Final

Question 1

What single feature distinguishes an Integrated Healthcare Network form a multi-hospital system?

Answer 1

Ownership of insurance where the other does not.

Question 2

Define Vertically Integrated Healthcare System (Network) and give one example.

Answer 2

2 or more hospitals and own their own Captive Insurance. Ex: Intermountain healthcare

Question 3

Define multi-hospital system and give one example.

Answer 3

A group of hospitals (more than 1) that functions under 1 management structure. (Ex. Mountain Star)

Question 4

What is the meaning of the verb “to expense”? Do not confuse it with the noun “Expense.”

Answer 4

to charge

Question 5

From the “Income Statement,” define the following term: Capital

Answer 5

property or technology that costs more than $3,000

Question 6

From the “Income Statement,” define the following term: Net Revenue

Answer 6

Revenue remaining after expenses are subtracted, or the profit.

Question 7

From the “Income Statement,” define the following term: Gross Revenue

Answer 7

Revenue before expenses are subtracted.

Question 8

From the “Income Statement,” define the following term: Revenue

Answer 8

Money received as payment for services provided.

Question 9

Explain the following acronyms/terms (Merely identify the name. You do not need to explain its function.)
ABMS:

Answer 9

American Board of Medical Specialists

Question 10

Explain the following acronyms/terms (Merely identify the name. You do not need to explain its function.)
OIG:

Answer 10

Office of the Inspector General

Question 11

Explain the following acronyms/terms (Merely identify the name. You do not need to explain its function.)
ADL’s:

Answer 11

Activities of Daily Living

Question 12

Explain the following acronyms/terms (Merely identify the name. You do not need to explain its function.)
CRNA:

Answer 12

Certified Registered Nurse Anesthetists

Question 13

Explain the following acronyms/terms (Merely identify the name. You do not need to explain its function.)
Laparoscopy:

Answer 13

surgical procedure in which a fiber-optic instrument is inserted through the abdominal wall to view the organs in the abdomen or to permit a surgical procedure.

Question 14

What does PPO mean?

Answer 14

Preferred Provider Organization

Question 15

What does HMO mean?

Answer 15

Health Maintenance Organization

Question 16

What does MGMA mean?

Answer 16

Medical Group Management Association

Question 17

What does ACHE stand for?

Answer 17

American College of Healthcare Executives

Question 18

What does IRB stand for?

Answer 18

Institutional Review Board

Question 19

“A______ ______ committed against a _____ or _____, excluding ______.”

Answer 19

“A CIVIL WRONG committed against a PERSON or PROPERTY, excludingBREACH OF CONTRACT.”

Question 20

In the management structure of a hospital, who are the two people that the CFO can report to?

Answer 20

The CEO and governing board.

Question 21

Explain the meaning of the term “The ‘C’ Suite.”

Answer 21

Most influential group

Question 22

When are Medical Staff Privileges mandatory?

Answer 22

This is determined by the governing board.

Question 23

Is Board Certification for a physician mandatory or voluntary? Identify the entity that gives the exam and the certificate:

Answer 23

It is not mandatory but gives the physician credibility showing they have shown exceptional expertise in a certain area. Board certification is given by ABMS.

Question 24

Is a physician’s state licensure mandatory or voluntary?

Answer 24

mandatory

Question 25

Identify the six healthcare laws/regulations that we discussed in class. Identify what each does: Names must be exact!

Answer 25

1. Health Insurance Portability and Accountability Act (HIPAA): This addresses the protection of health data and the coverage for workers who change or loose their job.
2. EMTALA - Emergency Medical Treatment and Active Labor Act of 1986: Protect the way some providers treated patients who were uninsured or who didn’t have the funds for medical care. Now they treat regardless of the ability to pay.
3. False Claims Act (as amended in 1986): This is to make illegal the claims that providers submit to CMS that are a) not bona fide service, b) if the patient is not a medicare patient, c) greater than what they actually performed.
4. Anti-Kickback Legislation of 1972: Prohibits the act of exchange of anything of value for services
5. The OIG - Office of the Inspector General: Enforcement/policy arm of HHS and prosecutes suspected acts of fraud and abuse on Medicare
6. The Patient Protection and Affordable Care Act of 2010 - “ObamaCare”: Requires everyone to be insured and increasing insurance coverage to pre-exisiting conditions and is the most controversial piece of social legislation

Question 26

Define the following term and describe how it “works” in the healthcare industry: Co-Pay or Co-Insurance

Answer 26

A co-pay is a set dollar amount that a person pays for a specific service (such as for ER services or a doctor/clinic visit). Co-insurance is a percentage (often 10-20%) of the billed charges that the member is responsible to pay until they reach their out of pocket maximum amount. Both co-pays and co-insurance are ways for the insurance to cost-share with the member.

Question 27

Define the following term and describe how it “works” in the healthcare industry: Premium

Answer 27

The dollar amount the member pays for their insurance benefits.

Question 28

Define the following term and describe how it “works” in the healthcare industry: Deductible

Answer 28

A set dollar amount members covered by an insurance plan must pay out of pocket before their insurance benefits kick in.

Question 29

Fill in the blanks in the following statement:
The board is charged with establishing the ___________, ____________, ___________ and with hiring and supervising the ______________.

Answer 29

CEO, CFO, COO, physicians

Question 30

Please define and differentiate between (a) a Multihospital system and (b) an Integrated Healthcare Network.

Answer 30

A multi-hospital system just refers to a health care system that consists of more than 1 hospital or other health care facility. An integrated healthcare network is a system that includes hospitals and other health care facilities as well as affiliated physicians, and may also include an insurance company.

Question 31

Please define and differentiate between (a) a Multi-hospital system and (b) an Integrated Healthcare Network.

Answer 31

A multi-hospital system just refers to a health care system that consists of more than 1 hospital or other health care facility. An integrated healthcare network is a system that includes hospitals and other health care facilities as well as affiliated physicians, and may also include an insurance company.

Question 32

What is managed care and what is an example of a managed care plan?

Answer 32

Managed care is techniques used to reduce the cost of healthcare. HMO is an example of a managed care plan.

Question 33

What role(s) does the Federal Government play in US Healthcare?

Answer 33

1) through regulation and laws governing healthcare providers/facilities and (2) via Medicare and Medicaid and other government insurance payers, since they are funded all or in part by the federal government.

Question 34

Name the two national organizations that represent (advocate for) (A) Not-for-Profit Hospitals, and (B) For-Profit Hospitals. [Name both the acronym and the “correct,” full name of the organization]

Answer 34

(A) Not-for-Profit Hospitals: AHA-American Hospital Association
(B) For-Profit: FAH- Federation of American Hospitals