ABQAURP CORE EXAM SET 2025/2026 QUESTIONS AND
SOLUTIONS GRADED A+
✔✔Focused Professional practice evaluation (FPPE) - ✔✔the organization considers
judgement , technical performance and outcome
-direct observation is the review technique of choice
✔✔Medicare- Medicaid Expansion - ✔✔affordable care act will reduce 30million
uninsured people-Medicaid increase of 20%
Pre Existing Condition Insurance Plan , and Dept coverage til age 26
Medicaid to expand to all persons below 138% of poverty level.
✔✔Traditional Insurance - ✔✔Indemnity plan- protect financial risk, easy access, few
restriction
✔✔Capitated payment - ✔✔Enrollee is at full risk
✔✔IPA-indept practice Ass - ✔✔providers are paid on a capitated or discounted fee-for
-service
HMO-IPA own office, use HMO docs, plan approves treatment and makes referals
✔✔PPO-Preferred Provider Org - ✔✔providers offer discounted fee, in return for
direction of pt to their office
can chose in our out of network
✔✔HMO Staff Model - ✔✔central building, low prev co-payment cost, use doctors in the
HMO, plan makes referral and approves care
✔✔HMO-POS Point of Service - ✔✔More choice of providers, higher cost out on
network
✔✔Traditional Health Insurance - ✔✔unrestricted choice of provider, more expensive,
may have deductible
✔✔Medicare Advantage - ✔✔Medicare part C-Created by BBA ( balanced budget act
1997), enhanced in 2003 by MMA( Medicare Modernization Act)
Get all of Medicare A&B, not Hospice Care
Extra Coverage hearing, dental, wellness
Select PCP
Higher Monthly fees
✔✔C-SNP Chronic Special Needs plan - ✔✔Listed special conditions,
Others D-SNP dual eligible Medicare and Medicaid
, ✔✔SCHIP State Childrens Health Insurance Program - ✔✔program provides matching
funds for health insurance to families c children, income too high for Medicaid, but still
poverty.
✔✔Tricare Prime - ✔✔For Active Duty members, and thei family is encouraged
HMO
✔✔Tricare Extra& Tricare Standard - ✔✔Beneficiary are responsible for annual dec and
cos0-shaes
✔✔Tricare for Life - ✔✔Over 65, must obtain Medicare B
✔✔IHS- Indian Health Services - ✔✔1. Direct Health Care-IHS facility
2. Cotract health service -CHS
1.5mill lives
eligible- rec tribe, regarded as member in his community, tribal affairs
✔✔FSA- Flexible Spending Account - ✔✔employee set funds aside into an account
through salary reduction, to pay health care
Funds are NOT rolled over
✔✔HSA- Health savings Account - ✔✔tax advantage , high deductible
Funds rolled over if not spent
✔✔MSA-Medical Savings Account - ✔✔Self employed
Tax deferred deposits for medical expenses
Coupled c HDHP ( high deductible health plan)
✔✔HEDIS HealthCare Effectiveness Data Information Set - ✔✔tool used by 90% Health
plans to measure performance re service of care.
✔✔PQRS-phys quality reporting system - ✔✔voluntary,
financial incentive
✔✔WC- workers comp - ✔✔IW can not sue company, but can sue 3rd party
✔✔FELA- Federal employers Liability Act 1908 - ✔✔compensation for past and future
earnings, loss of life enjoyment
Go before a judge or jury, no limits in settlement
✔✔Jones act for Maritime workers-1920 - ✔✔compensation, similar to FELA, no judge
✔✔impairment - ✔✔loss of the use or derangement to any body part, organ system or
function
SOLUTIONS GRADED A+
✔✔Focused Professional practice evaluation (FPPE) - ✔✔the organization considers
judgement , technical performance and outcome
-direct observation is the review technique of choice
✔✔Medicare- Medicaid Expansion - ✔✔affordable care act will reduce 30million
uninsured people-Medicaid increase of 20%
Pre Existing Condition Insurance Plan , and Dept coverage til age 26
Medicaid to expand to all persons below 138% of poverty level.
✔✔Traditional Insurance - ✔✔Indemnity plan- protect financial risk, easy access, few
restriction
✔✔Capitated payment - ✔✔Enrollee is at full risk
✔✔IPA-indept practice Ass - ✔✔providers are paid on a capitated or discounted fee-for
-service
HMO-IPA own office, use HMO docs, plan approves treatment and makes referals
✔✔PPO-Preferred Provider Org - ✔✔providers offer discounted fee, in return for
direction of pt to their office
can chose in our out of network
✔✔HMO Staff Model - ✔✔central building, low prev co-payment cost, use doctors in the
HMO, plan makes referral and approves care
✔✔HMO-POS Point of Service - ✔✔More choice of providers, higher cost out on
network
✔✔Traditional Health Insurance - ✔✔unrestricted choice of provider, more expensive,
may have deductible
✔✔Medicare Advantage - ✔✔Medicare part C-Created by BBA ( balanced budget act
1997), enhanced in 2003 by MMA( Medicare Modernization Act)
Get all of Medicare A&B, not Hospice Care
Extra Coverage hearing, dental, wellness
Select PCP
Higher Monthly fees
✔✔C-SNP Chronic Special Needs plan - ✔✔Listed special conditions,
Others D-SNP dual eligible Medicare and Medicaid
, ✔✔SCHIP State Childrens Health Insurance Program - ✔✔program provides matching
funds for health insurance to families c children, income too high for Medicaid, but still
poverty.
✔✔Tricare Prime - ✔✔For Active Duty members, and thei family is encouraged
HMO
✔✔Tricare Extra& Tricare Standard - ✔✔Beneficiary are responsible for annual dec and
cos0-shaes
✔✔Tricare for Life - ✔✔Over 65, must obtain Medicare B
✔✔IHS- Indian Health Services - ✔✔1. Direct Health Care-IHS facility
2. Cotract health service -CHS
1.5mill lives
eligible- rec tribe, regarded as member in his community, tribal affairs
✔✔FSA- Flexible Spending Account - ✔✔employee set funds aside into an account
through salary reduction, to pay health care
Funds are NOT rolled over
✔✔HSA- Health savings Account - ✔✔tax advantage , high deductible
Funds rolled over if not spent
✔✔MSA-Medical Savings Account - ✔✔Self employed
Tax deferred deposits for medical expenses
Coupled c HDHP ( high deductible health plan)
✔✔HEDIS HealthCare Effectiveness Data Information Set - ✔✔tool used by 90% Health
plans to measure performance re service of care.
✔✔PQRS-phys quality reporting system - ✔✔voluntary,
financial incentive
✔✔WC- workers comp - ✔✔IW can not sue company, but can sue 3rd party
✔✔FELA- Federal employers Liability Act 1908 - ✔✔compensation for past and future
earnings, loss of life enjoyment
Go before a judge or jury, no limits in settlement
✔✔Jones act for Maritime workers-1920 - ✔✔compensation, similar to FELA, no judge
✔✔impairment - ✔✔loss of the use or derangement to any body part, organ system or
function
