FACHE WK8 and 9 Healthcare Study Questions and correct answers 100%
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Claims Adjuster
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Claims Adjuster
Name 3 functions of a physician organization? - correct answer1) Improvement of clinical quality and cost expectation
2) Credentialing and privileging of physicians
3) Continuing education for physicians and other clinical professionals
Name 2 purposes of the HC Quality Improvement Act, Title ...
name 3 processes recognized by ncqa and tjc for pr
name 3 purposes of nursing
t or f medical savings accts msa allow for the
or f hmos have consistently reduced their costs s
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FACHE WK8 and 9 Healthcare Study Questions and correct answers
100%
Name 3 functions of a physician organization? - correct answer1)
Improvement of clinical quality and cost expectation
2) Credentialing and privileging of physicians
3) Continuing education for physicians and other clinical professionals
Name 2 purposes of the HC Quality Improvement Act, Title IV of P.L.
100-177 of 1986: - correct answer1) Reduce the chance of
incompetent physicians moving to a new location
2) Reduce the chance for physicians to misrepresent his/her skills
Name 3 reasons for the change to healthcare delivery from a fee-for-
service to managed care: - correct answer1) Increased cost to
employers
2) Overall societal belief that optimal use of limited resources is more
appropriate than maximal use
3) Need to increase efficiency in the overall health system
What is an approval granted by govt that allows someone to engage in
an occupation after finding the applicant has achieved a certain
minimum competency? - correct answerLicensure
Name 3 processes recognized by NCQA and TJC for privileging
physicians: - correct answer1) Bylaws
2) Privileges
3) Peer Review
Name 3 purposes of nursing - correct answer1) Promote health,
including emotional and social well-being
2) Prevent disease and disability
3) To promote environmental, physical, cognitive, and emotional
support in illness
, T or F: Medical Savings Accts (MSA) allow for the rollover of unspent
funds from one coverage period to another - correct answerTrue
T or F: HMOs have consistently reduced their costs since their first
high-growth period of managed care - correct answerFalse
T or F: In most circumstances, high deductible lower premium costs
for enrollees - correct answerTrue
T or F: Elminating first-dollar coverage can be considered a form of
self-insurance by the enrollee - correct answerTrue
What focuses on the development of a continuum of care, from health
promotion to disease prevention to inpatient acute care to long-term
and palliative care? - correct answerVertical Integration
What Occurs when the hospital extends its reach to capture and
control more services that lead to hospital inpatient hospitalization -
correct answerVertical Integration
By 1965, the For Profit healthcare sector had virtually ceased to exist.
What was the driving force behind a switch to For Profit? - correct
answerPassage of Medicare which provided a ready source of funding
and guaranteed rates of return.
The "gag rules" that some managed care organizations have issued
are defined as what? - correct answerlook this up:
a) A contractual provision between plan and provider that limits
information, advice, and counsel that a provider may give a patient
b) Anti-criticism provisions in contracts that prohibit providers from
making any communication that may adversely affect confidence in
the plan
c) Any health plan practice that inhibits open communication between
a physician and a patient
d) All of the above
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