ABQAURP CORRECT STUDY QUESTIONS AND
ANSWERS SURE A+
✔✔HCQIA-health care quality improvement act - ✔✔provides hospt and peer rev
actions with immunity from damages where
-belief for furtherance of quality health care
-reasonable effort to obtain the facts
-adequate notice of hearing
-action was warranted
✔✔credential vs competency - ✔✔credential-peer recommendation and aggregated info
re performance
competency- direct observation
✔✔privileges - ✔✔-relates to specific competency
-each org establishes own criteria for competency(ie # of cases, CME) and
privileges.(residency training, board certification)
✔✔economic credentialing - ✔✔granting privileges based on effective medical care c
specific cost limits.
✔✔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
ANSWERS SURE A+
✔✔HCQIA-health care quality improvement act - ✔✔provides hospt and peer rev
actions with immunity from damages where
-belief for furtherance of quality health care
-reasonable effort to obtain the facts
-adequate notice of hearing
-action was warranted
✔✔credential vs competency - ✔✔credential-peer recommendation and aggregated info
re performance
competency- direct observation
✔✔privileges - ✔✔-relates to specific competency
-each org establishes own criteria for competency(ie # of cases, CME) and
privileges.(residency training, board certification)
✔✔economic credentialing - ✔✔granting privileges based on effective medical care c
specific cost limits.
✔✔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
