Deck 1: Introduction to Health Care Systems

Question 1

In a ______________ system the health care provider charges and is paid for each item of service provided.

A) prospective payment
B) fee-for-service
C) capitation
D) per diem

Answer 1

fee-for-service

Question 2

Which of the following is NOT one of the administrative simplification provisions of HIPAA?

A) EDI
B) Privacy
C) Security
D) PPS

Answer 2

PPS

Question 3

A(n) _________ links data provided by various health care providers.

A) HIE organization/RHIO
B) patient-focused record
C) fee-for-service network
D) prospective payment system

Answer 3

HIE organization/RHIO

Question 4

A longitudinal patient record documents a patient's health status, conditions, and treatments _____________________________.

A) using electronic signals to transmit clinical information from one site to another
B) throughout the patient's life
C) in a prospective payment system
D) throughout the patient's residence in a particular community

Question 5

The State Children's Health Insurance Program (SCHIP or CHIP) is _________________.

A) a private health insurance program with variable coverage from state-to-state
B) a Medicare Part A program for uninsured children
C) a Medicare Part D program for uninsured children
D) a joint state-federal program providing insurance for lower income children not covered by Medicaid

Question 6

Under HIPAA, it is permissible to use or disclose PHI without a specific written authorization when it is necessary for ____________________.

A) treatment
B) payment
C) health care operations
D) all of the above
E) none of the above

Question 7

This part of Medicare is optional insurance coverage available to all Medicare beneficiaries designed to lower prescription drug costs.

A) Part B
B) Part A
C) None of the above
D) Part D
E) Part C

Question 8

This law, passed in 2010, expanded Medicaid eligibility requirements.

A) American Recovery and Reinvestment Act (ARRA)
B) Children's Health Insurance Program (CHIP)
C) Hill-Burton Act
D) Health Information Technology for Economic and Clinical Health Act (HITECH)

Question 9

A program designed by CMS to recover improper Medicare payments is named _______________.

A) Recovery Audit Contractor (RAC)
B) Pay-for-performance (P4P)
C) Quality improvement organization (QIO)
D) Clinical documentation improvement (CDI)

Question 10

Under this type of program, reimbursement may be rewarded or penalized based upon the provider's ability to meet pre-established targets for delivery of health care services.

A) Pay-for-performance (P4P)
B) Zone Program Integrity Contractors (ZPICs)
C) Quality improvement organization (QIO).
D) Clinical documentation improvement (CDI)

Question 11

This legislation amends the HIPAA privacy and security rules.

A) Hill-Burton Act
B) Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)
C) Health Information Technology for Economic and Clinical Health Act (HITECH)
D) Clinical documentation improvement (CDI)

Question 12

Under this care model, the primary care physician acts as a "gatekeeper" to coordinate the patient care across providers by addressing preventive, acute, and chronic care needs and by providing the patient with access to electronic tools.

A) Health information exchange organization
B) Patient-centered medical home model
C) Pay-for-performance (P4P)
D) Patient safety organization (PSO)

Question 13

This program was developed by The Joint Commission to help accredited health care institutions focus upon specific patient safety concerns.

A) National Quality Forum (NQF)
B) Quality Improvement Organization (QIO)
C) National Patient Safety Goals (NPSG)
D) Patient Safety Organization (PSO)

Question 14

This federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information was mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009.

A) Office of the National Coordinator for Health Information Technology (ONC)
B) Nationwide Health Information Network (NHIN)
C) Centers for Medicare and Medicaid Services (CMS)
D) Institute of Medicine

Question 15

Americans have heavily depended on hospitals for lifesaving health care since the 1700s.

Question 16

The American College of Surgeons was one of the first organizations to establish standards for hospitals.

Question 17

The purpose of the Hill-Burton program in the mid-twentieth century was to decrease the number of hospital beds in over served areas

Question 18

Part A of Medicare pays for hospital inpatient care, home health care, skilled nursing care, and hospice care.

Question 19

Federal and state governments jointly fund the Medicaid program.

Question 20

In a prospective payment system, the health care provider charges and is paid for each item of service provided.

Question 21

The administrative simplification provisions of HIPAA deal with insurance portability, fraud and abuse, and medical liability reform.

Question 22

A per diem method of payment means that the provider is paid based on the number of persons the provider agrees to treat.

Question 23

Medicare pays skilled nursing facilities, home health providers, inpatient rehabilitation hospitals, and long-term care hospitals under prospective payment systems.

Question 24

A Health Information Exchange links data provided by various health care providers.

