CAHIMS - Unit 3 Latest recent and
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,_____ is the recording of all treatments, diagnoses, and other medical services. It is commonly done
electronically but may be done on paper. - correct ans:charge capture
____ is the process of translating treatments, diagnoses, and other medical services into established
alphanumeric codes so that they can be submitted as part of a claim. - correct ans:coding
When a healthcare organization such as a physician group receives a per-head fee for each individual
enrolled in a plan, it is known _____. A capitation payment reflects the ____ of its enrollees. A medical
service or condition that is exempted from a capitation plan is called a/an _____. If a physician or
physician group receives the payment whether or not the individual enrolled in the plan seeks medical
services, it represents a ____ mode. - correct ans:CAPITATION;health status;carve out;CAPITATION
A physician organization contracts with a health maintenance organization (HMO) to provide services to
its subscribers. The physician organization receives a flat monthly fee for each patient enrolled in the
HMO. No additional payments are made for complications or higher-than-expected usage of some
healthcare services. This arrangement is known as a _____
fee-for-service
bundled service
prevention model
capitation model - correct ans:capitation model
Provides for continued healthcare coverage after employment is terminated - correct ans:Consolidated
Omnibus Budget Reconciliation Act of 1985 (COBRA)
Limits exclusions based on preexisting conditions; mandates electronic medical records (EMR);
mandates privacy requirements for patient information - correct ans:Health Insurance Portability and
Accountability Act (HIPAA)
HITECH is contained within ______ - correct ans:American Reinvestment and Recovery Act of 2009
(ARRA)
Promotes meaningful use of health information technology - correct ans:Health Information Technology
for Economic and Clinical Health Act (HITECH Act)
,Focuses on making health insurance more affordable for Americans and increasing the number of those
with health insurance - correct ans:Health Care and Education Reconciliation Act of 2010 (Affordable
Healthcare Act)
Lester's health insurance pays for colonoscopies as a screening tool for colon cancer. What type of
screening is described?
Primary prevention
Secondary prevention
Tertiary prevention
Perioperative treatment - correct ans:primary prevention
What are bundled payments associated with?
Primary prevention
Actuarial research
Episodes of care
Capitation models - correct ans:Episodes of care
The Physicians Group of Arizona is an independent practice association (IPA) that contracts with an HMO
to provide medical services to the members of the group. The physicians group is reimbursed a flat
yearly fee for every individual in the HMO regardless of how much an individual uses the plan. What
type of financing model is described?
Capitation
Fee-for-service
Primary care
A bundled payment model - correct ans:Capitation
____ occurs when the account is settled with the patient. Copays, coinsurance, and deductibles may
need to be taken into account. This must be done before a claim can be submitted. - correct ans:final
settlement
Which of the following is not true of Medicaid?
, Medicaid sometimes has a copay.
Medicaid offers a fairly wide range of services.
Medicaid has an income requirement.
Medicaid is entirely funded by the federal government. - correct ans:Medicaid is entirely funded by the
federal government.
Jody can choose between a variety of private health providers. However, her medical expenses are paid
for by the government. What kind of system is Jody participating in?
Multiple payer
Single payer
Indemnity
Health maintenance organization (HMO) - correct ans:single payer
Which of the following is a common criticism of the capitated model?
It is more expensive than a fee-for-service model.
Sicker patients are denied access to the health plan.
It is impossible to predict the future health of patients.
Physicians tend to use more expensive treatments. - correct ans:Sicker patients are denied access to the
health plan.
Where was most healthcare provided in the late 19th and early 20th centuries?
In hospitals
In clinics where an employee worked
At patients' or doctors' homes
At sites sponsored by the employee's insurance company - correct ans:At patients' or doctors' homes
Which of the following is considered a common strength of managed care organizations?
