TEST BANK FOR HIM 410 FINAL EXAM 2026 |
ALL QUESTIONS AND CORRECT ANSWERS |
VERIFIED ANSWERS | UPDATED VERSION |
BRAND NEW VERSION!
In the accounting system of the physician office, the account is categorized as
"self-pay." How should the insurance analyst interpret this category?
a) The guarantor will pay the entire bill
b) The physician, himself or herself, will pick up the balance of the bill
c) The employer's self-insured healthcare insurance plan will cover the account
d) The patient will pay deductibles and non-covered charges ------------Correct
Answer--------------------a) The guarantor will pay the entire bill
In which HMO model is the choice of physicians likely to be most restricted?
a) Staff model
b) Group model
c) Network model
d) IPA model ------------Correct Answer--------------------a) Staff model
,This committee reviews and makes the initial recommendation on the application
of a new medical staff member
a) Medical Executive Committee
b) Medical Record Committee
c) Credentials Committee
d) Quality improvement Committee ------------Correct Answer--------------------c)
Credentials Committee
The most prominent reason for the decline in the number of procedures
performed in hospitals is:
a) Most of these procedures were shifted to outpatient setting
b) Most of these procedures were deemed outdated
c) Most of these procedures were unsafe
d) Most of these procedures used technology that was too expensive ------------
Correct Answer--------------------a) Most of these procedures were shifted to
outpatient setting
Which of the following is a typical setting for ambulatory care services?
a) Sports medicine clinics
b) Physicians' offices
c) Dialysis centers
,d) All of the above ------------Correct Answer--------------------d) All of the above
What is the purpose of managed care?
a) To improve the quality of care for patients
b) To reduce the costs of healthcare services
c) To leverage negotiations with state and federal agencies
d) A and B only
e) All of the above ------------Correct Answer--------------------d) A and B only
Capitation is best described as
a) monthly lump sum payment regardless of utilization
b) monthly lump sum payment regardless of cost
c) fixed monthly fee per member
d) payments capped to a maximum cost for delivering services ------------Correct
Answer--------------------c) fixed monthly fee per member
Gatekeeping ______ secondary care services.
a) bypasses
b) encompasses the delivery of
, c) requires a referral for
d) does not control ------------Correct Answer--------------------c) requires a referral
for
Which of the following is a reason for the growth in outpatient services?
a) Managed care
b) New technology
c) Patient preference
d) All of the above ------------Correct Answer--------------------d) All of the above
Which of the following was the biggest impact of the Hill-Burton Act of 1946?
a) Supported construction of new hospitals and modernization of old ones
throughout the United States
b) Creation of a national health insurance plan
b) Regulation of physicians' salaries
d) Raising the legal drinking age to 21 years ------------Correct Answer------------------
--a) Supported construction of new hospitals and modernization of old ones
throughout the United States
The role of the government in the U.S. healthcare system is:
ALL QUESTIONS AND CORRECT ANSWERS |
VERIFIED ANSWERS | UPDATED VERSION |
BRAND NEW VERSION!
In the accounting system of the physician office, the account is categorized as
"self-pay." How should the insurance analyst interpret this category?
a) The guarantor will pay the entire bill
b) The physician, himself or herself, will pick up the balance of the bill
c) The employer's self-insured healthcare insurance plan will cover the account
d) The patient will pay deductibles and non-covered charges ------------Correct
Answer--------------------a) The guarantor will pay the entire bill
In which HMO model is the choice of physicians likely to be most restricted?
a) Staff model
b) Group model
c) Network model
d) IPA model ------------Correct Answer--------------------a) Staff model
,This committee reviews and makes the initial recommendation on the application
of a new medical staff member
a) Medical Executive Committee
b) Medical Record Committee
c) Credentials Committee
d) Quality improvement Committee ------------Correct Answer--------------------c)
Credentials Committee
The most prominent reason for the decline in the number of procedures
performed in hospitals is:
a) Most of these procedures were shifted to outpatient setting
b) Most of these procedures were deemed outdated
c) Most of these procedures were unsafe
d) Most of these procedures used technology that was too expensive ------------
Correct Answer--------------------a) Most of these procedures were shifted to
outpatient setting
Which of the following is a typical setting for ambulatory care services?
a) Sports medicine clinics
b) Physicians' offices
c) Dialysis centers
,d) All of the above ------------Correct Answer--------------------d) All of the above
What is the purpose of managed care?
a) To improve the quality of care for patients
b) To reduce the costs of healthcare services
c) To leverage negotiations with state and federal agencies
d) A and B only
e) All of the above ------------Correct Answer--------------------d) A and B only
Capitation is best described as
a) monthly lump sum payment regardless of utilization
b) monthly lump sum payment regardless of cost
c) fixed monthly fee per member
d) payments capped to a maximum cost for delivering services ------------Correct
Answer--------------------c) fixed monthly fee per member
Gatekeeping ______ secondary care services.
a) bypasses
b) encompasses the delivery of
, c) requires a referral for
d) does not control ------------Correct Answer--------------------c) requires a referral
for
Which of the following is a reason for the growth in outpatient services?
a) Managed care
b) New technology
c) Patient preference
d) All of the above ------------Correct Answer--------------------d) All of the above
Which of the following was the biggest impact of the Hill-Burton Act of 1946?
a) Supported construction of new hospitals and modernization of old ones
throughout the United States
b) Creation of a national health insurance plan
b) Regulation of physicians' salaries
d) Raising the legal drinking age to 21 years ------------Correct Answer------------------
--a) Supported construction of new hospitals and modernization of old ones
throughout the United States
The role of the government in the U.S. healthcare system is:
