HIM 410 Final Exam | UPDATED Questions with 100%
Verified Answers
Q1: List the primary objectives of the US healthcare system.
A: 1. enable all citizens to obtain needed healthcare
2. Ensure services are cost effective and meet standards of quality
Q2: Quad-function model of the US healthcare system
A: 1. Financing
2. Insurance
3. Payment
4. Delivery
Q3: National Health Insurance
A: Government finances care through taxes, but care is through private practice
EX: Canada
Q4: National Health System
A: Care is supported through taxes but the government is also responsible for delivery and
infrastructure
EX: UK
Q5: Socialized Health Insurance
A: Financed through government mandated contributions by employers and delivered by
providers
EX: Germany
Q6: Public Health
A: A wide variety of activities undertaken by state and local governments to promote
optimal health for society as a whole
Q7: Private Practice
A:
Q8: Organize medicine
A: concerted activities of physicians, mainly to protect their own interests, through
associations such as the American Medical Association
Q9: Defensive Medicine
A: excessive medical tests and procedures performed as protection against malpractice law
suits, otherwise regarded as unnecessary
,Q10: Two Types of Physicians
A: MD: Doctor of Medicine
DO: Doctor of Osteopathic Medicine
Q11: MD
A: allopathic medicine: medicine is an active intervention
specialists: non-primary care
Q12: DO
A: Emphasizes musculoskeletal system, correction of joints and tissues, holistic health
generalists: primary care
Q13: Allied health professionals
A: techs, assistants, therapists, technologists
certificate or degree in science related to health field
Q14: Nurses (RN, LPN, APN)
A: largest group of HCP
many different types/sub groups
Q15: Registered Nurse (RN)
A: Associates or BA in nursing
Q16: Licensed Practical Nurse (LPN)
A: State-approved program and national written exam
Q17: Advanced Practice Nurse (APN)
A: Nurses who have classifications beyond those of an RN
ex: CNS, CRNA, NP, CNM
Q18: non-physician practitioner (NPP)
A: Can provide a large portion of care
PAs
NPs
Q19: National Practitioner Data Bank
A: tracks physicians malpractice and peer review records
Q20: What are third-party payers
A: Insurance companies, Managed care organizations, Government
, Q21: Prospective Payment
A: A bundled payment decided upon before the services are delivered
EX: optometrist charging flat fee for eye exam, glasses, corrective lenses
Q22: Retrospective Payment
A: setting rates after evaluating the individual cost of each service
Q23: episode of care
A: the set of services provided to treat a clinical condition or procedure
value-based bundle is a single payment for treating a patient with a specific medical
condtion
Q24: Fee for service
A: each service is paid for on an individual basis and itemized separately
Q25: Group health insurance
A: insurance through an employer, union, or organization
costs are lower because they are shared among a group
Q26: benefits
A: services covered under an insurance plan
Q27: Cost sharing provisions
A: deductible: amount the insured must pay before the insurance company pays for the
claim
Copayment: flat amount insured must pay each time a service is recieved
Coinsurance: when the insured is responsible for a certain percentage (80/20)
Q28: EOB
A: Explanation of benefits
Q29: RA
A: Remittance advice
Q30: Carve-out
A: Special contract outside regular capitation that an HMO funds separately; paid at a
different rate
EX: mental health
Q31: balance billing
Verified Answers
Q1: List the primary objectives of the US healthcare system.
A: 1. enable all citizens to obtain needed healthcare
2. Ensure services are cost effective and meet standards of quality
Q2: Quad-function model of the US healthcare system
A: 1. Financing
2. Insurance
3. Payment
4. Delivery
Q3: National Health Insurance
A: Government finances care through taxes, but care is through private practice
EX: Canada
Q4: National Health System
A: Care is supported through taxes but the government is also responsible for delivery and
infrastructure
EX: UK
Q5: Socialized Health Insurance
A: Financed through government mandated contributions by employers and delivered by
providers
EX: Germany
Q6: Public Health
A: A wide variety of activities undertaken by state and local governments to promote
optimal health for society as a whole
Q7: Private Practice
A:
Q8: Organize medicine
A: concerted activities of physicians, mainly to protect their own interests, through
associations such as the American Medical Association
Q9: Defensive Medicine
A: excessive medical tests and procedures performed as protection against malpractice law
suits, otherwise regarded as unnecessary
,Q10: Two Types of Physicians
A: MD: Doctor of Medicine
DO: Doctor of Osteopathic Medicine
Q11: MD
A: allopathic medicine: medicine is an active intervention
specialists: non-primary care
Q12: DO
A: Emphasizes musculoskeletal system, correction of joints and tissues, holistic health
generalists: primary care
Q13: Allied health professionals
A: techs, assistants, therapists, technologists
certificate or degree in science related to health field
Q14: Nurses (RN, LPN, APN)
A: largest group of HCP
many different types/sub groups
Q15: Registered Nurse (RN)
A: Associates or BA in nursing
Q16: Licensed Practical Nurse (LPN)
A: State-approved program and national written exam
Q17: Advanced Practice Nurse (APN)
A: Nurses who have classifications beyond those of an RN
ex: CNS, CRNA, NP, CNM
Q18: non-physician practitioner (NPP)
A: Can provide a large portion of care
PAs
NPs
Q19: National Practitioner Data Bank
A: tracks physicians malpractice and peer review records
Q20: What are third-party payers
A: Insurance companies, Managed care organizations, Government
, Q21: Prospective Payment
A: A bundled payment decided upon before the services are delivered
EX: optometrist charging flat fee for eye exam, glasses, corrective lenses
Q22: Retrospective Payment
A: setting rates after evaluating the individual cost of each service
Q23: episode of care
A: the set of services provided to treat a clinical condition or procedure
value-based bundle is a single payment for treating a patient with a specific medical
condtion
Q24: Fee for service
A: each service is paid for on an individual basis and itemized separately
Q25: Group health insurance
A: insurance through an employer, union, or organization
costs are lower because they are shared among a group
Q26: benefits
A: services covered under an insurance plan
Q27: Cost sharing provisions
A: deductible: amount the insured must pay before the insurance company pays for the
claim
Copayment: flat amount insured must pay each time a service is recieved
Coinsurance: when the insured is responsible for a certain percentage (80/20)
Q28: EOB
A: Explanation of benefits
Q29: RA
A: Remittance advice
Q30: Carve-out
A: Special contract outside regular capitation that an HMO funds separately; paid at a
different rate
EX: mental health
Q31: balance billing
