D545 Healthcare Administration Evolution,
Systems, and Leadership Exam Questions and
Correct Answers
Fee-for-Service (FFS)
Providers are paid for each service performed
Fee-for-Service (FFS)
A physician bills separately for an office visit, blood test and x-ray
Health Maintenance Organization (HMO)
Insurance plans requiring members to use a network of providers and obtain referrals for
specialist
Health Management Organization (HMO)
A patient must get a primary care physician referral before seeing a cardiologist
Point of Service (POS)
Insurance plan combining HMO and PPO features; referrals are needed, but out of network care
is allowed at higher cost.
Point of Service (POS)
A patient sees an out-of-network specialist and pay more than if they stayed in-network.
Accountable Care Organization (ACO)
A group of providers coordinating care to improve quality and reduce cost.
,Accountable Care Organization (ACO)
A hospital and physician group share savings achieved through reducing hospital readmission's.
Maxtrix Structure
Employees report to more than one manager
Matrix structure
A nurse reports to both the nursing director and the manager of a cardiac care project.
Affordable Care Act (ACA)
Federal law aimed at increasing healthcare access, quality and affordability
Affordable Care Act
Young adults may remain on parents insurance until age 26
ACA Impact on Medicaid
Expanded Medicaid eligibility to more low income adults in participating states
ACA Impact on Medicaid
A previously uninsured adult qualifies for Medicaid coverage
Joint Commission Accreditation
Independent Organization that evaluates healthcare organization for quality and safety standards.
Joint Commission Accreditation
A hospital undergoes a survey to maintain accreditation status
, False Claims Act
Prohibits submitting fraudulent claims to government healthcare programs.
False Claims Act
A provider knowingly bills Medicare for services not performed.
Anti-Kickback Statute
Prohibits offering or receiving payment for patient referrals involving federal healthcare
programs
Anti-Kickback Statute
A provider knowingly bills Medicare for services not performed.
A physician receives money for referring Medicare patients to a diagnostic center.
Stark Law
Prohibits physician self-referrals for designated services when financial interests exist.
Stark Law
A physician refers patients to a laboratory they own.
COBRA
Allows individuals to continue employer-sponsored health insurance after losing employment.
COBRA
An employee keeps health coverage after being laid off by paying premiums.
Systems, and Leadership Exam Questions and
Correct Answers
Fee-for-Service (FFS)
Providers are paid for each service performed
Fee-for-Service (FFS)
A physician bills separately for an office visit, blood test and x-ray
Health Maintenance Organization (HMO)
Insurance plans requiring members to use a network of providers and obtain referrals for
specialist
Health Management Organization (HMO)
A patient must get a primary care physician referral before seeing a cardiologist
Point of Service (POS)
Insurance plan combining HMO and PPO features; referrals are needed, but out of network care
is allowed at higher cost.
Point of Service (POS)
A patient sees an out-of-network specialist and pay more than if they stayed in-network.
Accountable Care Organization (ACO)
A group of providers coordinating care to improve quality and reduce cost.
,Accountable Care Organization (ACO)
A hospital and physician group share savings achieved through reducing hospital readmission's.
Maxtrix Structure
Employees report to more than one manager
Matrix structure
A nurse reports to both the nursing director and the manager of a cardiac care project.
Affordable Care Act (ACA)
Federal law aimed at increasing healthcare access, quality and affordability
Affordable Care Act
Young adults may remain on parents insurance until age 26
ACA Impact on Medicaid
Expanded Medicaid eligibility to more low income adults in participating states
ACA Impact on Medicaid
A previously uninsured adult qualifies for Medicaid coverage
Joint Commission Accreditation
Independent Organization that evaluates healthcare organization for quality and safety standards.
Joint Commission Accreditation
A hospital undergoes a survey to maintain accreditation status
, False Claims Act
Prohibits submitting fraudulent claims to government healthcare programs.
False Claims Act
A provider knowingly bills Medicare for services not performed.
Anti-Kickback Statute
Prohibits offering or receiving payment for patient referrals involving federal healthcare
programs
Anti-Kickback Statute
A provider knowingly bills Medicare for services not performed.
A physician receives money for referring Medicare patients to a diagnostic center.
Stark Law
Prohibits physician self-referrals for designated services when financial interests exist.
Stark Law
A physician refers patients to a laboratory they own.
COBRA
Allows individuals to continue employer-sponsored health insurance after losing employment.
COBRA
An employee keeps health coverage after being laid off by paying premiums.
