AHIC Healthcare Delivery Systems and Payment Models

Question 1

In a fee-for-service payment model, providers are paid based on what?

Accepted Answer

The volume of services delivered

Answer

Fee-for-service pays for each individual service or procedure, so more services mean more payment. Value-based models were developed partly to counter this volume incentive.

Question 2

Capitation payment means a provider receives:

Accepted Answer

A fixed per-member per-period amount regardless of services used

Answer

Under capitation, providers receive a set amount per enrolled patient per time period. They assume financial risk for the cost of care.

Question 3

What is an Accountable Care Organization (ACO)?

Accepted Answer

A group of providers collectively responsible for the quality and cost of care for a patient population

Answer

ACOs are networks of providers who share responsibility, and savings or losses, for the care of a defined population. They depend heavily on data sharing and analytics.

Question 4

Which program ties Medicare payment adjustments to quality, cost, improvement activities and promoting interoperability for clinicians?

Accepted Answer

MIPS

Answer

The Merit-based Incentive Payment System (MIPS), part of the Quality Payment Program under MACRA, adjusts clinician payments based on performance in these categories.

Question 5

Which care setting is an example of ambulatory care?

Accepted Answer

Outpatient physician clinic

Answer

Ambulatory care is delivered on an outpatient basis without an overnight stay, such as in a physician clinic. ICUs, surgical wards and inpatient nursing wings are inpatient.

(AHIC) AMIA Health Informatics Certification Practice Test

(AHIC) AMIA Health Informatics Certification Practice Test

AHIC Healthcare Delivery Systems and Payment Models