HCA Final Exam| 50 Questions | With Complete Solutions

The Affordable Care Act extended dependent healthcare coverage up to age: correct answer: 26 What is the purpose of the Summary of Benefits and Coverage (SBC)? correct answer: Provides health insurance benefits information which enables consumers to compare different insurance plans. Gross Domestic Product (GDP) is the total finished products or services that are produced in a country within a year. In 2014, what percent of the United States GDP was spent on health care? correct answer: 17.5% An epidemic is defined as a widespread occurrence of an infectious disease in a community at a particular time. correct answer: True True or False? Many healthcare systems are evaluated using the Iron Triangle—a concept that focuses on the balance of three factors—quality, cost, and accessibility to health care. correct answer: True True or False? A buffet plan is a type of employer-sponsored benefit plan that allows employees to select the type of benefits appropriate for their lifestyle. correct answer: False The Affordable Care Act has the following provisions: correct answer: -Established the Health Insurance Marketplace -Bans health plans from establishing lifetime dollar amounts on most healthcare insurance reimbursement -Requires most U.S. citizens to purchase health insurance or pay a fine -All of the above!!!!!!!!!!! There are 8 major provisions of the Patient Protection and Affordable Care Act of 2010 correct answer: False In the phrase "The United States spends more per capita on health care than any other country worldwide," what does per capita mean? correct answer: Per person True or False? Tertiary prevention reduces the impact of an already established disease by reducing disease-related complications. It focuses on rehabilitation and monitoring of diseased individuals. correct answer: True True or False? A National Health Care Workforce Commission will review workforce needs and make recommendations to the federal government to ensure that national policies are in alignment with consumer needs. correct answer: True True or False? Quaternary prevention reduces the impact of an already established disease by reducing disease-related complications. It focuses on rehabilitation and monitoring of diseased individuals. correct answer: False The Organization for Economic Cooperation and Development (OECD) is membership organization that provides comparable statistics of economic and social data worldwide. correct answer: True True or False? Bad debt or charitable care means the provider either doesn't expect payment after the person's inability to pay has been determined or efforts to secure the payment have failed. correct answer: True True or False? The Healthcare Home Medicaid website will publish data that will enable consumers to compare the quality of long term facilities' care. There will be links to state websites, summary of complaints of facilities, and any criminal violations. correct answer: False The PPACA is also known as the Affordable Care Act. correct answer: True Which professional organization represents nursing, assisted living, developmentally disabled, and subacute-care providers? correct answer: American Health Care Association True or False? A National Allied Healthcare Workforce Commission will review workforce needs and make recommendations to the federal government to ensure that national policies are in alignment with consumer needs. correct answer: False Which legislative act was passed to ensure that consumers were not refused treatment for an emergency life threatening health situation? correct answer: Emergency Medical Treatment and Active Labor Act (EMTALA) True or False? State health departments often develop targeted, large education campaigns regarding a specific health issue in their area. Primary prevention activities are focused on early disease detection which prevents progression of the disease. Screening programs such as high blood pressure testing is an example of secondary prevention activities. correct answer: False Which one of the following is NOT a stakeholder in healthcare: correct answer: -Consumer -Hospital -Robots!!!!!! -Employer Which of these are essential health benefits? a) Prescription drugs b) Emergency services c) Maternity and newborn care d) All of these are correct. correct answer: d) All of these are correct. A principle in the U.S. Healthcare System is duty to treat - meaning that everyone deserves basic care. correct answer: True The establishment of the __________ in 1847 for physicians was a driving force for the concept of private practice in medicine. correct answer: American Medical Association The Elder Justice Act was passed in order to: correct answer: prevent and eliminate elder patient abuse Coinsurance is part of a fee for service policy where the patient pays a percentage of the cost of the services. correct answer: True Medicare Part D covers hospitalization. correct answer: False True or False? Health maintenance organizations (HMOS) are the oldest type of managed care. Members must see their primary care provider first in order to see a specialist. correct answer: True True or False? The most common type of prospective reimbursement is a service benefit plan which is used primarily by managed care organizations. correct answer: True A gatekeeper is the primary care provider who coordinates all patient care. correct answer: True The most common type of healthcare services reimbursement is called: correct answer: Service benefit plan Copayments are costs that patients must pay at the time they receive the services. correct answer: True Medicare Part A covers professional services, like physician visits. correct answer: False Deductibles are payments that are required prior to the insurance paying for services rendered in a fee-for-service plan correct answer: True The National Committee on Quality Assurance (NCQA) was established to maintain the quality of care in health plans. correct answer: True Medicare cost plans are a type of HMO and have similar rules to Medicare Advantage plans. CMS reimburses the MCOs on a preset monthly basis per enrollee based on a forecasted budget. correct answer: True Fee for service is the concept of a person purchasing coverage for certain benefits, using the health insurance coverage for these designated benefits, and paying the provider for the services provided. correct answer: True Implemented in October 2000, the __________ which is a prospective payment used by Medicare, pays a fixed predetermined rate for each 60-day episode of care, regardless of the services. correct answer: Home Health Resource Group (HHRG). Medicare Advantage covers Parts A and B. correct answer: True True or False? A fee for service (FFS) system was the traditional health insurance plan that paid a fee for a provided service by the provider. This system increased the costs of healthcare throughout its history. correct answer: True When Medicare pays a premium per member that is based on the member's county of residence, it is called a(an): correct answer: a) risk plan There are two basic types of insurance plans - fee for service and managed care plans correct answer: True Deductibles are payments that are required prior to the insurance paying for services rendered. correct answer: True Medicare Part B covers prescription drugs. correct answer: False Worker's compensation is a state-administered program providing cash for lost wages, payment for medical treatment and survivor's death benefits. correct answer: True What are limited benefit plans? correct answer: They only provide one or two Medicaid benefits. True or False? Add on are health care services that will not be paid by MCOs which could include experimental treatment, drug costs, and behavioral health costs. correct answer: False True or False? Carve outs are health care services that will not be paid by MCOs which could include experimental treatment, drug costs, and behavioral health costs. correct answer: True True or False? A classification system called resource utilization group (RUG) was designed to differentiate patients based on how much they use the resources of the facility. As the patient's condition changes, the rate of reimbursement changes. A per diem rate was established using these classifications. correct answer: True Medicare risk plans pay a premium per member that is based on the member's county of residence. correct answer: True