National Provider Data Bank Search

c. Provider credentialing

Appeals may be submitted to managed care organizations for decisions regarding treatment and reimbursement by: a. Physicians only b. Patients only c. Providers and patients d. Patients and family members

c. Providers and patients

The formula: Patient Fees Collected divided by Net charges is: a. The percentage of write-offs for a given practice b. The rate of return of a collection agency c. The collection percentage for a given practice d. The percentage of actual billed charges the practice may collect

c. The collection percentage for a given practice

Ideally, a managed care contract contains an appeal process with an option for an urgent review and a last resort option for arbitration and how many levels of appeals in between? a. One level of Appeals for non-urgent reviews before arbitration b. Two levels of Appeals for non-urgent reviews before arbitration c. Three levels of Appeals for non-urgent reviews before arbitration d. Four levels of Appeals for non-urgent reviews before arbitration

c. Three levels of Appeals for non-urgent reviews before arbitration

Which of the following is NOT a level of need from Abraham Maslow's Hierarchy of Needs? a. Ego b. Physiological c. Travel opportunities d. Security

c. Travel opportunities

The method of scheduling two, three, or more patients on the hour of half-hour, and seeing them in the order of their arrival is known as: a. Modified wave scheduling b. Stream scheduling c. Wave scheduling d. Modified stream scheduling

c. Wave scheduling

By federal law, which of the following coverage plans must first either make payment, deny services, or have exhausted benefit coverage before Medicare can consider payment? a. Employer Group Health Plan (EGHP) End State Renal Disease Coverage b. Veteran's Administration (VA) benefits c. United Mine Workers (UMW) Black Lung Disease coverage d. All of the above

d. All of the above

Which of the following is a typical function of an electronic health record? a. Clinical decision support (CDS) b. Computerized physician order entry (CPOE) c. E-prescribing d. All of the above

d. All of the above

Staff meetings are beneficial because they: a. Provide multiple points of view to evaluate problems b. Allow group support for decisions c. Provide a forum for members to ask for clarification of their duties and responsibilities. d. All the above

d. All the above

Incidents of health care fraud reported via the fraud hotline may result in the caller: a. Being charged with violating medical confidentiality laws b. Obtaining a position with the FBI Healthcare Fraud Squad c. Conducting covert operations to entrap the fraud conspirators d. Being rewarded with a percentage of funds recouped by the government

d. Being rewarded with a percentage of funds recouped by the government

Health care quality measures include all of the following except: a. Process measures B. Structural measures c. Outcome measures d. Cost effectiveness measures

d. Cost effectiveness measures

Which of the following questions are not part of a detailed review of a proposed contract with a Managed Care Organization? a. Does the contract demand exclusivity or can you contract with competing plans? b. Under what circumstances can the contract be terminated by the practice and by the plan? c. If this is a capitated plan, are ancillary service included in the cap? d. Does the contract

d. Does the contract

The Fair Labor Standards Act established a minimum wage, regulates child labor, and: a. Prohibited sexual discrimination b. Established the equal pay act c. Prohibited age discrimination d. Established overtime pay

d. Established overtime pay

Which of the following federal policies is not necessary to consider when addressing the privacy and security of health information exchange? a. Privacy rule b. Security rule c. Breach Notification rule d. Health Information Exchange eligibility rule

d. Health Information Exchange eligibility rule

Which is not a basic element in determining a marketing plan? a. The budget b. Define your marketing strategies c. Define your services d. Implement your marketing strategies

d. Implement your marketing strategies

Which of the following would be inappropriate to include in a practice promotional brochure? a. Introduction to the practice b. Professional profile of the physicians c. Layman's explanation of medical specialty d. Legal consequences of non-payment of medical bills

d. Legal consequences of non-payment of medical bills

The acronym PQRS stands for: a. Practice Quality Research Statistics b. Physician Query Response Index c. Patient Query Response Initiative d. Physician Quality Reporting System

d. Physician Quality Reporting System

CLIA places all facilities performing laboratory services, including physician office laboratories into one of four categories. Which of the following is not a CLIA recognized category? a. Certificate of waiver laboratory b. Moderate testing complexity laboratory c. Provider performed microscopy laboratory d. Privately owned exempt laboratory

d. Privately owned exempt laboratory

Which of the following is not a theory of motivation? a. Maslow's Hierarchy of Needs b. The Path/Goal Approach c. Expectancy Theory d. Reward and Punishment Theory

d. Reward and Punishment Theory

What is the most significant benefit of having a centralized, organized, purchasing system for office materials and supplies? a. Eliminates or minimizes employee theft b. Eliminates or minimizes vendor theft c. Creates loyal vendor relationships d. Saves money by minimizing the need to pay higher prices due to "crisis ordering" or ordering supplies already on hand

d. Saves money by minimizing the need to pay higher prices due to "crisis ordering" or ordering supplies already on hand

Which of the following is not a key element of developing and managing a marketing mix when growing the practice: a. The location of the practice b. The price of the services (out-of-pocket for the patient) c. What services the practice offers d. The number of providers of the same specialty within the immediate geographic area

d. The number of providers of the same specialty within the immediate geographic area

The physician - patient relationship continues until ended by any one of the following, except: a. The patient is cured and has no need of further treatment b. The patient terminates the relationship c. The physician terminates the relationship d. The patient declares that he/she is unable to pay the medical bills

d. The patient declares that he/she is unable to pay the medical bills

Pay-for-performance is a method of reimbursing providers for medical services based on: a. The volume of services rendered b. The cost of services rendered c. The quality of services rendered without regard for the cost d. The quality and efficiency of patient care as measured by the degree of improvement in patient health outcomes

d. The quality and efficiency of patient care as measured by the degree of improvement in patient health outcomes

Title III of the American with Disabilities Act requires that any disabled person (employee, vendor, visitor, customer) have safe access to the building and within the building (disabled parking spaces, ramps, wheelchair space through doorways and aisles...) if: a. The practice has 15 or more employees who worked at least 20 weeks over the past year b. The practice's facility is owned, not rented c. The practice's facility is less than 30 years old d. There are no exceptions; all medical practices must comply

d. There are no exceptions; all medical practices must comply

Which of the following is not an objective of a practice marketing plan? a. To understand healthcare consumers - their needs and concerns b. To assess the current office environment and its impact on maintaining a loyal patient case c. To develop external practice strategies that attract a targeted population and increase the number of new patients referred to the office by other providers d. To save money by focusing on getting existing patients to encourage their friends to change to your practice

d. To save money by focusing on getting existing patients to encourage their friends to change to your practice

Stage 3 MU criteria focused on all of the following except: a. Decision support for national high-priority conditions b. Patient access to self-management tools c. Access to comprehensive patient data through patient-centered HIE d. Using information to engage patients and their family in their care

d. Using information to engage patients and their family in their care

For which of the following would Medicare be the Secondary Payer (MSP)? a. Patient is under age 65, disabled and covered by a group health plan through his or her current employment and the employer has fewer than 100 employees b. Patient is 65 or older and covered by a Group Health Plan through current employment or spouse's current employment and the employer has fewer than 20 employees c. Patient is 65 or older, retired and covered by an employer retirement Group Health Plan d. patient is 65 or older and covered by a Group Health Plan through current employment or spouse's current employment and the employer has more than 20 employees.

d. patient is 65 or older and covered by a Group Health Plan through current employment or spouse's current employment and the employer has more than 20 employees.