Chapter 01
Healthcare in the United States

Multiple Choice Questions
 
1.  The American Medical Association (AMA) was founded primarily to:  
A.  create better working conditions for physicians. 
B.  create better standards of education for physicians. 
C.  create a framework of medical ethics for physicians. 
D.  create a lobbying organization for legal change in healthcare. 
 Nathan Smith Davis founded the AMA "to elevate the standard of medical education." 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
2.  The professional group with the purpose of improving medical care through advocacy, education, and monitoring of healthcare-related issues is:
  
A.  The Joint Commission. 
B.  The Centers for Medicare and Medicaid Services (CMS). 
C.  The American Medical Association. 
D.  The American Medical Association. 
 The AHA is the professional association of hospitals whose purpose is to improve medical care through advocacy, education, and monitoring of healthcare-related issues.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: II.A.2. Identify the use of legal documents
CAHIIM: III.D.2. Analyze data to identify trends
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
3.  Licensure, as a means to improve medical care, is:
  
A.  mandatory with standards established by the federal government.
 
B.  voluntary with standards established by the federal government.
 
C.  mandatory with standards established by individual states.
 
D.  voluntary with standards established by individual states. 
 Licensure is mandatory for healthcare providers with standards set by individual states.

ABHES: 4.f. Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.13. Discuss all levels of governmental legislation and regulation as they apply to medical assisting practice, including FDA and DEA regulations
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
CAHIIM: V.A.2. Collaborate with staff in preparing the organization for accreditation, licensure, and/or certification
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
4. Which federal program, established in 1965, provides financial assistance for healthcare for persons 65 years of age and over and to disabled persons?
 
A. Medicaid
B. Medicare

C. Social Security

D. American Hospital Association
Medicare was established in 1965 to provide financial assistance for healthcare for persons 65 years of age or older and disabled persons.

ABHES: 4.f. Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.13. Discuss all levels of governmental legislation and regulation as they apply to medical assisting practice, including FDA and DEA regulations
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
CAHIIM: V.A.2. Collaborate with staff in preparing the organization for accreditation, licensure, and/or certification
CAHIIM: V.A.3. Adhere to the legal and regulatory requirements related to the health information management
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
5. In order be eligible to receive Medicare and Medicaid reimbursement for healthcare services, hospitals and physicians must comply with the set of regulations known as:
 
A. Conditions of Participation (CoP).

B. Professional Standards Review Organizations (PSROs).

C. Title XVII of the Social Security Act of 1935.

D. Prospective Pay System (PPS).
Hospitals and physicians must comply with the Conditions of Participation in order to be eligible to receive reimbursement from Medicare.

ABHES: 4.f. Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.13. Discuss all levels of governmental legislation and regulation as they apply to medical assisting practice, including FDA and DEA regulations
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
CAHIIM: V.A.3. Adhere to the legal and regulatory requirements related to the health information management
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
6. The act that required Peer Review Organizations (PROs) to report substandard care to licensing agencies is:
 
A. TEFRA.

B. HIPAA.

C. ARRA.

D. OBRA.
OBRA requires PROs to report substandard care to licensing agencies.

ABHES: 4.f. Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.13. Discuss all levels of governmental legislation and regulation as they apply to medical assisting practice, including FDA and DEA regulations
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
7. The Health Insurance Portability and Accountability Act has ___ parts: they are _____.
 
A. 4; privacy, security, administrative simplification, and enforcement and compliance

B. 5; privacy, security, data sets and electronic transmission standards, administrative simplification, and enforcement and compliance

C. 4; privacy, security, patient consent, and data sets and electronic transmission standards

D. 5; privacy, security, patient consent, administrative simplification, and enforcement and compliance
HIPAA was a much anticipated and intensive change to the healthcare system, enacted at various points beginning in 2003, and has five parts—privacy, security, data sets and electronic transaction standards, administrative simplification, and enforcement and compliance.

ABHES: 4.f. Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.13. Discuss all levels of governmental legislation and regulation as they apply to medical assisting practice, including FDA and DEA regulations
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
8. The Hill-Burton Act requires hospitals to provide care for patients for free or at a reduced rate in exchange for:
 
A. income tax abatements.

B. lower liability and malpractice insurance.
C. funding for the modernization of hospitals or for building new ones.

D. funding to create new medical schools.
The Hill-Burton Act requires hospitals to provide care for patients for free or at a reduced rate in exchange for funding for the modernization of existing hospitals or for building new ones.

ABHES: 4.f. Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.13. Discuss all levels of governmental legislation and regulation as they apply to medical assisting practice, including FDA and DEA regulations
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
9. The federal law signed by President Obama in 2009 that incentivizes hospitals and physicians for adopting technology and electronic health records (EHRs) in meaningful ways is: 
A. HITECH.
B. PQRI.

