Introduction to Healthcare and Public Health in the US: Financing Healthcare (Part 2)
Self-assessment
1. Samples of and electronic data interchange transaction include (choose all that apply):
a. a fax copy of the claim
b. CMS Form 1500
c. CMS Form 1450
d. 837 transaction for healthcare claims
2. Which of the following is currently used to code claims for healthcare services (choose all that apply):
a. CPT
b. ICD-9-CM
c. NDC - National Drug Codes
d. ICD-10-PCS
3. Which of the following is used for diagnosis coding and reporting on claims regardless of the provider?
a. ICD-9
b. CPT
c. HCPCS
d. CDT
4. Fee-for-service payment type include (choose all that apply):
a. episode-of-care
b. traditional retrospective
c. prospective payment
d. global payment
e. self-pay
5. The third party payer is
a. the insured
b. the provider
c. the insurance company
d. all of the above
6. Episode of care reimbursement types include all of the following except:
a. self-pay
b. prospective payment
c. capitation
d. global payment
7. Managed care reimbursement may be paid using which of the following methods:
a. fee-for-service
b. episode-of-care
c. either fee-for-service or episode-of-care
d. none of the above
8. The sectors of healthcare spending that utilize the most resources include (choose all that apply):
a. hospitals
b. physician services
c. pharmaceutical costs
d. nursing homes
9. Which of the following is not considered a chronic disease?
a. hypertension or high blood pressure
b. diabetes
c. asthma
d. influenza
10. The age group associated with the highest medical expenses is:
a. children <5
b. adults age 25-44
c. adults age 45-64
d. adults > 65
11. The EMTALA act requires hospitals receiving federal funds to evaluate individuals presenting to the emergency department
a. only if they have insurance
b. regardless if their ability to pay
c. only if they pay in advance
d. only if it is a true emergency
12. Healthcare spending can be slowed by
a. reducing unnecessary services
b. reducing care of marginal value
c. rationing resources
d. all of the above
13. Evidence-based medicine is
a. provided by physician experts during malpractice suits
b. leads to higher medical costs
c. examines the evidence gathered from scientific research and applies it to clinical decision making
d. cannot be used to predict a treatment outcome
14. Defensive medicine
a. results in increased healthcare expenditures
b. a practice to safeguard the provider against potential malpractice lawsuits
c. involves additional testing or valuations that is of marginal value in the treatment and care of an individual
d. all of the above
15. Concierge medicine or retainer practices
a. is a business model that involves the payment of a monthly or annual retainer or membership fee
b. limits the total number of patients in the practice
c. does not eliminate the need for health insurance
d. all of the above
16. Alternative delivery methods for delivering primary care at a low cost include (choose all that apply):
a. urgent care
b. retail clinics
c. emergency departments
d. requiring specialists to also provide primary care
17. (Choose all that apply) Factors that contribute to escalating healthcare expenditures in the US include:
a. Technology.
b. Chronic disease.
c. Increased demand and utilization.
d. An excess of primary care doctors.
e. New pharmaceutical treatments.
f. Administrative costs.
g. The uninsured.
18. Methods to control healthcare costs that raise ethical questions for providers, policy makers, and patients include which of the following?
a. Rationing.
b. Changing utilization patterns through wellness and prevention.
c. Use of evidence based medicine and clinical practice guidelines.
d. Changing utilization patterns through increased patient out-of-pocket expenses.
e. a and d
f. b and c
g. All of the above.
Health IT Workforce CurriculumIntroduction to Healthcare and1
Version 3.0/Spring 2012Public Health in the US
Financing Healthcare (Part 2)
This material (Comp1_Unit5) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.