No deductibles for patients
The ability for the patient to choose any physician, including a specialist
Wellness initiatives
frequently tested exam with
comprehensive questions and verified
accurate solution (detailed & elaborated)
GRADED A+
Professional Academic Assistance Services
Services Offered
Proctored Exam Assistance
Online Class Management (Full Course Support)
Exam Preparation & Study Materials
Assignments and Coursework Support
Essays and Research Papers
Discussion Posts and Replies
CONTACT INFORMATION
WHATAPPSLINK- https://wa.me/254784769540
,_____ is the recording of all treatments, diagnoses, and other medical services. It is commonly done
electronically but may be done on paper. - correct ans:charge capture
____ is the process of translating treatments, diagnoses, and other medical services into established
alphanumeric codes so that they can be submitted as part of a claim. - correct ans:coding
When a healthcare organization such as a physician group receives a per-head fee for each individual
enrolled in a plan, it is known _____. A capitation payment reflects the ____ of its enrollees. A medical
service or condition that is exempted from a capitation plan is called a/an _____. If a physician or
physician group receives the payment whether or not the individual enrolled in the plan seeks medical
services, it represents a ____ mode. - correct ans:CAPITATION;health status;carve out;CAPITATION
A physician organization contracts with a health maintenance organization (HMO) to provide services to
its subscribers. The physician organization receives a flat monthly fee for each patient enrolled in the
HMO. No additional payments are made for complications or higher-than-expected usage of some
healthcare services. This arrangement is known as a _____
fee-for-service
bundled service
prevention model
capitation model - correct ans:capitation model
Provides for continued healthcare coverage after employment is terminated - correct ans:Consolidated
Omnibus Budget Reconciliation Act of 1985 (COBRA)
Limits exclusions based on preexisting conditions; mandates electronic medical records (EMR);
mandates privacy requirements for patient information - correct ans:Health Insurance Portability and
Accountability Act (HIPAA)
HITECH is contained within ______ - correct ans:American Reinvestment and Recovery Act of 2009
(ARRA)
Promotes meaningful use of health information technology - correct ans:Health Information Technology
for Economic and Clinical Health Act (HITECH Act)
,Focuses on making health insurance more affordable for Americans and increasing the number of those
with health insurance - correct ans:Health Care and Education Reconciliation Act of 2010 (Affordable
Healthcare Act)
Lester's health insurance pays for colonoscopies as a screening tool for colon cancer. What type of
screening is described?
Primary prevention
Secondary prevention
Tertiary prevention
Perioperative treatment - correct ans:primary prevention
What are bundled payments associated with?
Primary prevention
Actuarial research
Episodes of care
Capitation models - correct ans:Episodes of care
The Physicians Group of Arizona is an independent practice association (IPA) that contracts with an HMO
to provide medical services to the members of the group. The physicians group is reimbursed a flat
yearly fee for every individual in the HMO regardless of how much an individual uses the plan. What
type of financing model is described?
Capitation
Fee-for-service
Primary care
A bundled payment model - correct ans:Capitation
____ occurs when the account is settled with the patient. Copays, coinsurance, and deductibles may
need to be taken into account. This must be done before a claim can be submitted. - correct ans:final
settlement
Which of the following is not true of Medicaid?
, Medicaid sometimes has a copay.
Medicaid offers a fairly wide range of services.
Medicaid has an income requirement.
Medicaid is entirely funded by the federal government. - correct ans:Medicaid is entirely funded by the
federal government.
Jody can choose between a variety of private health providers. However, her medical expenses are paid
for by the government. What kind of system is Jody participating in?
Multiple payer
Single payer
Indemnity
Health maintenance organization (HMO) - correct ans:single payer
Which of the following is a common criticism of the capitated model?
It is more expensive than a fee-for-service model.
Sicker patients are denied access to the health plan.
It is impossible to predict the future health of patients.
Physicians tend to use more expensive treatments. - correct ans:Sicker patients are denied access to the
health plan.
Where was most healthcare provided in the late 19th and early 20th centuries?
In hospitals
In clinics where an employee worked
At patients' or doctors' homes
At sites sponsored by the employee's insurance company - correct ans:At patients' or doctors' homes
Which of the following is considered a common strength of managed care organizations?
No deductibles for patients
The ability for the patient to choose any physician, including a specialist
Wellness initiatives
