Chapter One

Question 1

American Medical Association (AMA)

Answer 1

formed in 1847 by Nathan Smith Davis to ensure quality medical education.

“to elevate the standard of medical education in the US.”

AMA’s purpose is to develop standards for medical education, to improve public health, to establish a set of medical ethics, and to advance the study of science

Question 2

American Hospital Association (AHA)

Answer 2

founded near the end of the 19th century.

committed to improving medical care by advocating for the healthcare community, educating health care leaders, and tracking trending healthcare-related issues, specifically for hospitals and all other types of healthcare facilities.

Question 3

Licensure

Answer 3

regulations regarding the minimum requirements to practice medicine or provide medical services: they vary from state to state

Question 4

American College of Surgeons (ACS)

Answer 4

founded in 1913 in Chicago

purpose it was to improve the quality of patient care by setting high standards for surgical education and practice- it went on to establish a system of hospital standardization as well.

they believed written records were essential for quality patient care and that data collected from the records would lead to the information necessary to set and measure standards of care.

Question 5

Accreditation

Answer 5

Voluntary assessment by an accrediting agency that proves a healthcare facility exceeds the minimum requirements set by licensing agencies

Question 6

The Joint Commission (TCJ)

Answer 6

Formerly known as the Joint Commission on Accreditation of Hospitals, a voluntary accrediting agency holding deemed status by Medicare.

Question 7

Healthcare Facilities Accreditation Program (HFAP)

Answer 7

A voluntary accreditation program used by the American Osteopathic Association, which, like the Joint Commission, holds deemed status for Medicare.

Question 8

Hill-Burton Act

Answer 8

legislation that supplied funding for the modernization of existing hospitals and building of new ones, in exchange for which hospitals provided care at a reduced rate or for free to patients who did not have the ability to pay

Question 9

Medicare

Answer 9

Title XVII of the Social Security Act of 1935: Medicare provides financial assistance for healthcare coverage to persons 65 years of age and over, to persons who are disabled and to those with end-stage renal disease.

Question 10

Medicaid

Answer 10

Title XIX of the Social security Act of 1935: Medicaid provides financial assistance for healthcare coverage to poor and indigent populations

Question 11

Conditions of Participation (CoP

Answer 11

Regulations that health-care facilities and providers must meet in order to receive reimbursement from Medicare and Medicaid

Question 12

Fee for Service

Answer 12

Billing for healthcare services after the services have been provided (retrospectively) according to the facility’s or office’s actual fees for each service

Question 13

Quality Improvement Organizations (QIOs)

Answer 13

Entities with which CMS contracts to review medical care, base on health record documentation and to assist Medicare and Medicaid beneficiaries with complaints about quality of care issues and to implement improvements in the quality of care available throughout healthcare facilities.

Question 14

Centers for Medicare and Medicaid Services (CMS)

Answer 14

Formerly known as the Health Care Financing Administration (HCFA),CMS manages Medicare and Medicaid claims and regulates Medicare and Medicaid programs.

Question 15

Tax Equity and Fiscal Responsibility Act of 1982

Answer 15

Legislation that resulted in a shift from fee-for-service reimbursement to a prospective payment system

Question 16

Prospective Payment System (PPS)

Answer 16

A fixed reimbursement system based on the diagnosis related group (DRG) assigned to each inpatient stay”used by Medicare and Medicaid reimbursement and some third-party payers

Question 17

Diagnosis related group (DRG)

Answer 17

A system that classifies patients into groups based on a patient’s principal and secondary diagnoses, procedures performed and other factors and determines the amount reimbursed to the hospital by Medicare, Medicaid and other third-party payers

Question 18

Omnibus Budget Reconciliation Act of 1986

Answer 18

The act that focused on substandard care and resulted in the requirement that PROs report substandard care to licensing agencies

Question 19

Informed Consent

Answer 19

Patient consent required for invasive surgical procedures and any treatment or procedure that carries a risk to the patient, informed consent provides explanation of the procedure/treatment to be performed and the reason for it, in other words, the risk and benefits of the procedure/treatment, alternatives, to the procedure/treatment and their risks and benefits, and the name(s) of the healthcare providers(s) performing the procedure/treatment.