C. OBRA.

D. TEFRA.
President Obama signed the HITECH Act in 2009 to provide incentive pay to providers and hospitals that adopt or upgrade existing electronic health record systems.

ABHES: 4.f. Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.13. Discuss all levels of governmental legislation and regulation as they apply to medical assisting practice, including FDA and DEA regulations
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
10. Which three tenets have guided governmental officials as they have worked to improve healthcare in the United States over the past decade?
 
A. Quality, information, and testing

B. Physicians, hospitals, and patients

C. Quality, positive outcomes, and access
D. Regulations, education, and insurance
There has been more healthcare reform in the past decade that at any other time since the passage of Medicare and Medicaid in the 1960s. Quality care, positive outcomes, and access to affordable care have been issues high on the priority list of government officials.

ABHES: 4.f. Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IX.C.13. Discuss all levels of governmental legislation and regulation as they apply to medical assisting practice, including FDA and DEA regulations
CAHIIM: II.A.2. Identify the use of legal documents
CAHIIM: III.D.2. Analyze data to identify trends
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
11. This represents one of the most famous and earliest examples of medical records:
 
A. Ebers papyrus

B. Smith record

C. Green record

D. Hippocratic paper
The Ebers papyrus is one of the most famous examples of health records describing ailments, body systems, and remedies used to treat diseases in 2700 B.C.

ABHES: 4.a. Follow documentation guidelines
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: V.C.12. Identify types of records common to the healthcare setting
CAHIIM: I.B.1. Analyze the documentation in the health record to ensure it supports the diagnosis and reflects the patient’s progress, clinical findings, and discharge status
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
12. Medicine was not considered an actual "profession" until the:
 
A. mid-17th century.

B. mid-18th century.

C. mid-19th century.

D. mid-20th century.
Medicine was not considered a profession at all until the mid-19th century, as doctors prior to that time had no formal educational training.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
13. Which of the following was NOT one of the first four medical schools built in the United States?
 
A. Boston College

B. College of Philadelphia

C. Harvard University

D. King's College
Boston College was not one of the first four medical schools; they include the College of Philadelphia, Harvard University, King's College, and Dartmouth College.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
14. The first hospital in the United States was founded by Dr. Thomas Bond and:
 
A. Thomas Jefferson.

B. Andrew Jackson.

C. George Washington.

D. Benjamin Franklin.
Benjamin Franklin and Dr. Thomas Bond founded the Pennsylvania Hospital in 1751.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease
 
15. The first hospital in the United States, founded in 1751, was:
 
A. New York Hospital.

B. Boston Hospital.

C. Pennsylvania Hospital.

D. Plymouth Hospital.
Pennsylvania Hospital is still in existence today and was founded in 1751.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
16. This professional organization was formed in 1847 with the primary goal of ensuring quality medical education:
 
A. American Medical Association

B. American Physician's Association

C. American College of Surgeons

D. American Medical Education Association
The American Medical Association (AMA) was founded in 1847 to elevate the standard of medical education in the United States.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
17.  This organization was founded in 1924 to improve medical care by tracking and trending healthcare-related issues for hospitals and all other types of healthcare facilities:
  
A.  APA
 
B.  AMA
 
C.  AHA
 
D.  ACS 
 The American Hospital Association (AHA) as founded in 1924 as a professional association of hospitals with the purpose of improving medical care through advocacy, education of healthcare leaders, and tracking of trending healthcare-related issues.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: X.C.2. Compare personal, professional and organizational ethics
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
18.  A registered nursing professional must have this in place for the specific state in which she/he intends to work, indicating that she/he has met the minimum requirements to practice in that state:
  
A.  Licensure 
B.  Accreditation 
C.  Certification 
D.  Registration 
 Licensure reflects the regulations regarding the minimum requirements necessary to practice medicine and/or provide medical services, and vary from state to state.

ABHES: 4.f.1. Define scope of practice for the medical assistant within the state that the medical assistant is employed
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IX.C.5. Discuss licensure and certification as it applies to healthcare providers
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: II.B.1. Apply confidentiality, privacy and security measures and policies and procedures for internal and external use and exchange to protect electronic health information
CAHIIM: V.A.2. Collaborate with staff in preparing the organization for accreditation, licensure, and/or certification
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
19.  The professional association of physicians specializing in surgery with the purpose of improving quality of care by setting patient care and surgical standards is the:
  
A.  American College of Physicians. 
B.  American College of Surgeons. 
C.  American Medical Association. 
D.  American Surgical Association. 
 The American College of Surgeons, founded in 1913 by physicians specializing in surgery, is dedicated to improving the quality of care by setting patient care and surgical standards.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: VII.C.5. Discuss utilization review principles
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
20. Which of the following is NOT reflective of the original ACS minimum standard?
 
