HSM 4215 Final Exam - Questions and Answers (Complete Solutions) Which of the following are good sources of information for the practice manager?
... [Show More] Centers for Medicare and Medicaid Services, Dartmouth Atlas, Institute for Healthcare Improvement, and Kaiser family foundation Which of the following best describes accounting? A system for keeping score in business using dollars A group practice is defined as a medical practice consisting of two or more practitioners working in a common management and administrative structure. True Which of the following is not a medical practice form? A licensed medical organization What is the approximate number of physicians licensed in the United States? 1 million What are the components of the "Practice Conundrum?" Cost, quality and access In what manner is "the perfect storm" is a metaphor for medical practice today? It symbolizes the convergence of many of today's challenges on the medical practice. The United States has fewer physicians per capita than many other OECD countries. True What is the approximate percentage of medical are purchased by government entities? 35% Which of the following is not a major piece of healthcare legislation? IHI According to the National Center for Health Statistics, what percentage of visits involved dug therapy? More than 75% Which of the following would best be described as a chronic condition or disease? Diabetes Chronic conditions in the United States have been decreasing rapidly over the last 20 years False The United States has more specialty practitioners per capita than many other industrialized countries True Which of the following is not a cause of escalating medical costs in the United States? Too few hospitals The process that practices use to make significant decisions is which of the following Governance Which of the following are direct reports to the governing board who are held accountable for the practice's achievement of its objectives? Management Which of the following best describes accountability? accepting responsibility for decisions that affect organizational performance The American healthcare delivery system can be described as _____________? Diversified, fragmented, complex, expensive Relative to systems in other nations, the United States healthcare system tends to be characterized as ___________? low in quality, proportional to its high cost A fundamental aspect of any organization, including a medical practice is _______________? its governance structure Which of the following is not typically included in a practice's governance structure? Community members The medical practice manager or administrator provides as essential link between which of the following? Please choose the best answer The organization's employees and the governing board Which of the following is not a stand-alone practice form? Accountable care organizations Which of the following features of an employment agreement tends to be most controversial? Restrictive covenants Decision making in the medical practice is most influenced by ___________? A and B are both very important (culture and mission, vision and values) Which of the following was a central feature of the Affordable Care Act (ACA)? The accountable care organizations (ACO) and A standardized benefit structure. What is the difference between a merger and an acquisition of a medical practice? An acquisition involves the purchase of a practice's assets by another practice or healthcare organization and typically includes the employment of the physicians and staff by the acquiring practice, whereas the merger of two practices involves the combining of assets of both practices to form a new entity. Mergers and acquisitions are on the increase, resulting in practices of larger sizes True Accountable care organizations (ACOs) focus on improving population health, improving patient experience and reducing the total cost of care. True Clinical integration is an alternative care delivery model that aligns the incentives of physicians the statement is true but integration also involves many additional elements Which of the following best describes a patient-centered medical home (PCMH)? A practice model focusing on prevention and early intervention for patient care To be a certified PCMH, the practice must be certified by the NCQA True What are some of the positive benefits of integration? Economies of scale can be leveraged, cost-effectiveness is more likely to be achieved, clinical care can better be coordinated, more specialty staff with greater expertise may be hired and allows greater access to capital Why do mergers and acquisitions frequently produce suboptimal results? a clash of culture occurs Physicians who treat patients are known as which of the following Clinical staff and Providers Relative to the systems of other developed countries, what is the most unique feature of the American healthcare system? the number of citizens without healthcare coverage (insurance or other forms of third-party payment) The PCMH would be more likely to practice which of the following? Patient-directed care An osteopathic medical school graduate may take an allopathic residency true Judging from the merger checklist in the text, mergers and acquisitions are relatively simple if the checklist is followed False An electronic health record (EHR) is a absolute requirement for the medical practice False Which of the following are important characteristics of an IT system in the medical practice? Usable, Specific, Scalable, and Secure IT systems have a significant learning curve, and initially productivity ___________ until staff is fully trained and adapted to the system. Likely decrease Which of