Question 20

Patients Rights

Answer 20

Patients have the right to know who their healthcare team consists of, the right to privacy and confidentiality, the right to be informed about their diagnosis and treatment, the right to refuse treatment, the right to actively participate in their care plan, and the right to be cared for in a safe environment, free from abuse. Patients also have the right to read or have a copy (paper or electronic)of their health record, the right to know who has accessed their health record, and the right to request and amendment to their health record

Question 21

Health Insurance Portability and Accountability Act (HIPPA)

Answer 21

a law consisting of five rules-privacy, security, data sets and electronic transaction standards, administrative simplification and enforcement and compliance: it impacted healthcare in general and the health information profession in particular more than any place of legislation since Medicare and Medicaid

Question 22

Primary care physician (PCP)

Answer 22

A family practitioner, and internist, or a pediatrician who manages a patient’s basic healthcare needs and coordinates care with specialist under a managed care insurance plan

Question 23

Managed care insurance plans

Answer 23

insurance plans that promote quality, cost-effective healthcare through the monitoring of patients, preventive care and performance measures.

Question 24

Medicare Prescription Drug Improvement and Modernization Act of 2003

Answer 24

this act provides Medicare beneficiaries with financial assistance in paying for prescription medications

Question 25

Deficit Reduction Act

Answer 25

legislation passed with the intent to reduce growth in Medicare and Medicaid spending and decrease the number of fraudulent Medicare and Medicaid claims

Question 26

Physician Quality Reporting Initiative (PQRI)

Answer 26

A voluntary pay for performance incentive program

Question 27

Affordable Care Act (ACA)

Answer 27

healthcare reform with the goal of improving quality of care and affordable healthcare coverage through health insurance exchanges”provides healthcare consumers with stability and flexibility of healthcare coverage

Question 28

Health Information Technology for Economic and Clinical Health Act (HITECH)

Answer 28

legislation resulting from the ARRA that provides incentives to providers and hospitals that adopt or upgrade existing electronic health record (EHR) systems and associated technologies and use them in specified ways.

Question 29

Health Information Technology (HIT)

Answer 29

the framework on which health information is collected, stored, exchanged, and reported

Question 30

Office of the National Coordinator for Health Information Technology (ONC)

Answer 30

located within the office of the secretary of Health and Human Services, the ONC is the federal agency promoting a national health information technology infrastructure and overseeing its development

Question 31

Meaningful Use

Answer 31

This section of HITECH meant to increase the effective use of the electronic health records through monetary incentives to adopt and use certified technology

Question 32

Patient-Centric

Answer 32

communications, information sharing, and decision making that includes the patient and is managed by both the patient and the provider

Question 33

Clinical decision support (CDS)

Answer 33

case-specific computerized alerts, clinical guidelines, and current resources regarding diagnosis and treatments options, based on the data found in individual patient records

Question 34

Independent Practice Association (IPA)

Answer 34

a group of physicians that contracts with a managed care organization to provide care at a pre-determined, pre-negotiated (often reduced) rate.

Question 35

Department of Health and Human Services (HHS)

Answer 35

the federal agency responsible for ensuring the provision of vital human services and health protection to Americans

Question 36

Evidence-based medicine (EBM)

Answer 36

diagnostic and treatment protocols based on proven research and documented best practice

Question 37

Population Health Management (PHM)

Answer 37

providing quality healthcare to a specific group of patients in a more cost- effective manner through the use of digitized patient records and analytics

Question 38

Accountable care organization (ACOs)

Answer 38

groups of doctors, hospitals, and other healthcare providers that come together voluntarily to give high-quality care using a fixed payment model” they work collaboratively and accept collective accountability for cos and the quality for care

Question 39

Patient-centered medical home (PCMH)

Answer 39

a healthcare model that involves the patient and family in the care of the patient, care is rendered in a team approach

Question 40

mHealth

Answer 40

the sending and receiving of health information using a mobile phone, mobile device, or other wireless device

Question 41

Who is considered the model for modern medicine?

Answer 41

the greeks

Question 42

Who founded the first hospital in the US?

Answer 42

Ben Franklin/ Dr. Thomas Bond (1751)