ABPS Healthcare Systems & Administration 2

Question 1

Which federal agency oversees the Medicare and Medicaid programs in the United States?

Accepted Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

The Department of Health and Human Services (DHHS)

Answer

The Joint Commission (TJC)

Answer

Agency for Healthcare Research and Quality (AHRQ)

Question 2

A hospital's 'case mix index' (CMI) is primarily used to measure which of the following?

Accepted Answer

The complexity and resource intensity of patient cases

Answer

The average length of patient stays

Answer

The ratio of inpatient to outpatient encounters

Answer

The percentage of Medicare versus Medicaid patients

Question 3

Under EMTALA, what is a hospital's obligation when a patient presents to the emergency department?

Accepted Answer

Screen and stabilize any patient regardless of ability to pay

Answer

Provide care only to patients with insurance

Answer

Transfer all uninsured patients to county hospitals

Answer

Obtain pre-authorization before rendering any treatment

Question 4

Which payment model reimburses a fixed amount per patient per month regardless of services used?

Accepted Answer

Capitation

Answer

Fee-for-service

Answer

Pay-for-performance

Answer

Per diem

Question 5

What does the term 'credentialing' refer to in a hospital setting?

Accepted Answer

Verifying a physician's education, training, licensure, and competence before granting privileges

Answer

Issuing billing codes for clinical procedures

Answer

Establishing quality benchmarks for nursing staff

Answer

Registering the hospital with state health departments

Question 6

Which accreditation body sets standards for hospitals in the United States and conducts on-site surveys?

Accepted Answer

The Joint Commission (TJC)

Answer

National Committee for Quality Assurance (NCQA)

Answer

Utilization Review Accreditation Commission (URAC)

Answer

American Medical Association (AMA)

Question 7

A Diagnosis-Related Group (DRG) is best described as:

Accepted Answer

A classification system used to determine Medicare inpatient reimbursement

Answer

A quality metric used to rank hospitals by patient outcomes

Answer

A method of tracking chronic disease prevalence in populations

Answer

A billing code for outpatient physician services