the following is the best definition of meaningful use? A three-stage process requiring practices to effectively use electronic record systems for the benefit of patients, allowing providers to receive incentives under the Medicare and Medicaid EHR incentive programs What is the most important benefit of an easy interface for an IT system? The system is more likely to be accepted by stakeholders. Stand-alone system are the most efficient and effective IT system. False When training physicians and non-physician staff on a new IT system, which of the following approaches is best? Carefully plan and designed training for each group that will be using the system There is substantial evidence that electronic records increase clinical productivity False Which statement best describes the decision-support functions of an IT system? Decision support assists practices in justifying the business case for actions it plans to take Which of the following is not typically part of the electronic medical record? Billing records Which of the following is not an ancillary service Physician services What are the three levels of health information technology interoperability? Foundational, structural and semantic Which of the following statements is true regarding IT and value-based care? A modern IT system is essential if the practice wishes to participate in value-based care, Manual systems are perfectly acceptable in providing value-based care; however, using a manual system may be unrealistic. Value-based care requires the acquisition and analysis of large data sets. For our purposes, population health management is defined as "a process by which patient data are collected from multiple sources, compiled into patient records, and accessed by providers to inform them on the population’s health status." True Project management is often described as a constrained relationship between which of the following? Scope, time, quality, and cost What are some potential advantages of cloud computing in the medical practice? Reduce cost, increase security, Backup, expertise, flexibility Despite their many benefits, electronic records have increased record vulnerability and privacy violations. False, electronic records are much more secure than paper records HIPPA stands for Health insurance portability and accountability act A large medical practice is concerned about waiting time, and it has considered three potential alternatives: same-day appointments, next day access to primary care, and an after-hours urgent care center. These ideas represent which of the following attributes? Increased access to appropriate care Public reporting of practice performance is increasing. This would be an example of which of the following? Transparency What is the most critical feature of accountability in the governance process? Having measurable goals and objectives Legal issues in the practice management realm generally fall into which of the following categories? General application of the law, which includes most areas of state and federal law that apply to all businesses and all employment situations Specific applications of the law, which apply to the medical practice and the healthcare environment Medical practices as regulated by state laws Medical licenses issued by state medical examining boards Most medical practices require a general business license in many cities and municipalities True The National provider Data Bank (NPDB) does which of the following Tracks the significant negative occurrences of medical professionals Which of the following are organizational forms that a medical practice may utilize? S-corporations, partnerships, c-corporations Which of the following statements are true about the number of shareholders a corporation may have? C-corporations may have an unlimited number of shareholders Jargon can be confusing. What does PA stand for? The state of Pennsylvania, physician assistant, and professional association In many states, medical practice tax years must be based on the calendar year regardless of the organizational form. Why is this? It prevents medical practices from shifting income from a personal tax year to a corporate tax year and Medical practices are taxed at the highest personal income tax rate Which of the following relate to antitrust issue for the medical practice The Sherman act the Clayton act the Robertson-Patman act the hart Ccott-Rodino act What are three important laws that govern medical practice billing practices? False claims act, the anti-kickback statute and stark law Which of the following are exceptions to the Stark law? In-office ancillary services prepaid plans implants furnished in an ACS Inra-family rural referrals The Health Insurance Portability and Accountability Act (HIPAA) allows the sharing of protected health information in which of the following principal areas? Treatment Payment Healthcare operations In the healthcare organization, who is responsible for the protection of the patient's health information? The medical providers All healthcare professionals The nonclinical staff The practice manager Which of the following is the most common form of malpractice coverage as of 2017? Claims made coverage Federal law requires all physicians to be licensed in the United States by the state where they practice. No federal license is required. True Certificate-of-need laws (CON) were once found in every state; however, today only Alaska and Hawaii still use CON. False Stark violations are expensive. What are some of the consequences of violations? Civil money penalties Repayment of fees to Medicare and Medicaid exclusion from the Medicare and Medicaid programs criminal fines possible prison sentences