HEALTHCARE UPDATED RATED A+ | 2026
Which of the following si true about a capitated Managed Care Organiza on (MCO)
arrangement:
a) The provider shi s financial risk to the MCO
b) The provider can bil separately for each service provided
c) The provider must wait to bil the MCO un l services have been provided to a pa ent
d) The provider is paid a set fee
d) The provider is paid a set fee
Which of the following is a unit of measure commonly used to determine provider produc vity?
a) RVU
b) CMS
c) IPA
d) TJC
a) RVU
What popula on factor is currently having the greatest impact on healthcare organiza ons?
a) Ethnic composi on
b) Economic status
c) Geographic distribu on
d) Age cohort
d) Age cohort
The principle reason for small and midsized employers to join buyers' coopera ves si to enable
them to:
a) Drop coverage from exis ng insurers
b) Gain leverage to obtain prices similar to large employers
c) Nego ate directly with physicians and hospitals
d) Lobby government agencies for more protec on from insurers
,b) Gain leverage to obtain prices similar to large employers
All areas of healthcare facili es are subject to safety and other regulatory requirements as
dictated by state life safety codes, The Joint Commission, Occupa onal Safety and Health
Administra on, state fire marshal, and others. Which area of the facility typically has the
highest standards?
a) The energy plant
b) Highly used public areas
c) Areas under construc on
d) Pa ent care areas
d) Pa ent care areas
Par cipa ng providers in the federal Medicare program must:
a) Be accredited by The Joint Commission
b) Serve Medicaid beneficiaries
c) Meet the Condi ons of Par cipa on
d) Be in compliance with state cer ficate of need laws
c) Meet the Condi ons of Par cipa on
Which organiza on is responsible for accredi ng residency training programs?
a) ACGME
b) AAMC
c) AMA
d) BPQA
a) ACGME
A pa ent is reques ng their full medical record. Which of the following is true regarding the
record that will be provided to the pa ent:
a) Psychotherapy notes may be excluded b) Physical therapy notes may be excluded
c) Labs and diagnos c imaging may be excluded d) The full record must always be provided.
a) Psychotherapy notes may be excluded
An inpa ent admission reimbursed based on the pa ent's diagnosis and an cipated length of
stay and services is known as:
, a) ICD-10 payment
b) Capita on payment
c) Fee for service payment
d) DRG payment
d) DRG payment
Bundled pricing (paying a single fee for al services) for such services as total hip
replacement or coronary artery bypass surgery affected physician-hospital rela onships by:
a) Reducing the need to devote administra ve effort to measuring outcomes and performance
indicators
b) Pu@ng the physician and hospital in compe on with each other for reimbursement c)
Promo ng collabora on and integra on efforts to provide more efficient care d) Guaranteeing
only top providers are allowed to par cipate in such programs
c) Promo ng collabora on and integra on efforts to provide more efficient care
A hospital acquires another hospital. This would be known as:
a) Ver cal integra on
b) Diagonal integra on
c) Circular integra on
d) Horizontal integra on
d) Horizontal integra on
Under capita on, the risks of over-u liza on are shi ed ot the:
a) Pa ent receiving the health services
b) Provider of the health services
c) Third-party payers
d) Health insurance company
b) Provider of the health services
In addi on to improving the health of the surrounding community, one of the primary reasons
non-profit hospitals may offer health fairs, screening programs, and smoking cessa on classes is
that they contribute to:
a) Demand for services
b) Supply of providers