More Questions for BCPA Flashcards
What are the four principles of Beauchamp and Childress?
Autonomy
Non-maleficence
Beneficence
Justice
Autonomy
Non-maleficence
Beneficence
Justice
What are the four principles of Beauchamp and Childress?
CLAS
Culturally and linguistically appropriate services
Culturally and linguistically appropriate service
CLAS
CLAS
About respect and responsiveness: respect the whole individual and respond to the individual’s health needs and preferences
Vertical integration in healthcare
Kaiser Permanente
Encompasses everything from patient care to insurance under one entity
Kaiser Permanente
Vertical integration in healthcare
USC, HCA Healthcare, UCLA
Horizontal integration in healthcare
Horizontal integration in healthcare
USC, HCA Healthcare, UCLA
A system where an organization expands by acquiring or managing multiple facilities or hospitals that provide similar services (hospitals or clinics) but does not own all aspects of care
Which of the following is NOT covered under Medicare Part A?
A. Inpatient hospital care
B. Skilled nursing facility care
C. Home health care
D. Outpatient physical therapy
Answer: D. Outpatient physical therapy
Which of the following services does Medicare Part B cover?
A. Prescription drugs
B. Routine dental care
C. Durable medical equipment (DME)
D. Hearing aids
Answer: C. Durable medical equipment (DME)
Which of the following is true about Medicare Advantage (Part C)?
A. It is a government-run program that replaces original Medicare.
B. It is an alternative to Original Medicare provided by private companies.
C. Medicare Advantage plans require no additional premiums.
D. Part C covers all prescription drugs automatically.
Answer: B. It is an alternative to Original Medicare provided by private companies.
What is the initial enrollment period for Medicare?
A. 6 months before turning 65
B. 7 months surrounding the 65th birthday (3 months before and after)
C. 12 months surrounding the 65th birthday
D. Only during annual open enrollment
Answer: B. 7 months surrounding the 65th birthday (3 months before and after)
Medicare Part D primarily covers:
A. Doctor visits
B. Prescription drugs
C. Hospital care
D. Long-term care
Answer: B. Prescription drugs
Which of the following does Medicare Supplement Insurance (Medigap) do?
A. Replaces Medicare Part A and B
B. Helps cover costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles
C. Provides prescription drug coverage
D. Offers dental and vision coverage
Answer: B. Helps cover costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles
Which of the following is NOT a condition for Medicare eligibility?
A. Being 65 years old or older
B. Having End-Stage Renal Disease (ESRD)
C. Receiving Social Security Disability Insurance (SSDI) for at least 24 months
D. Being covered under an employer’s health plan
Answer: D. Being covered under an employer’s health plan
How does Medicare Part B typically calculate premiums?
A. A flat rate for all enrollees
B. Based on annual income
C. Based on health status
D. Based on the number of dependents
Answer: B. Based on annual income
Which of the following is NOT covered under Original Medicare (Part A and Part B)?
A. Hospice care
B. Acupuncture
C. Medically necessary doctor’s visits
D. Inpatient hospital stays
Answer: B. Acupuncture
During the annual Medicare Open Enrollment Period, beneficiaries can:
A. Sign up for Medicare Part A and B for the first time
B. Switch from Original Medicare to a Medicare Advantage Plan
C. Change Medigap plans without medical underwriting
D. Only change their Part D prescription drug plan
Answer: B. Switch from Original Medicare to a Medicare Advantage Plan
Which of the following is the primary source of funding for Medicare Part A?
A. Premiums paid by beneficiaries
B. General tax revenue
C. Payroll taxes through the Federal Insurance Contributions Act (FICA)
D. State funding
Answer: C. Payroll taxes through the Federal Insurance Contributions Act (FICA)
Medicare Part B generally covers what percentage of the approved amount for most doctor services, after the annual deductible is met?
A. 50%
B. 80%
C. 90%
D. 100%
Answer: B. 80%
Which of the following preventive services is covered by Medicare at no cost to the beneficiary under Part B?
A. Annual wellness visit
B. Long-term care
C. Routine hearing exams
D. Cosmetic surgery
Answer: A. Annual wellness visit
What is the “Donut Hole” in Medicare Part D?
A. A period when beneficiaries can switch plans
B. A coverage gap during which beneficiaries must pay a larger share of prescription drug costs
C. A time when no medications are covered
D. A period of free prescription drug coverage
Answer: B. A coverage gap during which beneficiaries must pay a larger share of prescription drug costs
Which of the following is NOT true about Medicare Part C (Medicare Advantage)?
