HIM 431 Exam 1 ACTUAL QUESTIONS AND
CORRECT ANSWERS
Types of Managed Care - CORRECT ANSWER HMO, PPO, POS
Which is NOT a type of managed care? - CORRECT ANSWER HMO
TQM
PPO
POS
- TQM
1st sign of infection control - CORRECT ANSWER when the newly arrived
immigrants were being sequestered that contracted diseases
Model hospital for the organization & development of other hospitals - CORRECT
ANSWER Pennsylvania Hospital
Why was the American Medical Association (AMA) created? - CORRECT
ANSWER to represent the interest of physicians across the US
Trustees = Board of Directors - CORRECT ANSWER Trustees received regular reports
on the # of patients that were treated, and the patient's outcome at discharge.
What hospital was the 1st to start reporting to trustees? - CORRECT
ANSWER Massachusetts General
What did Public Law 89-97 do? - CORRECT ANSWER established Medicare &
Medicaid
Value-based purchasing (VBP)
,(pay for performance P4P) - CORRECT ANSWER holds providers accountable for
cost & quality of care
Quality Assurance (QA) - CORRECT ANSWER Audit activities designed to measure
the quality of services, products, or processes followed by remedial action to improve care
delivery
Retrospective payment system - CORRECT ANSWER Type of fee-for-service
reimbursement in which providers receive recompense after health services have been
rendered
payment after services
Affordable Care Act - CORRECT ANSWER An expansion of medicaid, most of
employers must provide health insurance, have insurance or face surtax, prevents rejection
based on pre-existing condition. Also referred to as "Obamacare", signed into law in 2010.
providing or improving access to healthcare services
Managed Care - CORRECT ANSWER broad term used to describe several types of
managed healthcare plans.
Health Maintenance Organization (HMO) - CORRECT ANSWER members pay a set
premium and are entitled to a specific network of healthcare providers/services
- MOST familiar
Preferred Provider Organization (PPO) - CORRECT ANSWER limited list
- providers have agreed in advance to accept discounted payment for service
Point of Service (POS) - CORRECT ANSWER out of network
- pay greater portion of healthcare expense
, W. Edwards DEMING - CORRECT ANSWER Total Quality Management (TQM)
- problematic processes, not people, cause inferior products and outcomes
DONABEDIAN - CORRECT ANSWER 4 perspectives:
1. Structure
2. Process
3. Outcome
4. Cost
AKA; Continuous Quality Improvement (CQI)
Structure - CORRECT ANSWER foundation of caregiving (physical building,
equipment, technology)
Process - CORRECT ANSWER inter-related activities of healthcare organizations
(governance, managerial support, clinical services that affect patient outcomes)
- policies & procedures in place for employees to follow
Outcome - CORRECT ANSWER results of care, treatment & services in terms of the
patient's expectations, needs, & quality of life can be positive or negative
Cost - CORRECT ANSWER amount of resources consumed in the prevision of
healthcare services
National Patient Safety Goals - CORRECT ANSWER The Joint Commission
Joint Commission developed __________________ in response to the IOM's report (To Err is
Human) - CORRECT ANSWER National Patient Safety Goals
CORRECT ANSWERS
Types of Managed Care - CORRECT ANSWER HMO, PPO, POS
Which is NOT a type of managed care? - CORRECT ANSWER HMO
TQM
PPO
POS
- TQM
1st sign of infection control - CORRECT ANSWER when the newly arrived
immigrants were being sequestered that contracted diseases
Model hospital for the organization & development of other hospitals - CORRECT
ANSWER Pennsylvania Hospital
Why was the American Medical Association (AMA) created? - CORRECT
ANSWER to represent the interest of physicians across the US
Trustees = Board of Directors - CORRECT ANSWER Trustees received regular reports
on the # of patients that were treated, and the patient's outcome at discharge.
What hospital was the 1st to start reporting to trustees? - CORRECT
ANSWER Massachusetts General
What did Public Law 89-97 do? - CORRECT ANSWER established Medicare &
Medicaid
Value-based purchasing (VBP)
,(pay for performance P4P) - CORRECT ANSWER holds providers accountable for
cost & quality of care
Quality Assurance (QA) - CORRECT ANSWER Audit activities designed to measure
the quality of services, products, or processes followed by remedial action to improve care
delivery
Retrospective payment system - CORRECT ANSWER Type of fee-for-service
reimbursement in which providers receive recompense after health services have been
rendered
payment after services
Affordable Care Act - CORRECT ANSWER An expansion of medicaid, most of
employers must provide health insurance, have insurance or face surtax, prevents rejection
based on pre-existing condition. Also referred to as "Obamacare", signed into law in 2010.
providing or improving access to healthcare services
Managed Care - CORRECT ANSWER broad term used to describe several types of
managed healthcare plans.
Health Maintenance Organization (HMO) - CORRECT ANSWER members pay a set
premium and are entitled to a specific network of healthcare providers/services
- MOST familiar
Preferred Provider Organization (PPO) - CORRECT ANSWER limited list
- providers have agreed in advance to accept discounted payment for service
Point of Service (POS) - CORRECT ANSWER out of network
- pay greater portion of healthcare expense
, W. Edwards DEMING - CORRECT ANSWER Total Quality Management (TQM)
- problematic processes, not people, cause inferior products and outcomes
DONABEDIAN - CORRECT ANSWER 4 perspectives:
1. Structure
2. Process
3. Outcome
4. Cost
AKA; Continuous Quality Improvement (CQI)
Structure - CORRECT ANSWER foundation of caregiving (physical building,
equipment, technology)
Process - CORRECT ANSWER inter-related activities of healthcare organizations
(governance, managerial support, clinical services that affect patient outcomes)
- policies & procedures in place for employees to follow
Outcome - CORRECT ANSWER results of care, treatment & services in terms of the
patient's expectations, needs, & quality of life can be positive or negative
Cost - CORRECT ANSWER amount of resources consumed in the prevision of
healthcare services
National Patient Safety Goals - CORRECT ANSWER The Joint Commission
Joint Commission developed __________________ in response to the IOM's report (To Err is
Human) - CORRECT ANSWER National Patient Safety Goals