A. Physicians and surgeons should be organized as a group or staff.

B. Membership on hospital staffs should follow a code of ethics.

C. A defined and complete medical case record should be kept on all patients.

D. A hospital should contain a clinical laboratory, a radiology service, and outpatient chemotherapy services.
The original ACS minimum standard did not include rules/regulations pertaining to chemotherapy services.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: VII.C.5. Discuss utilization review principles
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
21. The original ACS minimum standard called for:
 
A. daily medical staff rounds.

B. monthly medical staff meetings.

C. monthly medical staff consultations.

D. annual medical staff meetings.
The ACS minimum standard called specifically for monthly medical staff meetings.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: VII.C.5. Discuss utilization review principles
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
22. This status indicates that a hospital has exceeded the minimum requirements and was meeting or exceeding the optimal level of standards set by an organization.
 
A. Accreditation

B. Licensure

C. Certification

D. Registration
Accreditation demonstrates that a facility has exceeded the minimum requirements and was meeting or exceeding a defined set of standards set by an organization, such as The Joint Commission.

ABHES: 4.a. Follow documentation guidelines
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.5. Discuss licensure and certification as it applies to healthcare providers
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
CAHIIM: V.A.2. Collaborate with staff in preparing the organization for accreditation, licensure, and/or certification
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
23. Accreditation is:
 
A. mandatory.

B. necessary for licensure.

C. voluntary.

D. minimum standard for operations.
Accreditation is voluntary in nature.

ABHES: 4.a. Follow documentation guidelines
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.5. Discuss licensure and certification as it applies to healthcare providers
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
24. Which of the following is NOT an accreditation agency?
 
A. AOA

B. The Joint Commission

C. HFAP

D. CMS
CMS does not accredit healthcare facilities but does set a minimum standard of operation for participation in Medicare/Medicaid reimbursement.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
25. Which of the following does not include "deemed status" from Medicare?
 
A. The Joint Commission

B. Healthcare Facilities Accreditation Program

C. American College of Surgeons

D. All of these
Although the ACS accredits cancer programs, it does not provide accreditation for hospitals and facilities that leads to "deemed status" from Medicare.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
26. A set of regulations that hospitals and providers must meet in order to be eligible to receive reimbursement from Medicare and Medicaid is:
 
A. Accreditation Standards.

B. Conditions of Participation.

C. Medicare Licensure.

D. Healthcare Regulations.
The Conditions of Participation are a set of regulations that facilities must meet in order to be eligible to receive reimbursement from Medicare and Medicaid.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
CAHIIM: V.A.3. Adhere to the legal and regulatory requirements related to the health information management
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
27. Payments based on "fee for service" are:
 
A. retrospective.

B. prospective.

C. concurrent.

D. none of these.
Payments for claims on a fee-for-service basis (whatever the facility/provider charges) are completed after the service is performed, or retrospectively.

ABHES: 8.a. Gather and process documents
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: VII.C.1. Identify types of insurance plans
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
28.  The progression of independent entities contracted to monitor the quality provided to Medicare patients can be reflected by the following:
  
A.  PSRO-PRO-QIO. 
B.  QIO-CMS. 
C.  PSRO-PRO-CMS. 
D.  PRO-PSRO-QIO. 
 Professional Standards Review Organizations (PSROs) were the first entities contracted to monitor the quality of care, replaced by Peer Review Organizations (PROs) in the 1980s and then renamed Quality Improvement Organizations (QIOs).

ABHES: 4.a. Follow documentation guidelines
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: III.D.2. Analyze data to identify trends
CAHIIM: III.H.1. Apply policies and procedures to ensure the accuracy and integrity of health data both internal and external to the health system
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
29. Legislation that resulted in a shift from retrospective to prospective payment for hospital inpatients is:
 
A. the Hill-Burton Act.

B. TEFRA.

C. OBRA of 1986.

D. Title XVIII of the Social Security Act.
The Tax Equity and Financial Responsibility Act shifted fee-for-service payments for Medicare to a prospective payment system for hospital inpatients.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
30. A coding professional enters the appropriate code assignments for diagnoses and procedures, the patient's age, and the dates of admission and discharge in order to calculate and assign a reimbursement for hospital inpatients under this process:
 