A. Medicare Advantage plans are required to cover all the services Original Medicare covers.
B. Medicare Advantage plans may include additional benefits such as dental, vision, and wellness programs.
C. Medicare Advantage beneficiaries cannot switch back to Original Medicare.
D. Medicare Advantage plans are offered through private insurance companies.
Answer: C. Medicare Advantage beneficiaries cannot switch back to Original Medicare.
Medicare Part A covers inpatient care in all of the following settings EXCEPT:
A. Hospitals
B. Skilled nursing facilities (under specific conditions)
C. Long-term care facilities
D. Hospice care
Answer: C. Long-term care facilities
Which of the following could result in a penalty when enrolling in Medicare Part B?
A. Enrolling after your 65th birthday without having other credible coverage
B. Enrolling during the annual open enrollment period
C. Switching from Medicare Advantage back to Original Medicare
D. Enrolling in a Medigap plan
Answer: A. Enrolling after your 65th birthday without having other credible coverage
For individuals eligible for both Medicare and Medicaid (dual eligibles), which of the following statements is true?
A. Medicare is always the primary payer, and Medicaid covers some additional services.
B. Medicaid is always the primary payer, and Medicare covers the balance.
C. They cannot receive services under both programs.
D. Medicaid covers all costs for dual-eligible individuals.
Answer: A. Medicare is always the primary payer, and Medicaid covers some additional services.
Medicare Part D plans are required to cover which of the following types of medications?
A. All FDA-approved prescription drugs
B. Medications that fall into certain therapeutic categories or classes
C. Over-the-counter medications
D. Experimental drugs not yet approved by the FDA
Answer: B. Medications that fall into certain therapeutic categories or classes
Which of the following is true about the Medicare Savings Program?
A. It is available only to beneficiaries under age 65.
B. It helps pay for Medicare Part B premiums, deductibles, and coinsurance for low-income beneficiaries.
C. It provides prescription drug coverage for dual-eligible beneficiaries.
D. It offers free vision and dental care for Medicare beneficiaries.
Answer: B. It helps pay for Medicare Part B premiums, deductibles, and coinsurance for low-income beneficiaries.
Which of the following is a Special Enrollment Period (SEP) in Medicare?
A. Enrolling during the first three months of the year
B. Enrolling without a penalty after leaving employer-sponsored coverage
C. Enrolling only during the annual open enrollment period
D. Enrolling within the first month after eligibility begins
Answer: B. Enrolling without a penalty after leaving employer-sponsored coverage
Which of the following factors can impact the monthly premium for a Medicare Advantage Plan (Part C)?
A. Geographical location
B. The number of years you’ve been on Medicare
C. Your health condition
D. The number of prescription drugs you take
Answer: A. Geographical location
Which of the following is NOT covered by Medicare Part A or B?
A. Hospice care
B. Home health care
C. Long-term custodial care
D. Skilled nursing care
Answer: C. Long-term custodial care
What is the primary purpose of the Medicare Supplement Insurance (Medigap) Plan?
A. Replace Medicare Part A and Part B coverage
B. Cover additional services like dental and vision
C. Cover out-of-pocket costs not covered by Original Medicare
D. Replace prescription drug coverage
Answer: C. Cover out-of-pocket costs not covered by Original Medicare
Which of the following is true about the Medicare Part B late enrollment penalty?
A. It applies if you enroll in Part B after your 65th birthday without qualifying coverage.
B. The penalty is a one-time fee.
C. It is waived if you sign up during the General Enrollment Period.
D. The penalty decreases the longer you wait to enroll.
Answer: A. It applies if you enroll in Part B after your 65th birthday without qualifying coverage.
Which of the following best describes the Medicare General Enrollment Period?
A. It occurs from January 1 to March 31 each year.
B. It allows individuals to enroll in Medicare Part A for the first time.
C. It guarantees no late enrollment penalties.
D. It allows for changes in Medicare Advantage plans only.
Answer: A. It occurs from January 1 to March 31 each year.
How does the Medicare Part D “catastrophic coverage” phase work?
A. It starts once the beneficiary has spent a certain amount out-of-pocket, after which they only pay a small coinsurance or copayment for covered drugs.
