HSA3111 EXAM 2 QUESTIONS &
ANSWERS(RATED A+)
What was the main purpose of the Health Maintenance Organization Act of 1973?
The federal HMO act significantly changed certain reimbursements in the US -
ANSWERProvide an alternative to fee-for-service healthcare
The second BL video after moral hazard in Module 6 and the second BL video after
outpatient services in module 7 where a series and focused mainly on -
ANSWERUnethical and illegal practices aimed at getting payouts from a
government-funded healthcare program (eg medicare)
Upcoding - ANSWERA fraudulent practice in which provider services are billed for
higher procedural codes than were actually performed, resulting in a higher payment.
Medicare Fraud Strike Force - ANSWERThe result of the Health Care Fraud
Prevention and Enforcement Action Team, this group uses data analytics to look for
evidence of fraud and abuse
What is self-insurance? - ANSWERLarge employers assume the risks and budget
for medical claims
Moral hazard can be described as: - ANSWERConsumer behavior that leads to
higher utilization of health care services
Which response is not one of the four fundamental principles associated with the
concept of insurance? - ANSWERInsurance protects an individual from catastrophic
loss due to major medical bills because their risk can be calculated based on
individual behavior and lifestyle factors.
What are the four fundamental principles associated with the concept of insurance? -
ANSWER1. Risk is unpredictable for the individual insured
2. Members of insured group share actual losses on some equitable basis
3. Insurance mechanism transfers risk from individual to group
4. Risk can be predicted with a reasonable accuracy for a large group
What type of reimbursement method involves a fixed monthly sum per enrollee? This
method pays a physician or group of physicians a set amount for each enrolled
person assigned to them, per period of time, whether or not that person seeks care -
ANSWERThe method incentivizes physicians to consider the cost of the treatment
referred to as capitation
What is the incentive under fee-for-service reimbursement? - ANSWERproviders
have an incentive to deliver nonessential services
, The ACA specified that ___________ can be coveted under their parents' health
insurance plans - ANSWERChildren under the age of 26
Capitation removes the incentive to - ANSWERprovide unnecessary services
In some markets, there is a danger that, improperly handled and managed,
_________ could create some disincentives to care, rather than encouraging
efficient care - ANSWERCapitation
Patient data in an electronic health record includes demographics, medical and
nursing diagnoses, and: - ANSWERA. Medication lists
B. Allergies
C. Test results
Who creates and updates EHRs? - ANSWERHealthcare provider
___________ is a draft standard describing data formats and elements and an
application programming interface for exchanging electronic health records -
ANSWERFHIR
FHIR intents to allow developers to build standardized browser applications that
allow access to data no matter what EHR operating system underpins the user's
infrastructure - ANSWERTrue
A patient can have only one electronic health record - ANSWERFalse
What is the purpose of risk-sharing with providers? - ANSWERIt makes providers
cost conscious
Occurrence Based Policy - ANSWERAn "occurrence-based" policy provides
coverage for injuries arising out of incidents occurring during the period the policy
was in effect, even if the policy subsequently expires or is not renewed by the policy-
holder.
Claims-made policy - ANSWERcovers only claims that are first reported during the
policy period or extended reporting period, provided that the event occurred after the
retroactive date, if any, stated in the policy
Occurrence Limit - ANSWERThe maximum amount payable by a liability policy for
each occurrence (one event)
Hospice services are primarily for people with: - ANSWERterminal illnesses
How is community-oriented primary care (COPC) different from primary care? -
ANSWERCOPC adds a population-based approach to identifying and addressing
community health problems.
Gate keeping can be defined as: - ANSWERThe process by which primary care
physicians refer patients to specialists
ANSWERS(RATED A+)
What was the main purpose of the Health Maintenance Organization Act of 1973?
The federal HMO act significantly changed certain reimbursements in the US -
ANSWERProvide an alternative to fee-for-service healthcare
The second BL video after moral hazard in Module 6 and the second BL video after
outpatient services in module 7 where a series and focused mainly on -
ANSWERUnethical and illegal practices aimed at getting payouts from a
government-funded healthcare program (eg medicare)
Upcoding - ANSWERA fraudulent practice in which provider services are billed for
higher procedural codes than were actually performed, resulting in a higher payment.
Medicare Fraud Strike Force - ANSWERThe result of the Health Care Fraud
Prevention and Enforcement Action Team, this group uses data analytics to look for
evidence of fraud and abuse
What is self-insurance? - ANSWERLarge employers assume the risks and budget
for medical claims
Moral hazard can be described as: - ANSWERConsumer behavior that leads to
higher utilization of health care services
Which response is not one of the four fundamental principles associated with the
concept of insurance? - ANSWERInsurance protects an individual from catastrophic
loss due to major medical bills because their risk can be calculated based on
individual behavior and lifestyle factors.
What are the four fundamental principles associated with the concept of insurance? -
ANSWER1. Risk is unpredictable for the individual insured
2. Members of insured group share actual losses on some equitable basis
3. Insurance mechanism transfers risk from individual to group
4. Risk can be predicted with a reasonable accuracy for a large group
What type of reimbursement method involves a fixed monthly sum per enrollee? This
method pays a physician or group of physicians a set amount for each enrolled
person assigned to them, per period of time, whether or not that person seeks care -
ANSWERThe method incentivizes physicians to consider the cost of the treatment
referred to as capitation
What is the incentive under fee-for-service reimbursement? - ANSWERproviders
have an incentive to deliver nonessential services
, The ACA specified that ___________ can be coveted under their parents' health
insurance plans - ANSWERChildren under the age of 26
Capitation removes the incentive to - ANSWERprovide unnecessary services
In some markets, there is a danger that, improperly handled and managed,
_________ could create some disincentives to care, rather than encouraging
efficient care - ANSWERCapitation
Patient data in an electronic health record includes demographics, medical and
nursing diagnoses, and: - ANSWERA. Medication lists
B. Allergies
C. Test results
Who creates and updates EHRs? - ANSWERHealthcare provider
___________ is a draft standard describing data formats and elements and an
application programming interface for exchanging electronic health records -
ANSWERFHIR
FHIR intents to allow developers to build standardized browser applications that
allow access to data no matter what EHR operating system underpins the user's
infrastructure - ANSWERTrue
A patient can have only one electronic health record - ANSWERFalse
What is the purpose of risk-sharing with providers? - ANSWERIt makes providers
cost conscious
Occurrence Based Policy - ANSWERAn "occurrence-based" policy provides
coverage for injuries arising out of incidents occurring during the period the policy
was in effect, even if the policy subsequently expires or is not renewed by the policy-
holder.
Claims-made policy - ANSWERcovers only claims that are first reported during the
policy period or extended reporting period, provided that the event occurred after the
retroactive date, if any, stated in the policy
Occurrence Limit - ANSWERThe maximum amount payable by a liability policy for
each occurrence (one event)
Hospice services are primarily for people with: - ANSWERterminal illnesses
How is community-oriented primary care (COPC) different from primary care? -
ANSWERCOPC adds a population-based approach to identifying and addressing
community health problems.
Gate keeping can be defined as: - ANSWERThe process by which primary care
physicians refer patients to specialists