A. encoding.

B. grouping.

C. coding.

D. abstracting.
The diagnostic related grouping system sets the rates and reimbursement for hospital inpatients.

ABHES: 8.c.3. Perform diagnostic and procedural coding
Accessibility: Keyboard Navigation
Bloom's: Apply
CAAHEP: VII.C.12. Define Diagnosis-Related Groups (DRGs)
CAHIIM: I.A.3. Apply diagnostic/procedural groupings
CAHIIM: I.A.4. Evaluate the accuracy of diagnostic/procedural groupings
Difficulty: 3 Hard
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
31. HIPAA is NOT a rule concerning:
 
A. privacy.

B. security.

C. enforcement of confidentiality.

D. professional licensing.
Professional licensing of healthcare workers is not a part of HIPAA.

ABHES: 7.c. Comply with federal, state, and local laws relating to exchange of information and describe elements of meaningful use and reports generated
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.3. Describe the implications of HIPAA for the medical assistant in various medical settings
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
CAHIIM: V.A.2. Collaborate with staff in preparing the organization for accreditation, licensure, and/or certification
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease
 
32. The patient group number from his/her policy is related to what type of data?
 
A. Digital

B. Legislative

C. Clinical

D. Administrative
Information related to payment and billing is a part of the administrative identification data.

ABHES: 8.a. Gather and process documents
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: VII.C.7. Describe how guidelines are used in processing an insurance claims
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: IV.A.2. Evaluate the revenue cycle management processes
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
33.  The goal of the Workgroup on Electronic Data was to:
  
A.  require electronic submission of claims.
 
B.  reduce administrative costs. 
C.  require digital processing and payment of claims.
 
D.  all of these. 
 The goals of the Workgroup on Electronic Data were to require the electronic submission of claims, reduce administrative costs, and require digital processing and payment of claims.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: V.C.11. Discuss principles of using Electronic Medical Records (EMR)
CAHIIM: II.A.1. Apply healthcare legal terminology
CAHIIM: III.A.2. Explain policies and procedures of networks, including intranet and Internet to facilitate clinical and administrative applications
CAHIIM: IV.A.2. Evaluate the revenue cycle management processes
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
34. Preventative medicine would be illustrated by the use of:
 
A. patient education on healthy diets.

B. reduced office visits to the primary care physician.

C. fewer vaccinations.

D. emphasis on the use of emergency rooms.
Preventative medicine would include making necessary preventative visits to the primary care physician, obtaining recommended vaccinations, and making less use of emergency rooms for basic healthcare needs.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IV.P.5. Instruct patients according to their needs to promote health maintenance and disease prevention
CAHIIM: III.F.1. Explain usability and accessibility of health information by patients, including current trends and future challenges
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
35.  A practitioner who maintains and manages all aspects of a patient's care is called a(an):
  
A.  primary care physician.
 
B.  family practitioner.
 
C.  gatekeeper.
 
D.  all of these. 
 A primary care physician and/or a family practitioner (also known as a "gatekeeper" in managed care) can be in charge of the management of all aspects of a patient's care.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: VI.F.3. Describe the differing types of organizations, services, and personnel and their interrelationships across the health care delivery system
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
36. Insurance plans that promote quality, cost-effective healthcare through the monitoring of patients, preventative care, and performance measures are called:
 
A. second-party payer.

B. managed care insurance.

C. Centers for Medicare Services.

D. primary physician care.
Managed care insurance plans promote quality, cost-effective healthcare through the monitoring of patients, preventative care, and performance measures. CMS is not an insurance plan, and neither are second-party payers or the primary care physician.

ABHES: 8.c.2. Differentiate managed care; i.e. HMO, PPO, IPA including referrals and pre-certification
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: VII.C.2. Identify models of managed care
CAHIIM: V.D.1. Identify discrepancies between supporting documentation and coded data
CAHIIM: VI.F.3. Describe the differing types of organizations, services, and personnel and their interrelationships across the health care delivery system
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
37. What Act, also known as Medicare Part D, allowed private insurance companies to bid on Medicare plans?
 
A. TEFRA

B. Deficit Reduction Act

C. Medicare Prescription Drug Improvement and Modernization Act

D. Medicare Insurance Act
The Medicare Prescription Drug Improvement and Modernization Act, also known as Medicare Part D, allowed private insurance companies to bid on Medicare plans.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAAHEP: VII.C.2. Identify models of managed care
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
38. A voluntary pay-for-performance incentive program is:
 
A. Medicare.

B. PQRI.

C. Deficit Reduction Act.

D. TEFRA.
Implemented in 2006, the Physician Quality Reporting Initiative is a voluntary pay-for-performance incentive program.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAAHEP: VII.C.2. Identify models of managed care
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
39. Which of the following is a FALSE statement concerning the Affordable Care Act?
 
