UIC HIM 410 FINAL Set 1 | UPDATED Questions with
100% Verified Answers
Q1: 1. What are the two primary objectives of the U.S. healthcare
system?
A: Enable universal access & deliver cost-effective, high-quality care.
Q2: 2. What is defensive medicine?
A: When physicians order extra tests or procedures to avoid malpractice claims rather than
to benefit the patient.
Q3: 3. Define prospective payment system (PPS).
A: Predetermined, fixed payments made to providers based on expected costs for a
defined service or case (e.g., DRGs).
Q4: 4. What is fee-for-service reimbursement?
A: Payment model where providers are paid for each service performed.
Q5: 5. What is the Donabedian model?
A: Framework for evaluating quality using structure, process, and outcome measures.
Q6: 6. Define "voluntary health insurance."
A: Private, employer-sponsored, or individually purchased insurance, not mandated by the
government.
Q7: 7. What law authorized the growth of HMOs?
A: The HMO Act of 1973.
Q8: 8. What are Activities of Daily Living (ADLs)?
A: Basic personal care tasks such as bathing, dressing, eating, toileting, and mobility.
Q9: 9. What distinguishes for-profit from non-profit hospitals?
A: For-profits distribute profits to owners; non-profits reinvest surplus into operations and
community benefit.
Q10: 10. What does "balance billing" mean?
A: Billing a patient for the difference between the provider's charge and the insurer's
allowed amount.
Q11: 11. What is the National Practitioner Data Bank (NPDB)?
, A: A federal repository tracking malpractice payments and disciplinary actions against
healthcare practitioners.
Q12: 12. Define "coordination of benefits."
A: Rules determining payment order when a patient has multiple insurance plans.
Q13: 13. What is "case-based payment"?
A: Payment tied to a defined episode of care, not each individual service.
Q14: 14. Name three classifications of hospitals by specialty.
A: General, specialty (e.g., pediatric, psychiatric), and rehabilitation hospitals.
Q15: 15. What is a Certificate of Need (CON)?
A: State approval process to control facility expansion and avoid duplication of services.
Q16: 16. Define "maldistribution of physicians."
A: Uneven geographic or specialty distribution of providers.
Q17: 17. What are IR-DRGs and APR-DRGs used for?
A: Risk-adjusted Diagnosis-Related Groups for payment classification in inpatient settings.
Q18: 18. Who are non-physician practitioners (NPPs)?
A: Advanced practice providers like nurse practitioners and physician assistants.
Q19: 19. What is an EOB or RA?
A: Explanation of Benefits / Remittance Advice — a summary of payment and patient
responsibility.
Q20: 20. What is the purpose of credentialing in hospitals?
A: To verify provider qualifications and ensure patient-care competency.
Q21: 21. What defines ambulatory or outpatient care?
A: Healthcare services not requiring an overnight hospital stay.
Q22: 22. What is the goal of long-term care (LTC)?
A: To assist individuals with chronic illness or disability in maintaining functional
independence.
Q23: 23. What are the three levels of healthcare?
100% Verified Answers
Q1: 1. What are the two primary objectives of the U.S. healthcare
system?
A: Enable universal access & deliver cost-effective, high-quality care.
Q2: 2. What is defensive medicine?
A: When physicians order extra tests or procedures to avoid malpractice claims rather than
to benefit the patient.
Q3: 3. Define prospective payment system (PPS).
A: Predetermined, fixed payments made to providers based on expected costs for a
defined service or case (e.g., DRGs).
Q4: 4. What is fee-for-service reimbursement?
A: Payment model where providers are paid for each service performed.
Q5: 5. What is the Donabedian model?
A: Framework for evaluating quality using structure, process, and outcome measures.
Q6: 6. Define "voluntary health insurance."
A: Private, employer-sponsored, or individually purchased insurance, not mandated by the
government.
Q7: 7. What law authorized the growth of HMOs?
A: The HMO Act of 1973.
Q8: 8. What are Activities of Daily Living (ADLs)?
A: Basic personal care tasks such as bathing, dressing, eating, toileting, and mobility.
Q9: 9. What distinguishes for-profit from non-profit hospitals?
A: For-profits distribute profits to owners; non-profits reinvest surplus into operations and
community benefit.
Q10: 10. What does "balance billing" mean?
A: Billing a patient for the difference between the provider's charge and the insurer's
allowed amount.
Q11: 11. What is the National Practitioner Data Bank (NPDB)?
, A: A federal repository tracking malpractice payments and disciplinary actions against
healthcare practitioners.
Q12: 12. Define "coordination of benefits."
A: Rules determining payment order when a patient has multiple insurance plans.
Q13: 13. What is "case-based payment"?
A: Payment tied to a defined episode of care, not each individual service.
Q14: 14. Name three classifications of hospitals by specialty.
A: General, specialty (e.g., pediatric, psychiatric), and rehabilitation hospitals.
Q15: 15. What is a Certificate of Need (CON)?
A: State approval process to control facility expansion and avoid duplication of services.
Q16: 16. Define "maldistribution of physicians."
A: Uneven geographic or specialty distribution of providers.
Q17: 17. What are IR-DRGs and APR-DRGs used for?
A: Risk-adjusted Diagnosis-Related Groups for payment classification in inpatient settings.
Q18: 18. Who are non-physician practitioners (NPPs)?
A: Advanced practice providers like nurse practitioners and physician assistants.
Q19: 19. What is an EOB or RA?
A: Explanation of Benefits / Remittance Advice — a summary of payment and patient
responsibility.
Q20: 20. What is the purpose of credentialing in hospitals?
A: To verify provider qualifications and ensure patient-care competency.
Q21: 21. What defines ambulatory or outpatient care?
A: Healthcare services not requiring an overnight hospital stay.
Q22: 22. What is the goal of long-term care (LTC)?
A: To assist individuals with chronic illness or disability in maintaining functional
independence.
Q23: 23. What are the three levels of healthcare?