B. It provides full coverage for drugs during the initial coverage phase.
C. It applies only to beneficiaries in a Medicare Advantage plan.
D. It eliminates all prescription drug costs for the rest of the year.
Answer: A. It starts once the beneficiary has spent a certain amount out-of-pocket, after which they only pay a small coinsurance or copayment for covered drugs.
Which of the following is a primary difference between Original Medicare and Medicare Advantage?
A. Medicare Advantage does not include prescription drug coverage.
B. Original Medicare allows you to see any doctor that accepts Medicare, while Medicare Advantage typically requires you to use a network of providers.
C. Medicare Advantage costs more than Original Medicare in all cases.
D. Original Medicare offers more comprehensive coverage for dental and vision services.
Answer: B. Original Medicare allows you to see any doctor that accepts Medicare, while Medicare Advantage typically requires you to use a network of providers.
Which of the following services is usually covered under Medicare Part B but not under Part A?
A. Inpatient hospital care
B. Preventive services like flu shots
C. Hospice care
D. Skilled nursing facility care
Answer: B. Preventive services like flu shots
What is the purpose of the Medicare Savings Programs (MSP)?
A. To provide dental and vision coverage
B. To help low-income individuals pay for their Medicare premiums, deductibles, and other costs
C. To replace Medicare Part D prescription drug coverage
D. To cover the cost of long-term care
Answer: B. To help low-income individuals pay for their Medicare premiums, deductibles, and other costs
Medicare Part A requires coinsurance for inpatient hospital stays beyond how many days in a benefit period?
A. 20 days
B. 60 days
C. 100 days
D. 150 days
Answer: B. 60 days
What is the purpose of the Medicare Part D formulary?
A. It is a list of preferred doctors and hospitals covered under Medicare Part D.
B. It is a list of drugs covered by a Part D prescription drug plan.
C. It is a list of services excluded from Medicare coverage.
D. It is a guide for enrolling in Medicare Advantage.
Answer: B. It is a list of drugs covered by a Part D prescription drug plan.
If a Medicare beneficiary is admitted to a skilled nursing facility, which of the following conditions must be met for Medicare to cover the stay?
A. The patient must have a hospital stay of at least three days before admission.
B. The stay must be for custodial care only.
C. The patient must have an ongoing diagnosis of cancer.
D. The stay must last no more than 10 days.
Answer: A. The patient must have a hospital stay of at least three days before admission.
Which of the following is true about Medigap policies?
A. They are available to anyone regardless of their health condition at any time.
B. They help cover costs not covered by Medicare, such as copayments and deductibles.
C. Medigap plans include dental and vision benefits.
D. Medigap replaces Original Medicare coverage.
Answer: B. They help cover costs not covered by Medicare, such as copayments and deductibles.
What is the maximum out-of-pocket limit for Original Medicare?
A. $5,000
B. $10,000
C. There is no out-of-pocket limit for Original Medicare.
D. $7,500
Answer: C. There is no out-of-pocket limit for Original Medicare.
Which of the following types of care is typically covered under Medicare Part A?
A. Outpatient physical therapy
B. Hospice care
C. Preventive vaccines
D. Doctor visits
Answer: B. Hospice care
What is the purpose of the Medicare Annual Election Period (AEP)?
A. To enroll in Medicare for the first time
B. To change Medicare Advantage or Part D plans
C. To change Medigap policies
D. To apply for the Medicare Savings Program
Answer: B. To change Medicare Advantage or Part D plans
Which of the following Medicare parts covers preventive services such as screenings and vaccinations?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: B. Part B
What is required for a Medicare beneficiary to receive home health services under Medicare?
A. A doctor must certify that the patient is homebound.
B. The patient must have Medicare Part D.
C. The patient must stay in a skilled nursing facility for at least 10 days.
D. The services must be related to end-of-life care.
Answer: A. A doctor must certify that the patient is homebound.
Which of the following is a requirement for enrolling in a Medicare Advantage Plan (Part C)?
A. The beneficiary must be enrolled in both Medicare Part A and Part B.
B. The beneficiary must be under age 65.
C. The beneficiary must qualify for Medicaid.
D. The beneficiary must pay an additional premium for Part A.
Answer: A. The beneficiary must be enrolled in both Medicare Part A and Part B.
What is the primary responsibility of a patient advocate?
A. To provide medical advice to patients
B. To represent and support patients in navigating the healthcare system
C. To make healthcare decisions on behalf of patients
D. To file insurance claims for patients
Answer: B. To represent and support patients in navigating the healthcare system
What is the principle of autonomy in patient advocacy?