A. The Act will restrict the types of insurance coverage available.

B. The Act will reduce costs by introducing new models of payment.

C. The Act will improve quality of care through expanded measurements.

D. The Act will streamline administrative processes.
One of the goals of the ACA is to improve access to care and broaden insurance coverage (not restrict its growth).

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
40. The ACA mandates that individuals under this age can remain on their parent's health insurance policy if they do not quality for coverage on their own.
 
A. 18

B. 21

C. 26

D. 30
The ACA mandates that individuals under the age of 26 may remain on their parent's health insurance policy.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAAHEP: VII.C.7. Describe how guidelines are used in processing an insurance claims
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
41. HITECH is a part of what larger Act?
 
A. ONC

B. ACA

C. ARRA

D. HIPAA
Health Information Technology for Economic and Clinical Health Act (HITECH) is a part of the American Recovery and Reinvestment Act (ARRA) signed into law in 2009.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
42. HITECH provides incentive payments in order to support the development of what type of electronic health record?
 
A. Interoperable

B. Certified

C. Meaningful

D. All of these
HITECH provides incentive payments to support the development of an interoperable electronic health record, through certification of applications that provide for meaningful use of the information by patients and clinicians.

ABHES: 7.c. Comply with federal, state, and local laws relating to exchange of information and describe elements of meaningful use and reports generated
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
43. The maximum range for incentive payments among Medicare and Medicaid incentive programs for the electronic health record is:
 
A. $10,000–$20,000.

B. $25,775–$50,755.

C. $50,000–$75,750.

D. $44,000–$63,750.
The maximum range among Medicare and Medicaid incentive programs for the electronic health record is $44,000–$63,750.

ABHES: 7.c. Comply with federal, state, and local laws relating to exchange of information and describe elements of meaningful use and reports generated
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: III.A.1. Utilize software in the completion of HIM processes
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
44. Stage 3 Meaningful Use can be illustrated by:
 
A. improved outcomes.

B. digital and telemedicine enhancements in treatments.

C. collecting information for patient engagement.

D. all of these.
Stage 3 Meaningful Use can be illustrated by improved patient outcomes.

ABHES: 7.c. Comply with federal, state, and local laws relating to exchange of information and describe elements of meaningful use and reports generated
Accessibility: Keyboard Navigation
Bloom's: Apply
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: III.A.2. Explain policies and procedures of networks, including intranet and Internet to facilitate clinical and administrative applications
CAHIIM: III.F.1. Explain usability and accessibility of health information by patients, including current trends and future challenges
Difficulty: 3 Hard
Est Time: 0-1 minute
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
45. Communications, information sharing, and decision making that include the patient and are managed by both the patient and the provider are part of:
 
A. clinical decision support.

B. patient-centric care.

C. meaningful use of documentation.

D. health information management.
Patient-centric care refers to communications, information sharing, and decision making that include the patient and are managed by both the patient and the provider.

ABHES: 5.c. Intervene on behalf of the patient regarding issues/concerns that may arise, i.e. insurance policy information, medical bills, physician/provider orders, etc.
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IV.P.5. Instruct patients according to their needs to promote health maintenance and disease prevention
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: III.A.2. Explain policies and procedures of networks, including intranet and Internet to facilitate clinical and administrative applications
CAHIIM: III.F.1. Explain usability and accessibility of health information by patients, including current trends and future challenges
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
46. After rounds, the nurse practitioner enters the patient characteristics, symptomatology, and lab values into a database that provides instructions and directives for possible treatment and care plans according to the diagnosis. This is illustrative of a(an):
 
A. electronic health record.

B. patient portal.

C. Meaningful Use component.

D. clinical decision support system.
A clinical decision support system aids in the diagnosis and treatment of disease by linking structured data with online clinical knowledge databases, which in turn improve patient care and outcomes.

ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management Systems
Accessibility: Keyboard Navigation
Bloom's: Apply
CAAHEP: V.C.11. Discuss principles of using Electronic Medical Records (EMR)
CAHIIM: III.A.2. Explain policies and procedures of networks, including intranet and Internet to facilitate clinical and administrative applications
Difficulty: 3 Hard
Est Time: 0-1 minute
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
47. In a single course of illness, the patient was seen by her primary care physician, referred to a specialist, admitted for outpatient surgery, and then discharged with home health. These episodes are an example of a(an):
 
A. patient engagement.

B. continuum of care.

C. high-level medical encounter.

D. managed care plan.
The continuum of care refers to the cycles of care experienced by a patient throughout his/her lifetime.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Apply
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 3 Hard
Est Time: 0-1 minute
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
48. A large research hospital facility, such as the Mayo Clinic, that performs procedures on a clinical trial basis and trains various levels of interns and residents would be referred to as what type of care?
 