Question 25

The patient-centered medical home unnecessarily fragments care among disconnected providers resulting in a lack of care coordination.

Question 26

Telemedicine involves transmitting medical information back and forth between patient and physician in separate locations by electronic means such as video, electronic mail, telephone, or satellite.

Question 27

A personal health record is a paper-based health record that is protected from disclosure to those outside the facility that created it.

Question 28

Changes in health care delivery have caused health information management professionals to focus more narrowly on acute inpatient settings.

Question 29

Under Part C, beneficiaries pay a monthly premium for the insurance plan, in addition to their Part B premium

Question 30

Under the American Recovery and Reinvestment Act (ARRA), providers that fail to demonstrate meaningful use for health information technology will be financially penalized.

Question 31

________involves the use of robotic technology to assist with or perform procedures remotely.

Question 32

​The ____________________ program was implemented by CMS to identify and investigate malicious fraudulent claims activity within Medicare's seven geographic regions (zones).

Question 33

​___________________________________ is the federal agency within the Department of Health and Human Services that administers the Medicare and Medicaid programs.​

Question 34

The ____________________ program is designed to recover improper Medicare payments.​

Question 35

A(n) ____________________________ is a partner or contractor performing a job or service on behalf of a covered entity.​

Question 36

​​A(n) _________________________________ is a locally implemented program focused upon improving the quality of clinical documentation to facilitate an accurate representation of health care services through complete and accurate reporting of diagnoses and procedures.

Question 37

A(n) ______________________________ system is one in which a health care provider maintains individual patient health records electronically​

Question 38

_________________________________ is a general term referring to electronic health records and related information systems to manage health care processes.​

Question 39

The Joint Commission created a_______ program to help accredited health care institutions focus upon specific patient safety concerns.​

Question 40

Under ___________, providers are paid based on the number of patients they agree to treat, rather than on the number of services they provide. Therefore, it is more profitable to the provider if the patient requires fewer services.

Question 41

__________provides medical assistance to lower-income individuals and families. Federal and state governments jointly fund this program.

Question 42

Match each description with the correct item

- Enacted in 2009 and also known as the "Stimulus Act," its main purpose was to create jobs and stimulate economic growth; however, it contained many provisions for health care, including billions of dollars for health information technology.

A) Health Insurance Portability and Accountability Act (HIPAA)
B) American Recovery and Reinvestment Act (ARRA)
C) Hill-Burton Act
D) Medicare Prescription Drug, Improvement, and Modernization Act
E) Patient Protection and Affordable Care Act (PPACA)
F) Health Information Technology for Economic and Clinical Health Act (HITECH)
G) Medicaid Integrity Program (MIP)
H) Zone Program Integrity Contractors (ZPICs)

Question 43

Match each description with the correct item

- Enacted as part of the "Stimulus Act" in 2009 to promote the adoption and meaningful use of health information technology, this legislation amended the HIPAA privacy and security rules by introducing additional privacy regulations, breach notification rules, and stiffer civil and criminal penalties for security violations.

A) Health Insurance Portability and Accountability Act (HIPAA)
B) American Recovery and Reinvestment Act (ARRA)
C) Hill-Burton Act
D) Medicare Prescription Drug, Improvement, and Modernization Act
E) Patient Protection and Affordable Care Act (PPACA)
F) Health Information Technology for Economic and Clinical Health Act (HITECH)
G) Medicaid Integrity Program (MIP)
H) Zone Program Integrity Contractors (ZPICs)

Question 44

Match each description with the correct item

- Also known as the "Hospital Survey and Construction Act," enacted by Congress in 1946, this legislation provided federal money to determine the need for more hospitals and to pay for their construction.

A) Health Insurance Portability and Accountability Act (HIPAA)
B) American Recovery and Reinvestment Act (ARRA)
C) Hill-Burton Act
D) Medicare Prescription Drug, Improvement, and Modernization Act
E) Patient Protection and Affordable Care Act (PPACA)
F) Health Information Technology for Economic and Clinical Health Act (HITECH)
G) Medicaid Integrity Program (MIP)
H) Zone Program Integrity Contractors (ZPICs)

Question 45

Match each description with the correct item

- This legislation made significant revisions to the Medicare program by calling for the creation of Part D, e-prescribing for prescription drug plans, revision of claims processing, and a Medicare payment recovery demonstration project.

