Question 1

The purpose of the gatekeeper is to

Accepted Answer

A)  approve all nonemergency services.
B)  approve hospitalizations.
C)  approve tests before they are given.
D)  all of the above.E) A) and B)
F) None of the above

Question 2

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

Accepted Answer

A)  allied health professional.
B)  physician.
C)  dentist.
D)  all of the above.E) None of the above
F) B) and C)

Question 3

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

Accepted Answer

A)  group practice.
B)  partnership.
C)  associate practice.
D)  corporation.E) C) and D)
F) B) and D)

Question 4

Benefits of a corporation include all of the following except

Accepted Answer

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

Question 5

Medicaid is a

Accepted Answer

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.E) A) and B)
F) A) and C)

Question 6

Managed care organizations may attempt to limit a patient's

Accepted Answer

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

Question 7

The members of a professional corporation are known as

Accepted Answer

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

Question 8

Diagnosis-related groups refer to

Accepted Answer

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.E) A) and B)
F) A) and C)

Question 9

Third-party payers are

Accepted Answer

A)  physicians.
B)  insurance companies.
C)  patients.
D)  hospitals.E) B) and C)
F) None of the above

Question 10

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

Accepted Answer

A)  organization.
B)  hospital.
C)  physician.
D)  all of the above.E) A) and C)
F) None of the above

Question 11

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

Accepted Answer

A)  associate practice.
B)  solo practice.
C)  partnership.
D)  group practice.E) A) and B)
F) A) and D)

Question 12

A Medicare-instituted method of hospital payment is

Accepted Answer

A)  HMO.
B)  DRG.
C)  PPO.
D)  EPO.E) A) and B)
F) A) and C)

Question 13

Medicare and Medicaid prohibit physicians from

Accepted Answer

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.E) A) and D)
F) B) and D) A

Question 14

A health maintenance organization (HMO) provides

Accepted Answer

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.E) B) and C)
F) All of the above

Question 15

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

Accepted Answer

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.E) B) and C)
F) A) and D)

Question 16

A fixed-payment plan of health insurance offers coverage for

Accepted Answer

A)  hospital care.
B)  physicians' visits.
C)  complete medical care.
D)  dental care.E) A) and C)
F) None of the above C

Question 17

Medicare is a federal program of

Accepted Answer

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.E) C) and D)
F) B) and C)

Question 18

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

Accepted Answer

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

Question 19

Fee splitting occurs when

Accepted Answer

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.E) A) and B)
F) A) and C) B

Question 20

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

Accepted Answer

A)  the wealthy.
B)  the poor and ignorant.
C)  those who understand the system.
D)  all of the above.E) None of the above
F) B) and D)

Exam 4: Todays Healthcare Environment

The purpose of the gatekeeper is to

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Benefits of a corporation include all of the following except

Correct AnswerverifiedShow Answer

Medicaid is a

Correct AnswerverifiedShow Answer

Managed care organizations may attempt to limit a patient's

Correct AnswerverifiedShow Answer

The members of a professional corporation are known as

Correct AnswerverifiedShow Answer

Diagnosis-related groups refer to

Correct AnswerverifiedShow Answer

Third-party payers are

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

A Medicare-instituted method of hospital payment is

Correct AnswerverifiedShow Answer

Medicare and Medicaid prohibit physicians from

Correct AnswerverifiedA

A health maintenance organization (HMO) provides

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

A fixed-payment plan of health insurance offers coverage for

Correct AnswerverifiedC

Medicare is a federal program of

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Fee splitting occurs when

Correct AnswerverifiedB

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

Correct AnswerverifiedShow Answer

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified
A

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified
C

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified
B

Correct Answer
verified