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HealthcareDelivery 4

For AHIMA Health Care Delivery Systems course: Chapter 4

QuestionAnswer
True or False: Efforts to encourage the delivery of quality care occur only at the local level. FALSE
True or False: Quality healthcare delivery is achieved when the patient's health status is improved as much as possible. TRUE
What is the federal program called that provides healthcare benefits for people 65 years old and older who are covered by Social Security? Medicare
Which organization first had the idea of providing prepaid health insurance? Baylor University Hospital was first with the idea of providing prepaid health insurance.
True or False: The vision of Healthy People 2020 is a society in which all people live long, healthy lives. TRUE
True or False: Peer-review processes have traditionally been at the center of quality assessment in healthcare delivery. TRUE
What is HEDIS (Healthcare Effectiveness Data and Information Set)? HEDIS is a a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed healthcare plans.
True or False: HMOs might use restricted access to physician specialists to control costs. TRUE
Which organization is a trade association for third-party medical billers? Healthcare Billing and Management Association
True or False: The Ambulatory Payment Classification system was created for Medicare reimbursement of physician services. FALSE. The Ambulatory Payment Classification system was created for Medicare hospital outpatient payments.
The National Practitioner Data Bank was established by _______. The National Practitioner Data Bank was established by the Health Care Quality Improvement Act.
Medicare + Choice payment by CMS is correctly described as ____. Third-party payment.
True or False: The lack of appropriate telecommunications technology in certain rural areas is a barrier to telemedicine. TRUE
Which federal agency administers CHAMPVA? The Department of Veterans Affairs administers CHAMPVA.
True or False: The work of the coding professional is often necessary in the Hospital Payment Monitoring Program (HPMP). TRUE
What does HPMP stand for? Hospital Payment Monitoring Program
An employee of a hospital wears high heels to work, catches one on the stairs and falls, breaking a leg. Her injuries are covered by Workers' Compensation even though she should have not worn this type of footwear to work or been going so fast down the stairs. Why? The theory underlying workers' compensation is that all accidents that occur at work, irrespective of fault, must be regarded as risks of industry and that the employer and employee shall share the burden of loss.
Give an example of a peer-review process. An example of a peer-review process would be a physician evaluating another physician's treatment decisions.
What was one thing identified as an approach to quality evaluation by the Institute of Medicine National Roundtable on Healthcare Quality? The IOM Roundtable identified market accountability with reliance on informed choices by employers as one approach to quality evaluation.
What company was the first to offer its employees a group insurance plan? Montgomery Ward was first to offer its employees a group insurance plan.
What is the difference between Medicare Part A and Medicare Part B? Medicare Part A is automatic and covers hospital costs, Medicare Part B, which is optional and costs more, helps pay physician and outpatient costs.
What are the four components of quality medical care? The four components are appropriateness, technical excellence, accessibility, and acceptability.
True or False: Affordability is considered one of the four components of quality care. FALSE
What is the federal program that provides a regionally managed healthcare program for active duty and retired members of the uniformed services, their families, and survivors? TRICARE is the federal program that provides a regionally managed healthcare program for active duty and retired members of the uniformed services, their families, and survivors.
CQI stands for _______. Continuous Quality Improvement.
Why did large medical billing companies emerge about 20 years ago? Large medical billing companies emerged because of the requirement that hospital-based physicians' services were to be billed separately.