C425 OA Review Questions And Answers

Which of the following is true in regards to health care today in the United States? There are more primary care physicians than specialty physicians. Primary care receives a higher reimbursement in professional fees. There are more specialty physicians than primary physicians. Outpatient care is slowly decreasing. - Answer- There are more specialty physicians than primary physicians. What triggered the downsizing phase in the U.S. hospital industry during the 1980s? Hill-Burton Act Managed care Prospective payment system Medicare and Medicaid - Answer- Prospective payment system Designated Related Groups (DRG) -based reimbursement necessitated hospitals to do what? Admit new patients at a faster rate than before Admit a greater number of Medicare patients than before Reduce the length of stay for hospitalized patients Admit a smaller number of Medicare patients than before - Answer- Reduce the length of stay for hospitalized patients In which type of utilization management is a primary care physician's opinion necessary in referring or not referring a patient to a specialist? Concurrent Retrospective Gatekeeping Precertification - Answer- Gatekeeping What is one aspect in which managed care differs from conventional insurance? Collection of premiums Assumption of risk Responsibility for delivery of services Payments to providers - Answer- Responsibility for delivery of services What is the purpose of Skilled Nursing Facilities (SNF) certification? It enables a facility to be operated as a skilled nursing facility. It is required to legally operate a nursing home. It enables a facility to serve Medicare clients. It enables a facility to serve both Medicare and Medicaid clients. - Answer- It enables a facility to serve Medicare clients. What is the m