Exam 2

Question 1

True/false: A 35 year old With congestive heart failure and on medical disability would be eligible for Medicare part A

Answer 1

True

Question 2

A corporate integrity agreement is comprehensive and last __________ years

A. 5
B. 3
C. 1
D. 2

Answer 2

5

Question 3

Largest civilian agency in the federal government

Answer 3

Office of Audit Services

Question 4

Operates the OIG hotline

Answer 4

Office of Investigations

Question 5

Protect the integrity of the Department of Health and human services and its beneficiaries

Answer 5

Office of Inspector General

Question 6

Focuses on customer satisfaction and information technology

Answer 6

Office of Management and Policy

Question 7

Overseas the state Medicaid fraud control units

Answer 7

Office of Evaluation and Inspections

Question 8

Provide return to work physical exams

Answer 8

Industrial/occupational health clinic

Question 9

Serves as the license to operate for an independent practice physician

Answer 9

State medical license

Question 10

Non RN working under the supervision of a MD

Answer 10

Physician Assistant

Question 11

Not owned or operated by or integrated with a hospital

Answer 11

Freestanding Ambulatory Center

Question 12

Employee has money deducted from payroll and placed in an account, if unused at the end of the year it is forfeited

Answer 12

Flexible spending account

Question 13

Voluntary accreditation for freestanding ambulatory care facilities

Answer 13

AAAHC

Question 14

Must be performed when Patient has more than one insurance policy for health care coverage

Answer 14

Coordination of benefits

Question 15

Employee makes contributions through payroll and the employer matches

Answer 15

Health savings account

Question 16

Clinic located on a college campus

Answer 16

University health center

Question 17

Located in underserved areas where patients otherwise would not receive services

Answer 17

Rural health centers

Question 18

Manages healthcare effectiveness data and information sets

Answer 18

National committee for quality assurance

Question 19

Evaluates proficiency of laboratory staff

Answer 19

CLIA

Question 20

Payment of a fixed dollar amount for each covered person

Answer 20

Capitation

Question 21

Flat rate based on services provided

Answer 21

Fee schedule

Question 22

Employer funds and account for the employee

Answer 22

Health reimbursement arrangement

Question 23

True/False: Patients who have Medicare part A coverage automatically receives part B coverage

Answer 23

False

Question 24

True/False: Payment of a civilian monetary penalty does not qualify as an admission of guilt and therefore keeps the facility off the exclusion list in certain circumstances

Answer 24

True

Question 25

Which of the following are characteristics of a managed care organization?

A. Organized system for providing health care in a geographic region
B. All
C. Enrolled members pay a monthly premium
D. Provides incentives for preventative care

Answer 25

B. All

Question 26

Inpatient physical medicine and rehabilitation

Answer 26

Medicare Part A

Question 27

Hospice

Answer 27

Medicare Part A

Question 28

Skilled nursing rehabilitation

Answer 28

Medicare Part A

Question 29

Physician visits during hospitalization

Answer 29

Medicare Part B

Question 30

MD office visits

Answer 30

Medicare Part B

Question 31

Outpatient laboratory and radiology diagnostics

Answer 31

Medicare Part B

Question 32

Ambulance services

Answer 32

Medicare Part B

Question 33

Durable medical equipment

Answer 33

Medicare Part B

Question 34

Long term acute care

Answer 34

Medicare Part A

Question 35

Inpatient acute care

Answer 35

Medicare Part A

Question 36

Documentation required in an ambulatory surgery record outlining all the risks in the ________

Answer 36

Informed surgical consent

Question 37

True/False: Managed care organizations do not monitor the documentation of providers, so licensure and certification are all that is required to join

Answer 37

False

Question 38

Providers usually purchase stop loss insurance

Answer 38

Independent practice association model

Question 39

Contracts do not allow for treatment outside of the HMO

Answer 39

Staff model

Question 40

Health care providers are employed by the multi-specialty physician practice and not the HMO

Answer 40

Group model

Question 41

Enrolled members selects coverage based on how much out of pocket they are willing to pay

Answer 41

Point of service plan

Question 42

Enrolled members agree to provide services at a discounted rate to members/subscribers/dependents

Answer 42

Preferred provider organization

Question 43

No incentive for over utilization of services by MD because profits go to the HMO

Answer 43

Staff model

Question 44

Covered over a large rural and geographic area

Answer 44

Network model

Question 45

Contracts with more than one facility and physician group

Answer 45

Network model

Question 46

Phase of the patient encounter where all the demographic information is obtained is during _________.

Answer 46

Registration

Question 47

True/False: MD offices utilize a problem list which details only active problems

Answer 47

False