A. Primary

B. Secondary

C. Tertiary

D. Quarternary
A high-level medical center environment that may include a teaching environment and perform procedures that would not be provided in a community hospital setting would be referred to as "quarternary" in the healthcare delivery hierarchy.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
49.  What type of ambulatory care is provided for patients who are seen without a prior appointment for problems that need prompt attention but are not emergency in level?
  
A.  Ambulatory clinic
 
B.  Urgent care center
 
C.  Ambulatory surgery center
 
D.  Independent practice association 
 An urgent care center sees patients with minor illnesses and injuries on a walk-in basis.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
50. A group of physicians that contracts with a managed care organization to provide care at a pre-determined, pre-negotiated rate is a(an):
 
A. ambulatory practice association.

B. integrated delivery network.

C. capitated practice.

D. independent practice association.
An independent practice association is a group of physicians that contracts with a managed care organization to provide care at a pre-determined, pre-negotiated rate.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: VI.F.3. Describe the differing types of organizations, services, and personnel and their interrelationships across the health care delivery system
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
51. What type of care is covered and reimbursed by Medicare?
 
A. Custodial care

B. Activities of daily living

C. Intermediate care

D. Skilled care
Skilled care is a type of long-term care for which Medicare covers and reimburses the services provided.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: VII.C.1. Identify types of insurance plans
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
52. Patients can exercise a more active role in their own healthcare decisions by:
 
A. personally engaging in healthcare encounters.

B. signing up to use a patient portal.

C. creating a personal health record.

D. all of these.
Appropriate use of health information through patient portals and personal health records can help the patient to engage productively in his/her own healthcare encounters and decisions.

ABHES: 4.b. Institute federal and state guidelines when releasing medical records or information
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: IV.P.5. Instruct patients according to their needs to promote health maintenance and disease prevention
CAHIIM: III.A.2. Explain policies and procedures of networks, including intranet and Internet to facilitate clinical and administrative applications
CAHIIM: III.F.1. Explain usability and accessibility of health information by patients, including current trends and future challenges
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
53. ICD10 has been used worldwide in most industrialized nations since: 
A. 1975.

B. 1980.

C. 1990.

D. 2000.
With the exception of the United States, ICD10 has been in use worldwide in most industrialized nations since 1990 for collection of data on disease.

ABHES: 8.c.3. Perform diagnostic and procedural coding
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: VII.C.9. Describe guidelines for third-party claims
CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
54. This process discovered the fact that when patients came in for mammography screening, they also tended to participate in free blood pressure screenings. This information, analyzed from separate data logs, led to the establishment of preventative skin cancer examinations becoming available near the radiology area in order to engage the patient in her/his care. This type of analysis is a result of:
 
A. data warehousing.

B. data mining.

C. data abstracting.

D. data cycling.
Data mining is the process of finding correlations or patterns among fields of data in larger related databases.

ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management Systems
Accessibility: Keyboard Navigation
Bloom's: Apply
CAAHEP: V.C.11. Discuss principles of using Electronic Medical Records (EMR)
CAHIIM: I.D.1. Collect and maintain health data
Difficulty: 3 Hard
Est Time: 0-1 minute
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
55. Pay-for-performance and Medicare value-based payments are examples of what type of reimbursement model?
 
A. Fee-for-service

B. Modified payment

C. Fee-for-value

D. None of these
Modified payment reimbursement models include pay-for-performance and Medicare value-based payment modifiers.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Understand
CAAHEP: VII.C.1. Identify types of insurance plans
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
56. Groups of doctors, hospitals, and other healthcare providers that come together to voluntarily give high-quality healthcare using a fixed-payment model based on overall performance are:
 
A. affordable care groups.

B. value-based medicine.

C. accountable care organizations.

D. pay-for-performance physician groups.
Accountable care organizations are groups of physicians, hospitals, and other providers that come together to voluntarily give high-quality healthcare using a fixed payment model; they work collaboratively and accept collective accountability for costs and the quality of care.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: VII.C.1. Identify types of insurance plans
CAHIIM: VI.F.3. Describe the differing types of organizations, services, and personnel and their interrelationships across the health care delivery system
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
57. Patient-centered medical home is a model developed by what organization to assist patients with chronic conditions with preventative services and a team approach to care? 
A. American Medical Association

B. American College of Surgeons

C. American Physicians Association

D. American Academy of Family Practitioners
The American Academy of Family Practitioners developed the healthcare model abbreviated as PCMH.

