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QUESTION NO:14

Gatekeepers requiring a patient to obtain a referral from his or her primary care

physician, the gatekeeper, before assign a specialist.

A. True

B. False

Answer: A

QUESTION NO:9

____________ is the tendency health care practitioners to do more testing and to provide

more care for patients than might otherwise be necessary to protect themselves against

potential litigation.

Answer:

Defensive medicine

QUESTION NO:15

Requiring providers to have their capital expenditures preapproved by an independent

state agency to avoid unnecessary duplication of services is referred to as:

A. Preapproval certifications and opinions

B. Preapproved payments

C. Certificate of need

D. State service reviews

Answer: C

QUESTION NO:16

Which one of the following systems is used to classify inpatients based o their diagnoses,

used by both Medicare and private insurers?

A. Diagnosis-related groups

B. Proactive payments system

C. Payment insurance group D.

None of the above

Answer: A

QUESTION NO:10

In which act, federal legislation designed to tighten accounting standards in financial

reporting and that holds top executives personally liable as to the accuracy and fairness of

their financial statements?

A. Sarbanes-Oxley Act

B. Insurance accountability Act

C. Financial statement Act

D. Portability and Accountability Standardized Act

Answer: A

QUESTION NO:4

The combination of age and technology has increased cost with the passage of time.

A. True

B. False

Answer: A

QUESTION NO:1

The key factors that have contributed to the higher cost of health care include:

A. Technology, aging population, chronic disease and litigation

B. Aging population, chronic disease, performance payment and litigation

C. Technology, performance payment and litigation

D. All of the above

Answer: A

QUESTION NO:7

that providers have to pay insurers to cover the cost of defending against

the lawsuits and paying large jury awards.

A. Ambulatory payment classifications

B. Reimbursement Insurance cost plan

C. Health proactive Insurance standard act

D. Increased insurance premiums

Answer: D

QUESTION NO:12

Which one of the following is NOT the factor of Uninsured?

A. Health insurance premiums becoming too costly

B. Requiring patients to pay for the part of their own care-up

C. Individuals being screened out of insurance policies

D. Employers feeling they cannot afford to continue to provide health insurance as a

benefit

Answer: B

QUESTION NO:13

Concurrent review states that:

A. Planning appropriateness and medical necessity of a hospital stay while the patient is

in the hospital and implementing discharge planning.

B. Monitoring appropriateness and medical necessity of a hospital stay while the patient

is not in the hospital and try to implement discharge planning.

C. Planning appropriateness and medical necessity of a hospital stay while the patient is

not in the hospital and try to implement preadmission planning.

D. Monitoring appropriateness and medical necessity of a hospital stay while the patient

is in the hospital and implementing discharge planning.

Answer: D

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