Who is primarily responsible for enforcement of the stark law CMS Which of the following is a durable medical item? A wheelchair It is absolutely illegal to rent an office from the hospital where the physician admits patients, due to the Stark law. False What are some good ways to prevent having issues with Stark, inurement, and anti-kickback laws? Check the National Provider Database each time a clinician is hired, have a compliance plan, train all practice staff on compliance issues Which of the following are essential elements for modern-day practice management? Strategic planning, Project management, Marketing The cycle of practice development begins with which of the following? Mission In developing a strategic plan, communication is one of the most critical factors. True What are the four elements of a SWOT analysis? Strengths, Weaknesses, opportunities and threats A system in equilibrium tends to favor which of the following? The status quo What are some advantages of the "Time to Payback" method of capital investment analysis? It is easy to calculate and it is easy to interpret Why might you choose the "net present value" method in doing a capital investment analysis? It results in dollars What is one of the biggest disadvantages to the "internal rate of return" method of capital investment analysis? It assumes reinvestment at the internal rate of return When doing a breakeven analysis, fixed cost ____________? is constant The breakeven point in a breakeven analysis is represented by which of the following formulas? TR-TC=0 The present value factor in a capital investment analysis is equal to which of the following? The interest rate over a specified period of time Project management represents a constrained relationship between which of the following factors? Time, Scope of the Project and Cost In marketing, which of the following is an example of promotion? Advertising When doing a market analysis, which of the following is a factor that should be considered Untapped markets for new procedures, Hiring new physicians in practice, Hiring new physicians in the practice, The need for gerontology in the community, Underserved areas in the community Which of the following could be threats to a medical practice?
New regulations, A growing elderly population, complex business services What are the four Ps of marketing? Price, Promotion, place, product Risk can be eliminated with careful planning False, it may be reduced but it can never be eliminated Which managerial function involves proper structuring of resources to accomplish the activities to meet the objectives of the practice? Organizing Which managerial function involves comparing the measurement of actual results with objectives to determine success or failure? Controlling Which managerial function involves the determination of goals and objectives? Planning As of 2016, how many large health insurance carriers were operating in the United States Approximately 35 Most practice managers consider managing the revenue cycle and dealing with third-party payers to be a simple mechanical task. False Services that are provided in the inpatient or outpatient setting are reimbursed at the same rate by most insurance carriers. False What is the primary purpose of health insurance? To protect against risk The portion of a medical claim that the patient is required to pay before insurance benefits are paid, usually expressed as a percentage, is called what? Coinsurance Providers that have negotiated fees with the health plan and have contracts to provide services at an agreed-upon fee at full payment are considered to be what? In-network In recent years, deductibles and coinsurances for most commercial health plans have been ____________________. increasing rapidly High-deductible health plans (HDHPs) and health savings accounts (HSAs) are synonymous for all practical purposes. False, High deductible health plans may use health savings accounts Which of the following are types of managed care plans? Open-panel HMO, Closed-panel HMO, POS plans Which of the following statements is true? Medicare covers people over the age of 65. Medicare covers people on kidney dialysis. Medicaid and Medicare cover the disabled. Medicare Part D helps pay for prescription drugs. A dual-eligible person may be covered by both Medicare and Medicaid. Medicare is funded by which of the following sources? Payroll taxes, premiums, payments from Medicaid for Part B coverage. Medigap coverage provides payment in which of the following circumstances? It may pay for some services not covered by Medicare A and B. It pays for the deductible on Medicare Part A It pays for the deductible on Medicare Part A and a portion of the coinsurance for Part B Which of the following statements describes the Medicare Access and CHIP Reauthorization Act (MACRA)? It repeals the sustainable growth rate methodology (SGR). It provides a new incentive structure for providers. It provides an annual positive or flat fee adjustment to the Medicare fee-for-service through 2025. It consolidates all existing Medicare quality programs into the merit-based incentive payment system (MIPS). The resource-based relative value scale (RBRVS) is used for which if the following purposes? It is used for funding Medicare and Medicaid services What are some of the reasons that the revenue cycle fails to produce optimum results? Lack of proper insurance information, Ineffective denial management, Incomplete or erroneous registration data Bad debt and charity care are the same, because they both result in loss of revenue False, It is true the both result in loss of revenue but in the case of charity care revenue was never expected [Show Less]