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Accessibility: Keyboard Navigation
Bloom's: Remember
CAAHEP: VII.C.1. Identify types of insurance plans
CAHIIM: V.A.2. Collaborate with staff in preparing the organization for accreditation, licensure, and/or certification
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 01.04
Topic: Health Information Empowering the Patient
 
58.  Which of the following is NOT a shared characteristic of the patient portal and the personal health record?  
A.  Both are owned by the patient. 
B.  Both provide accessibility to health information. 
C.  Both can be maintained on the WWW/Internet. 
D.  Both provide for continuity of care. 
 The patient portal is owned, housed, and maintained by the sponsoring healthcare institution, who then provides a secure access by the patient to the information.

ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management Systems
Accessibility: Keyboard Navigation
Bloom's: Apply
CAAHEP: V.C.5. Identify systems for organizing medical records
CAHIIM: III.A.1. Utilize software in the completion of HIM processes
Difficulty: 3 Hard
Est Time: 0-1 minute
Learning Outcome: 01.04
Topic: Health Information Empowering the Patient

 
59. Using an application on her iPhone, Mary Jones tracks her blood sugar results daily for download at her next appointment with her primary care physician. This is an example of:
 
A. eHealth.

B. aHealth.

C. iHealth.

D. mHealth.
Using a mobile device, such as an iPhone, to track health information is an application of mHealth.

ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management Systems
Accessibility: Keyboard Navigation
Bloom's: Apply
CAAHEP: V.C.11. Discuss principles of using Electronic Medical Records (EMR)
CAHIIM: III.A.1. Utilize software in the completion of HIM processes
Difficulty: 3 Hard
Est Time: 0-1 minute
Learning Outcome: 01.04
Topic: Health Information Empowering the Patient

 
60. As a result of continuous monitoring in the ICU for trauma sustained in an automobile accident, the patient has been determined to also be suffering from previously undiagnosed congestive heart failure that was present on admission. The presence of this condition is referred to as a(an):
 
A. comorbidity.

B. complication.

C. concomitant disease.

D. none of these.
A comorbid condition exists with the principal diagnosis in a patient who will often then require the additional care of a specialist in a different medical discipline.

ABHES: 8.c.3. Perform diagnostic and procedural coding
Accessibility: Keyboard Navigation
Bloom's: Apply
CAAHEP: VII.C.7. Describe how guidelines are used in processing an insurance claims
CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines
Difficulty: 3 Hard
Est Time: 0-1 minute
Learning Outcome: 01.04
Topic: Health Information Empowering the Patient

Short Answer Questions
 
61.  Which professional association first believed that written records were essential for quality patient care? Why?  
 The ACS believed in the importance of written records to improve the quality of care. 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Bloom's: Remember
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAAHEP: V.C.6. Describe various types of content maintained in a patient’s medical record
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 1 Easy
Est Time: 3-5 minutes
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
62.  Explain the meaning of "deemed status" by Medicare?  
 The CoPs are set forth in federal regulations to identify “deemed status” for facilities meeting eligibility requirements for Medicare. Deemed status indicates that the facility has met the intent of the CoPs through outside accreditation from private quality organizations, such as The Joint Commission. 

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Bloom's: Understand
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
Difficulty: 2 Medium
Est Time: 3-5 minutes
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease
 
63.  Compare and contrast Medicare and Medicaid.  
 Although both programs are an outgrowth of the Social Security Act, eligibility, benefits, and regulations are widely different. 

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Bloom's: Understand
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAAHEP: VII.P.2. Apply third party guidelines
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 2 Medium
Est Time: 3-5 minutes
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease

 
64.  Provide the elements included in the written evidence of appropriate informed consent.  
 Informed consent is required for surgical procedures and treatments or procedures that carry a risk to the patient. It provides an explanation of the procedure/treatment to be performed and the indications for that procedure. 

ABHES: 4.a. Follow documentation guidelines
Bloom's: Understand
CAAHEP: IX.C.6. Describe liability, professional, personal injury, and third party insurance
CAHIIM: V.A.2. Collaborate with staff in preparing the organization for accreditation, licensure, and/or certification
Difficulty: 2 Medium
Est Time: 3-5 minutes
Learning Outcome: 01.01
Topic: Healthcare Through the Ages—The Patient in Health and Disease
 
65.  What is the correct name for "Obamacare"?  
 The Patient Protection and Affordable Care Act, signed in 2010, is the correct name for the commonly used moniker “Obamacare.” 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Bloom's: Remember
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 1 Easy
Est Time: 3-5 minutes
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare
 
66.  As it applies to tax penalties, what is one of the key provisions of the Affordable Care Act?  
 The Internal Revenue Service will specify a fine for those patients filing income tax returns who do not have health insurance. 

