Deck 4: Todays Healthcare Environment

Question 1

Capitation is

A)a fixed monthly fee paid to the healthcare provider for providing patient services.
B)an additional payment for services paid directly by the patient at the time of service.
C)limitation of all services for care to a fixed dollar amount.
D)a fixed amount the managed care organization may charge the patient for membership in the organization.

Answer 1

a fixed monthly fee paid to the healthcare provider for providing patient services.

Question 2

Medicare is a federal program of

A)healthcare coverage for the poor and indigent.
B)healthcare coverage in which rationing of care might occur in the future.
C)healthcare coverage for the elderly and disabled.
D)B and C.

Answer 2

B and C.

Question 3

A gag clause,considered illegal in contracts between physicians and managed care organizations

A)prohibits the physician from discussing the income of the organization.
B)allows the physician to share financial incentives only with patients.
C)prohibits the physician from discussing financial incentives given by the organization.
D)allows the managed care organization to refuse to pay for care given by the physician.

Answer 3

prohibits the physician from discussing financial incentives given by the organization.

Question 4

An associate practice is a legal agreement in which the physicians

A)share a facility and staff.
B)share the loss and profits.
C)share responsibility for legal actions of each other.
D)all of the above.

Question 5

Diagnosis-related groups refer to

A)the classification of patients of illness by diagnosis.
B)persons without funds.
C)limiting care to a certain number of persons with a diagnosis.
D)limiting care to a set number of days.

Question 6

A medical practice consisting of three or more physicians who practice the same specialty and share expenses and income is a/an

A)group practice.
B)partnership.
C)associate practice.
D)corporation.

Question 7

Third-party payers are

A)physicians.
B)insurance companies.
C)patients.
D)hospitals.

Question 8

Managed care organizations may attempt to limit a patient's

A)choice of hospitals.
B)referrals to specialists.
C)length of stay in a hospital.
D)all of the above.

Question 9

A business operation of a medical practice in which two or more physicians are responsible for the actions of each,including debts,is called a/an

A)associate practice.
B)solo practice.
C)partnership.
D)group practice.

Question 10

Different methods of medical practice,such as partnerships and corporations,are the result of

A)increased insurance coverage costs.
B)a desire to better serve patients' needs.
C)increased patient-initiated malpractice lawsuits.
D)all of the above.

Question 11

The purpose of the gatekeeper is to

A)approve all nonemergency services.
B)approve hospitalizations.
C)approve tests before they are given.
D)all of the above.

Question 12

A health maintenance organization (HMO)provides

A)healthcare services available for a predetermined fee per member by a limited group of providers.
B)no preventive care services.
C)healthcare services by requiring a large copayment.
D)healthcare services through a nonrestricted group of providers.

Question 13

The members of a professional corporation are known as

A)the board of directors.
B)shareholders.
C)physicians.
D)lawyers.

Question 14

Those persons most likely to receive the best care under a managed care system are

A)the wealthy.
B)the poor and ignorant.
C)those who understand the system.
D)all of the above.

Question 15

Medicare and Medicaid prohibit physicians from

A)referring to services they own.
B)charging a reasonable fee for service.
C)referring to rehabilitation or long-term care.
D)ordering expensive tests.

Question 16

In a managed care organization,financial risk is shared by the

A)organization.
B)hospital.
C)physician.
D)all of the above.

Question 17

Medicaid is a

A)federally implemented program for indigent care.
B)state-funded program for indigent care.
C)federal program of care for the poor implemented by the states.
D)locally implemented program of indigent care.

Question 18

A practice in which the physician employs other physicians and pays them a salary is called

A)solo practice.
B)sole proprietorship.
C)partnership.
D)associate practice.

Question 19

A fixed-payment plan of health insurance offers coverage for

A)hospital care.
B)physicians' visits.
C)complete medical care.
D)dental care.

Question 20

A Medicare-instituted method of hospital payment is

A)HMO.
B)DRG.
C)PPO.
D)EPO.

Question 21

Which form of medical practice ends with the death of the owner?

A)A corporation
B)A partnership with several partners
C)An associate practice
D)A solo practice

Question 22

A person with the appropriate education who practices as a doctor of medicine or doctor of osteopathy is called a/an

A)allied health professional.
B)physician.
C)dentist.
D)all of the above.

Question 23

Fee splitting occurs when

A)a hospital is paid in proportion to business received for holders of the franchise.
B)one physician pays another physician for the referral of patients.
C)income in a group practice is shared.
D)a physician receives payment from both the insurance company and the patient.

Question 24

Benefits of a corporation include all of the following except

A)profit sharing for its members.
B)pension plans for its members.
C)insurance for its members.
D)protection from lawsuits for the corporation.

Question 25

Allied health professionals who are certified include all of the following except

A)medical assistants.
B)phlebotomist.
C)medical transcriptionists.
D)pharmacists.