HS 4300 Exam 2 practice questions

In the United States, on average approximately how much money is spent per person on health care each year?

$8000

An HMO is a type of insurance that A) Restricts use of speciality services B) Has no gatekeeper C) Combination of HMO & PPO

A

For whose financial benefit are proprietary hospitals operated? A. Stockholders B. The American public C. The local community D. The governing body

A

In the gatekeeping method, who makes referrals to specialists? A) a primary care physician B) the HMO C) a hospitalist D) a primary care nurse

A

It is a plan that is a hybrid between an HMO and a PPO. A) Point-of-service plans B) Mixed model HMO C) IPA D) Exclusive provider plans

A

Licensure, Certification and Accreditation. Pick the statement(s) that is(are) not true A. A hospital must be licensed by the federal government to operate B. Certification is not mandatory but is required if a hospital wants to participate in Medicare and Medicaid C. Accreditation is voluntary and confers that a hospital meets certain standards. D. None of the above

A

MCOs use various methods to control costs. One of those methods is ___________ which is mainly recommended for patients who need secondary and tertiary care more often than primary care. A) Case Management B) Choice restriction C) Disease Management D) Practice Profiling

A

Risk is generally predictable for what group? A) Groups of People B) Individuals C) Providers D) Underwriters

A

The biggest share of national health spending is attributed to A. Hospitals B. Physicians C. Prescription drugs D. Nursing home care

A

The first hospitals in the United States served mainly A. The poor B. The wealthy C. Those needing surgery D. Those needing antibiotics

A

What does Medicare Part A help cover? A) Hospital Costs B) Hearing Aids, and routine dental care C) Physician Visits

A

When an organization ceases to exist as a separate entity and is absorbed into the purchasing corporation is called a(n) A) Acquisition B) Merger C) Joint Venture D) Alliance

A

Which of the following best describes a copay? A) A specific dollar amount your insurer pays for a specific service B) A fixed percent of the cost of a procedure that you have to pay (the insurer pays the remainder) C) The amount your employer contributes to paying for your health premium

A

Which of the following is credited with having the greatest impact on the expansion of hospital beds in the U.S.? A. Hill-Burton Act B. Health Insurance C. Technological advances D. Medicare and Medicaid

A

A PPO is a type of insurance that A) Restricts use of speciality services B) Has no gatekeeper C) combination of HMO & PPO

B

A store clerk has an individual health insurance plan with a $20 co-payment for in network doctor visits. she goes to her doctor, who is in network, twice during the year. What can she expect to pay for health care for the year? A) $40 in co-payments only B) Her premiums plus $40 in co-payments plus any extra costs for prescriptions or non-covered services C) Her premium plus $40 in co-payments plus an extra office fee and any extra costs for non-covered services D) None of the above

B

MCOs use various methods to control costs. One of those methods is ______________ which means if the patient receives services from providers who are outside of the plan, they will not be covered A) Case management B) Choice restriction C) Disease Management D) Practice Profiling

B

Pick the statement that is true concerning Concurrent review A) The goal of this utilization review is to prevent unnecessary/inappropriate treatments or procedures. B) This utilization review determines the appropriateness of care DURING the course of treatment. C) This goal of this utilization review is to determine over or underutilization of health services

B

Pre-certification(pre-authorization) is associated with which type of utilization review? A) Concurrent B) Prospective C) Gatekeeping D) Retrospective

B

The Hill-Burton Act was passed to A. Make it mandatory for private insurers to cover hospital services B. Relieve shortage of hospitals C. Curtain the utilization of hospital beds D. Have federal control over community hospitals

B

To be called a hospital, a facility must have at least ___ beds. A. 3 C. 9 B. 6 D. 11

B

To be classified as a Critical Access Hospital, the number of acute care beds should not exceed ___ and should be located in _____ area. A. 20, rural B. 25, rural C. 30, rural D. 35, urban

B

What does Medicare Part D help cover? A) Over the counter drugs B) Prescription drugs C) Alternative therapies

B

When two organizations cease to exist, and a new corporation is formed is called a(n). A) acquisition B) Merger C) Joint venture D) Alliance

B

Which entity in hospital governance is legally responsible for the hospitals' operations? A. The CEO B. The board of trustees C. The chief of staff D. The chief operating officer

B

Which of the following best describes a premium? A) It is the set amount you pay for your health insurance plan, usually paid every month B) It is the set amount you pay for your health insurance plan, usually paid every month, regardless if you don't receive medical care that month. C) It is the percent amount you pay for your health insurance plan, usually paid every month D) It is the amount you pay before your health expenses are covered in full.

