CMD Healthcare Administration & Management 2 — Questions and Answers
Question 1: A medical director notices that physician documentation rates for Medicare Advantage patients fall significantly below CMS benchmark expectations. Which intervention most directly addresses this risk?
- Implement mandatory retrospective chart audits
- Launch a hierarchical condition category (HCC) coding education program (Correct answer)
- Increase hospitalist staffing levels
- Suspend new Medicare Advantage enrollments
Correct answer: Launch a hierarchical condition category (HCC) coding education program
HCC coding education helps physicians accurately document diagnoses that drive risk-adjustment scores, aligning with CMS expectations.
Question 2: Under the Stark Law, which arrangement is most likely to constitute a prohibited self-referral?
- A hospital employing physicians and paying fair-market-value salaries
- A physician referring Medicare patients to a lab in which she holds an ownership interest (Correct answer)
- A group practice sharing ancillary service revenue among its members
- A physician leasing office space from a hospital at fair market rates
Correct answer: A physician referring Medicare patients to a lab in which she holds an ownership interest
Stark Law prohibits physicians from referring Medicare patients to entities in which they have a financial relationship, including ownership interests, absent a statutory exception.
Question 3: A long-term care facility wants to reduce avoidable hospitalizations. Which evidence-based program is specifically designed to achieve this goal?
- INTERACT (Interventions to Reduce Acute Care Transfers) (Correct answer)
- HEDIS reporting framework
- CAHPS survey administration
- IHI Triple Aim initiative
Correct answer: INTERACT (Interventions to Reduce Acute Care Transfers)
INTERACT is a quality improvement program with tools and protocols designed to identify, evaluate, and manage acute changes in condition before they require hospitalization.
Question 4: A medical director is asked to evaluate a proposed incentive compensation plan for employed physicians. Which element is most essential to ensure compliance with Anti-Kickback Statute safe harbors?
- Bonuses tied to referral volume to affiliated services
- Compensation set in advance and not based on the value of referrals (Correct answer)
- Productivity targets linked to specialist referral rates
- Annual compensation reviews conducted by the medical director alone
Correct answer: Compensation set in advance and not based on the value of referrals
Anti-Kickback safe harbors for employment require that compensation be set in advance at fair market value and not reflect the volume or value of referrals.
Question 5: Which metric is most appropriate for evaluating throughput efficiency in an emergency department?
- Readmission rate within 30 days
- Door-to-provider time (Correct answer)
- Hospital-acquired infection rate
- Physician satisfaction score
Correct answer: Door-to-provider time
Door-to-provider time directly measures how quickly patients receive initial clinical evaluation, reflecting ED throughput efficiency.
Question 6: A post-acute care facility is transitioning to value-based purchasing. Which financial model most closely aligns provider incentives with patient outcomes across an episode of care?
- Fee-for-service with volume targets
- Bundled payment arrangement (Correct answer)
- Per-diem rate with no quality adjustments
- Cost-plus reimbursement contract
Correct answer: Bundled payment arrangement
Bundled payments assign a single prospective payment for an entire care episode, incentivizing all providers to coordinate care and manage costs while meeting quality benchmarks.
Question 7: A medical director must address a pattern of after-hours call avoidance by several physicians. Which approach best balances accountability with professional standards?
- Immediately terminate the physicians for policy violations
- Issue anonymous group warnings through a staff newsletter
- Review the on-call policy with affected physicians, document expectations, and implement a performance improvement plan if behavior continues (Correct answer)
- Reassign all after-hours call to advanced practice providers permanently
Correct answer: Review the on-call policy with affected physicians, document expectations, and implement a performance improvement plan if behavior continues
A structured response—reviewing policy, documenting expectations, and escalating to a PIP—respects due process while holding physicians accountable.
CMD Healthcare Administration & Management 2
A medical director notices that physician documentation rates for Medicare Advantage patients fall significantly below CMS benchmark expectations.
Which intervention most directly addresses this risk?