A) Health Insurance Portability and Accountability Act (HIPAA)
B) American Recovery and Reinvestment Act (ARRA)
C) Hill-Burton Act
D) Medicare Prescription Drug, Improvement, and Modernization Act
E) Patient Protection and Affordable Care Act (PPACA)
F) Health Information Technology for Economic and Clinical Health Act (HITECH)
G) Medicaid Integrity Program (MIP)
H) Zone Program Integrity Contractors (ZPICs)

Question 46

Match each description with the correct item

- Also known as "Health Reform," this legislation contained a number of health care provisions, including an expansion of Medicaid eligibility requirements and increased quality reporting requirements for health care providers.

A) Health Insurance Portability and Accountability Act (HIPAA)
B) American Recovery and Reinvestment Act (ARRA)
C) Hill-Burton Act
D) Medicare Prescription Drug, Improvement, and Modernization Act
E) Patient Protection and Affordable Care Act (PPACA)
F) Health Information Technology for Economic and Clinical Health Act (HITECH)
G) Medicaid Integrity Program (MIP)
H) Zone Program Integrity Contractors (ZPICs)

Question 47

Match each description with the correct item

- This program focuses on Medicaid overpayments.

A) Health Insurance Portability and Accountability Act (HIPAA)
B) American Recovery and Reinvestment Act (ARRA)
C) Hill-Burton Act
D) Medicare Prescription Drug, Improvement, and Modernization Act
E) Patient Protection and Affordable Care Act (PPACA)
F) Health Information Technology for Economic and Clinical Health Act (HITECH)
G) Medicaid Integrity Program (MIP)
H) Zone Program Integrity Contractors (ZPICs)

Question 48

Match each description with the correct item

- This identifies and investigate malicious fraud within seven geographic zones.

A) Health Insurance Portability and Accountability Act (HIPAA)
B) American Recovery and Reinvestment Act (ARRA)
C) Hill-Burton Act
D) Medicare Prescription Drug, Improvement, and Modernization Act
E) Patient Protection and Affordable Care Act (PPACA)
F) Health Information Technology for Economic and Clinical Health Act (HITECH)
G) Medicaid Integrity Program (MIP)
H) Zone Program Integrity Contractors (ZPICs)

Question 49

Match each description with the correct item

- A third-party entity working under the direction of CMS to detect improper Medicare payments through review of providers' medical records and Medicare claims data.

A) Patient safety organizations (PSO)
B) Office of the National Coordinator for Health Information Technology (ONC)
C) Health information exchange organizations
D) Regional extension centers (REC)
E) Recovery audit contractors (RAC)
F) Quality improvement organizations (QIO)

Question 50

Match each description with the correct item

- Non-profit organizations called for by ARRA and initially funded by federal grants to provide health information technology support to providers to help them become meaningful users of certified electronic health record technology.

A) Patient safety organizations (PSO)
B) Office of the National Coordinator for Health Information Technology (ONC)
C) Health information exchange organizations
D) Regional extension centers (REC)
E) Recovery audit contractors (RAC)
F) Quality improvement organizations (QIO)

Question 51

Match each description with the correct item

- Private, mostly not-for-profit organizations staffed by professionals trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care.

A) Patient safety organizations (PSO)
B) Office of the National Coordinator for Health Information Technology (ONC)
C) Health information exchange organizations
D) Regional extension centers (REC)
E) Recovery audit contractors (RAC)
F) Quality improvement organizations (QIO)

Question 52

Match each description with the correct item

- Organizations that can work with clinicians and health care organizations to identify, analyze, and reduce the risks and hazards associated with patient care.

A) Patient safety organizations (PSO)
B) Office of the National Coordinator for Health Information Technology (ONC)
C) Health information exchange organizations
D) Regional extension centers (REC)
E) Recovery audit contractors (RAC)
F) Quality improvement organizations (QIO)

Question 53

Match each description with the correct item

- An entity that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards, often used synonymously with regional health information organization (RHIO).

A) Patient safety organizations (PSO)
B) Office of the National Coordinator for Health Information Technology (ONC)
C) Health information exchange organizations
D) Regional extension centers (REC)
E) Recovery audit contractors (RAC)
F) Quality improvement organizations (QIO)

Question 54

How does a clinical documentation improvement program help health care facilities?​

Question 55

What is HITECH and how did it affect regulations regarding protected health information?​

Question 56

​Describe what a Health Information Exchange (HIE) is and think critically based on your understanding of the technology to provide at least one example suggesting how such a system could benefit a patient.

Question 57

Describe what a personal health record (PHR) is and three attributes that make them useful for patients.?

Question 58

What benefits does telemedicine provide for a patient?​

Question 59

According to Chapter 1, list four key principles for Medicare/Medicaid standards:?

Question 60

Describe the differences between Medicare Parts A, B, C and D.?