B

Which of the following statements about hospital utilization is incorrect? A. Utilization varies according to gender. B. Utilization among the poor is lower than among the nonpoor. C. The elderly spend more time in hospitals than younger people. D. Utilization is higher among blacks than whites.

B

A 30 year old woman broke her arm and went to the emergency room for treatment. Her health insurance plan has a $1500 deductible. What does this mean? A) She can deduct $1500 from the hospital bill, but must pay the rest B) the hospital will only charge her $1500 C) She is responsible for paying $1500 of her medical expenses before her insurance policy starts to pay D) Her insurance company is responsible for paying $1500 and she must pay the rest

C

A 30-year-old woman broke her arm and went to the emergency room for treatment. Her health insurance plan has a $1,500 deductible. What does this mean? A) She can deduct $1,500 from the hospital bill, but must pay the rest B) The hospital will only charge her $1,500. C) She is responsible for paying $1,500 of her medical expenses before her insurance policy starts to pay D) Her insurance company is responsible for paying $1,500 and she must pay the rest

C

A new corporation created by two partnering organizations that remains independent is called a (n). A) Acquisition B) Merger C) Joint Venture D) Alliance

C

ALOS (Average Length of Stay) is an indicator of A. Use of hospital capacity B. Frequency of use C. Severity of illness D. Access

C

DRG-based reimbursement necessitated hospitals to do what? A. Admit new patients at a faster rate than before. B. Admit a greater number of Medicare patients than before. C. Discharge patients quicker than before. D. Admit a smaller number of Medicare patients than before.

C

MCOs use various methods to control costs. One of those methods is ______________ which is focused on providing care to high-risk people with chronic illnesses which tend to be illnesses that more complicated and require more intense follow-up. This method is used to ensure that people are complying with their detailed and difficult medical regiment. A) Case Management B) Choice Restriction C) Disease Management D) Practice Profiling

C

What is the term for the consumer behavior that leads to a higher utilization of health care services when the services are covered by insurance? A) Demand Inducement B) Cost shifting C) Moral hazard D) Desensitivity

C

What triggered the downsizing phase in the U.S. hospital industry during the 1980s? A. Hill-Burton Act B. Managed care C. Prospective payment system D. Medicare and Medicaid

C

Which entity oversees the licensure of health care facilities? A. The Joint Commission B. Federal government C. State government D. Local county or city government

C

Which of the following best describes a deductible A) An amount deducted from your paycheck to pay for your insurance premium. B) The amount deducted (covered) out of your total yearly medical expenses. c) The amount you pay before your insurance company pays benefits D) The amount you pay before your health expenses are covered in full

C

Which of the following describes coinsurance? A) A specific dollar amount you pay for a specific service B) The total amount you are required to pay until you reach your deductible C) The percent of the cost of medical services that the insurer pays D) The amount your employer contributes to paying for your health premium

C

Which of the following is not a type of health insurance plan? A) Health Maintenance Organization (HMO) B) Preferred Provider Organization (PPO) C) Health Provider Organization (HPO) D) Point of Service (POS)

C

Which of the following was not a main factor in the growth of hospitals in the United States? A. Hill-Burton Act B. Private health insurance C. Immigrants coming into the United States D. Medicare and Medicaid

C

Which of these hospitals does not serve the general public? A. County and city hospitals B. Proprietary hospitals C. Federal hospitals D. Community hospitals

C

I am responsible for the day to day operations of the hospital

CEO (Chief Executive Officer)

Which federal government office is responsible for the Admn of Medicare

CMS

Average daily census is a measure of a hospital's A. Daily capacity B. Average admissions per day C. Days of care D. Number of inpatients served daily

