CHAP Healthcare Operations & Management 3 — Questions and Answers
Question 1: Under HIPAA's Minimum Necessary Standard, covered entities must:
- Share all PHI upon any patient request
- Limit PHI disclosures to the least amount needed for the intended purpose (Correct answer)
- Obtain written authorization for all internal PHI use
- Report all PHI disclosures to HHS within 24 hours
Correct answer: Limit PHI disclosures to the least amount needed for the intended purpose
The Minimum Necessary Standard requires covered entities to make reasonable efforts to use, disclose, or request only the minimum PHI needed to accomplish the intended purpose.
Question 2: Which financial metric measures the average number of days it takes a practice to collect payment after a service is rendered?
- Days in accounts payable
- Days in accounts receivable (DAR) (Correct answer)
- Gross collection rate
- Net collection rate
Correct answer: Days in accounts receivable (DAR)
Days in accounts receivable (DAR) measures the average time between service delivery and payment receipt, with lower values indicating more efficient collections.
Question 3: A hospital implements a Pay-for-Performance (P4P) program. The primary goal of this reimbursement model is to:
- Increase the volume of services billed
- Tie provider payments to quality metrics and outcomes (Correct answer)
- Reduce administrative overhead costs
- Standardize physician salaries across specialties
Correct answer: Tie provider payments to quality metrics and outcomes
P4P models incentivize providers by linking reimbursement to achieving defined quality, efficiency, and outcome benchmarks rather than volume alone.
Question 4: Which accreditation organization uses the 'tracer methodology' during on-site surveys of hospitals?
- NCQA
- URAC
- The Joint Commission (TJC) (Correct answer)
- AAAHC
Correct answer: The Joint Commission (TJC)
The Joint Commission uses tracer methodology, following individual patients through their care experience to evaluate systems and processes across departments.
Question 5: A healthcare organization's operating margin is calculated by dividing:
- Net income by total assets
- Operating income by net patient service revenue (Correct answer)
- Total expenses by total revenue
- Net revenue by total liabilities
Correct answer: Operating income by net patient service revenue
Operating margin = operating income ÷ net patient service revenue, expressed as a percentage, indicating profitability from core operations.
Question 6: What is the primary function of a utilization management (UM) program in a healthcare organization?
- Recruit and retain clinical staff
- Ensure appropriate use of healthcare services and resources (Correct answer)
- Manage employee benefits administration
- Oversee medical equipment maintenance
Correct answer: Ensure appropriate use of healthcare services and resources
UM programs review the necessity, appropriateness, and efficiency of healthcare services to ensure resources are used appropriately and costs are managed.
Question 7: Which federal law requires healthcare employers with 50 or more full-time equivalent employees to offer health insurance coverage or face penalties?
- ERISA
- COBRA
- Affordable Care Act (ACA) Employer Mandate (Correct answer)
- FMLA
Correct answer: Affordable Care Act (ACA) Employer Mandate
The ACA Employer Shared Responsibility Provision (employer mandate) requires applicable large employers to offer minimum essential coverage or pay penalties.
CHAP Healthcare Operations & Management 3
Under HIPAA's Minimum Necessary Standard, covered entities must: