HIM 410 Final Test Questions with Correct Answers Latest Update 2025 Graded A+
primary objective of health care system - Answers 1. enable all citizens to receive health services
2. To deliver services that are cost effective and meet established standards of quality
national health care system - Answers health insurance programs run by the government and financed
through general taxes
socialized health care system - Answers government mandated contributions by employers and
employees. Health care delivered by private providers. Private not for profit insurance companies called
sickness funds collect and pay physicians and hospitals. Insurance and payment closely integrated,
GOVERNMENT has overall control
public health - Answers a wide variety of activities undertaken by state and local governments to ensure
conditions that promote optimum health for society as a whole
private practice - Answers the work of a professional practitioner, such as a doctor or lawyer, who is self
employed
organized medicine - Answers concerted activities of physicians, mainly to protect their own interest
through such organizations such as the american medical association. when physicians join an
organization in oder to advocate for themselves and their patients.
defensive medicine - Answers excessive medical test and procedures performed as protection against
malpractice law suits. recommending tests that are not necessarily the best option for the patient but an
option that serves to protect the physician from lawsuit
physicians - Answers play central role in evaluating patient, states require licensure, graduate from an
accredited medical school
MD - Answers doctor of medicine
DO - Answers doctor of osteopathic medicine
allied health professionals - Answers includes many health related areas. constitutes 60% of US health
care workforce. Two broad categories: technicians/assistants, therapists/technologists
nurses - Answers largest group of healthcare professionals, profession developed after WWI, the major
caregivers of sick and injured patients (addressing physical, mental and emotional needs) need to be
licensed to practice
RN - Answers registered nurse
LPN - Answers licensed practical nurse
, non-physician practitioners - Answers clinical professionals who practice in many areas similar to a
physician but do not have a physician or DO degree. (PA, nurse practitioner)
national practitioner bank - Answers an electronic information repository created by congress. contains
information on medical malpractice payments and certain adverse actions related to health care
practitioners, entities, providers and suppliers
voluntary health insurance - Answers private insurance. decision to join and payment of a premium is
voluntary
third party - Answers in a multi-payer system, the PAYERS for covered services. neither the providers nor
the recipients of medical services.
prospective payment - Answers criteria for how much will be paid for particular services is
predetermined
retrospective payment - Answers amount of reimbursement is determined on the basis of costs actually
incurred. methods of case-based payment
episode of care - Answers the managed care provided by a healthcare facility or provider for a specific
medical problem or condition or specific illness during a set period of time
fee for service - Answers payment model where services are unbundled and paid for separately
group health insurance - Answers an insurance plan/policy purchased by an organization or association
as a benefit to its employees or members. typical groups are employers, union, or trade works, and
professional associations
cost sharing provisions - Answers sharing of cost of health insurance premiums by those enrolled and or
payment of of certain medical costs such as copayments and deductibles. The share of costs covered by
your insurances that you pay out of pocket*
coordination of benefits - Answers the process of determining which of two or more insurance policies
will have the primary responsibility of processing/paying a claim and the extent to which the other
policies will contribute.
covered services - Answers services, drugs, supply and equipment for which coverage benefits are
available under the health care plans
carve-out - Answers the assignment through contractual arrangements of specialized services to an
outside organization because these services are not included in the contracts MCOs have with their
provider or the MCO does not provide the services
balance billing - Answers billing of the leftover sum by the provider to the patient after insurance has
only partially paid the charge initially billed
primary objective of health care system - Answers 1. enable all citizens to receive health services
2. To deliver services that are cost effective and meet established standards of quality
national health care system - Answers health insurance programs run by the government and financed
through general taxes
socialized health care system - Answers government mandated contributions by employers and
employees. Health care delivered by private providers. Private not for profit insurance companies called
sickness funds collect and pay physicians and hospitals. Insurance and payment closely integrated,
GOVERNMENT has overall control
public health - Answers a wide variety of activities undertaken by state and local governments to ensure
conditions that promote optimum health for society as a whole
private practice - Answers the work of a professional practitioner, such as a doctor or lawyer, who is self
employed
organized medicine - Answers concerted activities of physicians, mainly to protect their own interest
through such organizations such as the american medical association. when physicians join an
organization in oder to advocate for themselves and their patients.
defensive medicine - Answers excessive medical test and procedures performed as protection against
malpractice law suits. recommending tests that are not necessarily the best option for the patient but an
option that serves to protect the physician from lawsuit
physicians - Answers play central role in evaluating patient, states require licensure, graduate from an
accredited medical school
MD - Answers doctor of medicine
DO - Answers doctor of osteopathic medicine
allied health professionals - Answers includes many health related areas. constitutes 60% of US health
care workforce. Two broad categories: technicians/assistants, therapists/technologists
nurses - Answers largest group of healthcare professionals, profession developed after WWI, the major
caregivers of sick and injured patients (addressing physical, mental and emotional needs) need to be
licensed to practice
RN - Answers registered nurse
LPN - Answers licensed practical nurse
, non-physician practitioners - Answers clinical professionals who practice in many areas similar to a
physician but do not have a physician or DO degree. (PA, nurse practitioner)
national practitioner bank - Answers an electronic information repository created by congress. contains
information on medical malpractice payments and certain adverse actions related to health care
practitioners, entities, providers and suppliers
voluntary health insurance - Answers private insurance. decision to join and payment of a premium is
voluntary
third party - Answers in a multi-payer system, the PAYERS for covered services. neither the providers nor
the recipients of medical services.
prospective payment - Answers criteria for how much will be paid for particular services is
predetermined
retrospective payment - Answers amount of reimbursement is determined on the basis of costs actually
incurred. methods of case-based payment
episode of care - Answers the managed care provided by a healthcare facility or provider for a specific
medical problem or condition or specific illness during a set period of time
fee for service - Answers payment model where services are unbundled and paid for separately
group health insurance - Answers an insurance plan/policy purchased by an organization or association
as a benefit to its employees or members. typical groups are employers, union, or trade works, and
professional associations
cost sharing provisions - Answers sharing of cost of health insurance premiums by those enrolled and or
payment of of certain medical costs such as copayments and deductibles. The share of costs covered by
your insurances that you pay out of pocket*
coordination of benefits - Answers the process of determining which of two or more insurance policies
will have the primary responsibility of processing/paying a claim and the extent to which the other
policies will contribute.
covered services - Answers services, drugs, supply and equipment for which coverage benefits are
available under the health care plans
carve-out - Answers the assignment through contractual arrangements of specialized services to an
outside organization because these services are not included in the contracts MCOs have with their
provider or the MCO does not provide the services
balance billing - Answers billing of the leftover sum by the provider to the patient after insurance has
only partially paid the charge initially billed