A. The advocate makes decisions for the patient
B. The patient has the right to make their own healthcare decisions
C. The healthcare team makes all decisions for the patient
D. The patient must follow the advocate’s advice
Answer: B. The patient has the right to make their own healthcare decisions
Which ethical principle emphasizes doing good for the patient?
A. Autonomy
B. Beneficence
C. Non-maleficence
D. Justice
Answer: B. Beneficence
Which of the following is an example of a conflict of interest for a patient advocate?
A. The advocate shares personal experiences with the patient
B. The advocate accepts a financial gift from a patient
C. The advocate works with multiple patients at once
D. The advocate provides information on healthcare services
Answer: B. The advocate accepts a financial gift from a patient
Which of the following is an ethical principle that requires a patient advocate to avoid causing harm to the patient?
A. Justice
B. Autonomy
C. Non-maleficence
D. Beneficence
Answer: C. Non-maleficence
Confidentiality is important in patient advocacy because:
A. It helps the advocate form a legal agreement with the patient
B. It builds trust and ensures that personal information is not shared without consent
C. It allows the advocate to discuss the patient’s case with any healthcare professional
D. It is not necessary in patient advocacy
Answer: B. It builds trust and ensures that personal information is not shared without consent
Which of the following behaviors could compromise a patient advocate’s professionalism?
A. Providing emotional support to patients
B. Accepting bribes from a healthcare provider to refer patients
C. Educating patients about treatment options
D. Respecting the patient’s right to make decisions
Answer: B. Accepting bribes from a healthcare provider to refer patients
A patient advocate’s role includes:
A. Diagnosing medical conditions
B. Informing patients about their rights and options
C. Recommending specific treatments to patients
D. Overriding the decisions of healthcare professionals
Answer: B. Informing patients about their rights and options
Which of the following is an essential aspect of advocacy in patient care?
A. Paternalism
B. Shared decision-making
C. Financial decision-making
D. Medical decision-making without patient input
Answer: B. Shared decision-making
Informed consent is important because:
A. It gives the advocate control over the patient’s healthcare decisions
B. It allows patients to make decisions based on a full understanding of risks and benefits
C. It is required by law in all healthcare settings
D. It is the sole responsibility of the advocate to obtain
Answer: B. It allows patients to make decisions based on a full understanding of risks and benefits.
Which of the following best reflects the ethical principle of justice in healthcare?
A. Allocating resources based on who can pay the most
B. Treating all patients fairly and equitably
C. Giving preferential treatment to certain groups of patients
D. Refusing to provide care to uninsured patients
Answer: B. Treating all patients fairly and equitably
Informed consent is important because:
A. It gives the advocate control over the patient’s healthcare decisions
B. It allows patients to make decisions based on a full understanding of risks and benefits
C. It is required by law in all healthcare settings
D. It is the sole responsibility of the advocate to obtain
Answer: B. It allows patients to make decisions based on a full understanding of risks and benefits
- Which of the following best reflects the ethical principle of justice in healthcare?
A. Allocating resources based on who can pay the most
B. Treating all patients fairly and equitably
C. Giving preferential treatment to certain groups of patients
D. Refusing to provide care to uninsured patients
Answer: B. Treating all patients fairly and equitably
Which of the following actions could violate a patient’s right to privacy?
A. Sharing patient information without their consent
B. Asking for patient input during treatment decisions
C. Communicating with the patient’s healthcare team
D. Keeping medical records up to date
Answer: A. Sharing patient information without their consent
Which of the following is a sign of professional burnout in patient advocates?
A. Enthusiastic participation in patient care
B. Emotional exhaustion and detachment from patients
C. Increased empathy and understanding toward patients
D. Frequent advocacy on behalf of patients
Answer: B. Emotional exhaustion and detachment from patients
What is a critical component of cultural competency for patient advocates?
A. Recommending specific religious practices to patients
B. Understanding and respecting patients’ cultural backgrounds and beliefs
C. Imposing one’s own cultural views on the patient
D. Ensuring that patients follow Western medical practices
Answer: B. Understanding and respecting patients’ cultural backgrounds and beliefs
How can a patient advocate best handle a situation where a patient refuses treatment?
A. Convince the patient to accept the treatment
B. Respect the patient’s decision, regardless of the consequences
C. Overrule the patient’s decision and consult the doctor
D. Report the patient to a healthcare provider for neglecting their health
Answer: B. Respect the patient’s decision, regardless of the consequences
What should a patient advocate do if they believe a patient is being treated unfairly by a healthcare provider?