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers
Bloom's: Understand
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 2 Medium
Est Time: 3-5 minutes
Learning Outcome: 01.02
Topic: New Policies Transforming Healthcare

 
67.  Describe the importance of outpatient care relative to the inpatient hospitalization rate currently in the United States.  
 According to the CDC, the number of outpatients is greater than inpatients currently in the United States. 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Bloom's: Remember
CAAHEP: IX.P.2. Perform within scope of practice
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: IV.A.2. Evaluate the revenue cycle management processes
Difficulty: 1 Easy
Est Time: 3-5 minutes
Learning Outcome: 01.03
Topic: Healthcare in Transition
 
68.  Provide an example of an integrated delivery network.  
 An integrated delivery network is a network of facilities and providers that work together to offer a continuum of care to a specific geographic area. 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Bloom's: Understand
CAAHEP: VII.C.2. Identify models of managed care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: VI.F.3. Describe the differing types of organizations, services, and personnel and their interrelationships across the health care delivery system
Difficulty: 2 Medium
Est Time: 3-5 minutes
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
69.  Identify the type of facility patients with substance abuse problems and/or panic disorders may go to for outpatient treatment.  
 Mental healthcare is more readily known now as behavioral health, spanning a wide variety of mental illness. 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Bloom's: Remember
CAAHEP: IX.P.2. Perform within scope of practice
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: VI.F.3. Describe the differing types of organizations, services, and personnel and their interrelationships across the health care delivery system
Difficulty: 1 Easy
Est Time: 3-5 minutes
Learning Outcome: 01.03
Topic: Healthcare in Transition
 
70.  Identify the health care entity in which local or county health departments operate:  
 Public health agencies are generally administered by the federal government, with individual states operating state and county health departments. 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Bloom's: Remember
CAAHEP: IX.P.8. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: VI.F.3. Describe the differing types of organizations, services, and personnel and their interrelationships across the health care delivery system
Difficulty: 1 Easy
Est Time: 3-5 minutes
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
71.  List the rationale for the need to classify data with ICD10.  
 ICD-10-CM and ICD-10-PCS will provide greater specificity in reporting healthcare data including more specification about severity of illness and laterality of disease. 

ABHES: 8.c.3. Perform diagnostic and procedural coding
Bloom's: Remember
CAAHEP: V.C.5. Identify systems for organizing medical records
CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines
Difficulty: 1 Easy
Est Time: 3-5 minutes
Learning Outcome: 01.03
Topic: Healthcare in Transition
 
72.  Explain the "value vs. volume" framework as it applies to U.S. healthcare.  
 The challenge is defining value—how to measure value and how to structure payments for value. The solution is based on an improved use of health information. 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Bloom's: Understand
CAAHEP: VII.C.2. Identify models of managed care
CAHIIM: IV.A.1. Apply policies and procedures for the use of data required in healthcare reimbursement
Difficulty: 2 Medium
Est Time: 3-5 minutes
Learning Outcome: 01.03
Topic: Healthcare in Transition
 
73.  Explain the relationship between risk management and population health management.  
 Population health management is based on the effective risk adjustment for a given pool of patients. 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Bloom's: Understand
CAAHEP: VII.C.2. Identify models of managed care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: V.A.1. Analyze policies and procedures to ensure organizational compliance with regulations and standards
Difficulty: 2 Medium
Est Time: 3-5 minutes
Learning Outcome: 01.03
Topic: Healthcare in Transition

 
74.  Explain the role of the primary care provider (PCP) to the patient-centered medical home (PCMH).  
 The cost of primary care is lower than that of specialists, and the PCP model results in coordinated efficient care. 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Bloom's: Understand
CAAHEP: IX.C.7. Compare and contrast physician and medical assistant roles in terms of standard of care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: VI.F.3. Describe the differing types of organizations, services, and personnel and their interrelationships across the health care delivery system
Difficulty: 2 Medium
Est Time: 3-5 minutes
Learning Outcome: 01.04
Topic: Health Information Empowering the Patient
 
75.  Compare and contrast "healthcare" to "medical care."  
 These two divisions of health systems in the United States represent two areas of focus but include the concept of coordinating the continuum of care to improve patient outcomes. 

ABHES: 1.b. Compare and contrast the allied health professions and understand their relation to medical assisting
Bloom's: Understand
CAAHEP: VII.C.2. Identify models of managed care
CAHIIM: I.B.4. Differentiate the roles and responsibilities of various providers and disciplines, to support documentation requirements, throughout the continuum of healthcare
CAHIIM: III.H.1. Apply policies and procedures to ensure the accuracy and integrity of health data both internal and external to the health system
Difficulty: 2 Medium
Est Time: 3-5 minutes
Learning Outcome: 01.04
Topic: Health Information Empowering the Patient