D

CHIPS A) Is an insurance program for children whose families do not qualify for Medicaid B) Is an insurance program that will cover these children up until the age of 19. C) Is an acronym for Children's Health Insurance Program D) All the above

D

Capitation is A) fixed premiums; the member pays a certain premium monthly B) fixed services per member; the member only obtains a certain amount of services C) When costs do not exceed a predetermined limit D) A fixed monthly payment per enrollee

D

Cost sharing means that insured individuals will pay a portion of their health care costs. Forms of cost-sharing are A) Premiums B) Deductibles C) Copayments D) All the above

D

MCOs use various methods to control costs. One of those methods is _________________ which refers to profiling how a provider practices. It is primarily used to decide if providers have the "right fit" with the plan's managed care philosophy and goals. A) Case Management B) Choice restriction C) Disease Management D) Practice Profiling

D

Medicaid: A) Is a means-tested program B) Is jointly financed by the federal and state governments C) Is primarily run by the state government D) All of the above

D

Other types of programs that are covered under various public health insurance programs are A) Indian Health Service B) Veterans Health Administration C) Health Care for the Military D) All of the above

D

What is Medicare Part C? A) Medicare Part C is also called Medicare Advantage B) Medicare Part C offers additional choices of insurance plans. C) Medicare Part C offers managed care plans D) All of the above

D

What is a health saving account (HSA) A) A type of policy in which employers let you save up sick days B) A type of medical saving account for individuals without insurance C) A type of medical savings account that allows individuals to save money to pay for future medical expenses with a reduced tax rate D) A type of health care plan that combines a qualified high-deductible health plan with a nontaxable account where funds can be deposited to pay for qualified medical expenses not covered by the plan

D

What is the main purpose of cost sharing? A)It reduces the cost of health insurance premiums B)It prevents the providers from delivering expensive services without approval C)It limits the insureds' out-of-pocket costs D) It controls the utilization of health care

D

When there is a sharing of existing resources without joint ownership of assets is called a(n). A) Acquisition B) Merger C) Joint Venture D) Alliance

D

Which of the following contributed to the growth of hospitals from 1930-1980? A. Hill-Burton Act B. Health Insurance C. Technological advances D. All of the above

D

Which primary factor was the trigger that made hospitals limit care to the more acute periods of illness rather than the full course of the disease? A. Technology B. Physician training C. Shortage of beds D. Pressure to contain costs

D

Which principle of ethics requires caregivers to involve the patient in medical decision making? A. Paternalism B. Fidelity C. Beneficence D. Autonomy

D

Who is a gatekeeper? A) A gatekeeper is a primary care physician who delivers primary care services. B) A gatekeeper is the provider who has first contact with the patient and decides if a referral to a specialist is necessary. C) A gatekeeper is employed by HMO plans D) All the above

D

The Primary purpose to utilize integration strategies in health care is A) to provide a seamless array of services B) to diversify C) to gain market share D) because it makes economic sense E) All the above

E

There are many ways to pay for health care services according to your readings. They are A) Fee for Service B) Package Pricing C) DRGs D) Paying for services before they are provided E) All of the above

E

They are considered to be the majority types of visits to the ER A) Urgent B) semi-urgent C) non-urgent D) All of the above E) B&C

E

What does Medicare Part B help cover? A. Doctor visits, ER visits B. Long term care, Rehabilitation services C. Ambulance , renal dialysis, organ transplants D. A and B E. A and C

E

What is utilization review? A)It is a process of determining how appropriate health care services are for a given health care situation B) It is a way for insurance companies to deny services C)Its main objective is to provide care that is deemed appropriate and cost effective. D) A and B E) A and C

E

covered services are A) services covered by an insurance plan that are deemed medically necessary B) services covered by an insurance plan that are considered medically necessary such as cosmetic and reconstructive surgery, genetic counseling C) Services covered by an insurance plan that are considered medically necessary such as hospitalization, prescriptions, maternity care and delivery of a baby D) A&B E) A&C

E

It is illegal for hospitals to turn patients away due to this law

EMTALA

T/F Costs for medical tests are universally the same throughout the country

False

T/F Hospitals only deliver inpatient services

False

T/F If a person with a preexisting medical condition such as diabetes or cancer starts a new job, his or her employer's health insurance company must provide him or her with coverage, but isn't obligated to cover costs associated with the preexisting condition

False

T/F Medicare is only for the elderly

False

T/F The VA hospital can be used by the general public

False

T/F The majority of hospitals in this country are for profit.