A. File a complaint without consulting the patient
B. Confront the healthcare provider immediately
C. Discuss the situation with the patient and advocate for their rights
D. Do nothing, as it is not the advocate’s role
Answer: C. Discuss the situation with the patient and advocate for their rights
A patient advocate must avoid dual relationships with patients because:
A. Dual relationships can lead to favoritism and ethical conflicts
B. It is acceptable only when approved by a healthcare team
C. It can help strengthen the advocate-patient bond
D. It makes the advocate more trustworthy
Answer: A. Dual relationships can lead to favoritism and ethical conflicts
What is the importance of patient-centered care in advocacy?
A. It focuses on the advocate making decisions for the patient
B. It ensures the patient’s preferences, values, and needs guide all decisions
C. It gives healthcare providers more control over the patient
D. It prioritizes the financial interests of the hospital
Answer: B. It ensures the patient’s preferences, values, and needs guide all decisions
Which of the following is considered unprofessional behavior in patient advocacy?
A. Building rapport with patients
B. Encouraging patients to seek second opinions
C. Accepting gifts from patients or their families
D. Educating patients on their treatment options
Answer: C. Accepting gifts from patients or their families
Equity in healthcare
In an equity-based approach, resources and opportunities are distributed based on need to ensure everyone has what they need to reach an equal outcome. For example, in a remote community with a high rate of diabetes, equity might include specialized diabetes care services, educational programs, and transportation to checkups.
Equitable healthcare
In an equality-based approach, everyone receives the same access to care, health resources, and health education. For example, a doctor spends the same amount of time with all patients, or a vaccine is available to everyone in a community
When should a patient advocate intervene in a patient’s care?
A. When the patient requests intervention
B. When the healthcare team asks for help
C. Whenever the advocate sees fit, even without the patient’s permission
D. After the patient’s treatment plan is completed
Answer: A. When the patient requests intervention
The ethical principle of veracity requires that the patient advocate:
A. Always tell the truth to the patient
B. Withhold information if it will upset the patient
C. Only communicate with the healthcare team
D. Tell the patient what they want to hear
Answer: A. Always tell the truth to the patient
Which of the following is an appropriate action for a patient advocate to take when a patient faces financial hardship?
A. Offer personal financial assistance to the patient
B. Connect the patient with available financial resources and assistance programs
C. Ignore the patient’s financial concerns
D. Recommend the patient withdraw from treatment
Answer: B. Connect the patient with available financial resources and assistance programs
Patient advocates should avoid personal relationships with patients because:
A. It can blur the boundaries of professional responsibility
B. It helps improve communication with patients
C. It increases the advocate’s credibility
D. It is necessary to build trust with the patient
Answer: A. It can blur the boundaries of professional responsibility
How should a patient advocate handle a situation in which a patient does not understand their diagnosis?
A. Explain the diagnosis in detail even without medical training
B. Refer the patient to a qualified healthcare professional for clarification
C. Avoid discussing the diagnosis to prevent confusion
D. Give the patient simplified information without consulting the doctor
Answer: B. Refer the patient to a qualified healthcare professional for clarification
The best way for a patient advocate to handle conflicts with healthcare providers is to:
A. Confront the provider in front of the patient
B. Discuss the issue privately with the healthcare provider in a respectful manner
C. Avoid addressing the conflict to maintain peace
D. Escalate the issue immediately to hospital management
Answer: B. Discuss the issue privately with the healthcare provider in a respectful manner
In a situation where a patient cannot make decisions for themselves, the patient advocate should:
A. Make decisions on the patient’s behalf
B. Refer to the patient’s advance directives or legal representative
C. Consult the patient’s family and make the final decision
D. Leave the decision entirely to the healthcare provider
Answer: B. Refer to the patient’s advance directives or legal representative
Which of the following reflects an ethical violation by a patient advocate?
A. Respecting patient confidentiality
B. Providing patients with all necessary information to make informed decisions
C. Accepting a financial gift from a patient’s family
D. Supporting the patient’s right to refuse treatment
Answer: C. Accepting a financial gift from a patient’s family
When a patient is dissatisfied with their care, the advocate should:
A. Ignore the patient’s concerns
B. Work with the patient and healthcare team to resolve the issue
C. Discourage the patient from filing a formal complaint
D. Advise the patient to change providers immediately
Answer: B. Work with the patient and healthcare team to resolve the issue