ABPS Healthcare Systems & Administration 5

Question 1

What does 'FQHC' stand for and what is its significance in U.S. healthcare?

Accepted Answer

Federally Qualified Health Center — safety-net providers receiving enhanced Medicare/Medicaid reimbursement

Answer

FQHCs are community-based health centers serving underserved areas that receive enhanced federal reimbursement rates and are required to serve all patients regardless of ability to pay.

Question 2

A hospital's 'charge master' (chargemaster) is best described as:

Accepted Answer

A comprehensive list of prices for every service, procedure, and supply the hospital provides

Answer

The chargemaster is the hospital's master list of standard prices for all billable items, serving as the starting point for negotiating rates with payers.

Question 3

Under the ACA's individual mandate (prior to its effective elimination), what was the consequence for not having qualifying health insurance?

Accepted Answer

A financial penalty assessed through the federal tax return

Answer

The ACA's individual mandate imposed a tax penalty on uninsured individuals, though the Tax Cuts and Jobs Act of 2017 reduced this penalty to $0 effective 2019.

Question 4

The 'medical loss ratio' (MLR) regulation under the ACA requires insurers to spend what minimum percentage of premium revenue on clinical care and quality?

Accepted Answer

80% for individual/small group and 85% for large group plans

Answer

The ACA requires insurers to spend at least 80% (individual/small group) or 85% (large group) of premiums on medical care; excess profits must be rebated to consumers.

Question 5

Which of the following best describes the role of a 'hospitalist' in the U.S. healthcare system?

Accepted Answer

A physician who specializes in the care of hospitalized patients and has no outpatient practice

Answer

Hospitalists focus exclusively on inpatient care, improving efficiency, reducing length of stay, and ensuring continuity of care during hospitalization.

(ABPS) American Board of Physician Specialties Certification Practice Test

(ABPS) American Board of Physician Specialties Certification Practice Test

ABPS Healthcare Systems & Administration 5