False

T/F There is a family coverage option for Medicare

False

T/F a hospital has to be certified and accredited in order to operate

False

T/F the only way to get health insurance coverage in through an employer

False

True or False: Emergency rooms are a large source of income for a hospital

False

what type of surgeon is Atul Gwande

General surgeon

Who is responsible for cost containment in other industrialized countries we have discussed?

Government

It was credited with having the greatest impact on hospital expansions

Hill Burton act of 1946

Which are considered major characteristics a Hospital must have in order to operate? A) License B) Pharmacy C) Medical records dept. D) Nursing E) Physician services F) CEO G) governing body H) Dietary services I) All of the above

I

In the hospital, patients have the right to make their own decisions, to make informed choices

Informed consent

Every patient admitted to a hospital must have one of the these

Medical record

This is a hospital that takes a holistic approach to treatment.

Osteopathic hospital

It is the type of hospital that is owned by the governments (state, federal or local)

Public Hospital

A hospital that specializes in PT, OT, Speech therapies. Rusk is an example

Rehabilitation hospital

It is the type of hospital that includes orthopedic, cardiac services and long term stay. Landmark is an example of one of these

Specialty hosptial

It is a law that prohibits the referral of Medicare and Medicaid patients to certain medical facility in which the referring physician has an ownership interest

Stark Law

The primary role of this hospital is to train physicians.

Teaching hospital

T/F A hospital must be licensed by the state in which it wants to operate before it can function

True

T/F Advance directives are documents that list a patient's wishes regarding continuation or withdrawal of treatment when the patient lack decision making capacity

True

T/F Ethics committees are multidisciplinary group of individuals whoa re consulted when there is a disagreement about the delivery of medical care

True

T/F Magnet hospitals have been found to attract and retain well-qualified nurses

True

T/F Managed care is a way of providing health care services by a single organization that manages financing, insurance, delivery, capitation and discounted fees.

True

T/F Medicare and Medicaid are both financed by the government but most health care services are obtained in the private sector.

True

T/F Medicare recipients pay copayments, premiums and deductibles

True

T/F Medicare, Parts A&B, are run by the federal government but the majority of services are received in the private sector

True

T/F Patients have the legal right to refuse medical treatment

True

T/F Students who have health care coverage through their parents typically have the option of staying on the plan until age 26

True

T/F The first hospital in the US served mainly the poor

True

T/F To participate in Medicare & Medicaid, a health care facility must be certified

True

T/F Women incur higher use of hospital services than men, even after childbirth-related utilization is factored out

True

T/F a hospital must have 6 beds in order to be called a hospital

True

T/F? Individuals who qualify can receive both Medicare and Medicaid simultaneously.

True

True or false: Hospitals consume the biggest share of national health spending

True

True or false: The Medicaid population is one of the largest consumers of ERs

True

This hospital only treats the military

VA

A type of hospital that is considered "not for profit", does not pay taxes to the community it resides in but must provide free services to the community in exchange for the tax exempt status

Voluntary Hospital

In order to receive payment for Medicare and Medicaid patients a hospital must be_______

certified

It is a small hospital with < 25 beds and located in the rural areas.

critical access hospital (CAH)

Which are measures that are used to determine who is utilizing the services at a hospital? A) discharged B) average length of stays c) inpatient days d) capacity e) all of the above

e

T/F Co-insurance and co-payment refer to the same thing

false

T/F a hospital has to be certified to operate

false

you must have at least six beds to be called a _____________

hospital

The first thing a hospital must have before it can operate

license

It is considered a for profit hospital; a hospital that is operated for the financial benefit of its shareholders.

proprietary hospital