CMD Healthcare Administration & Management 2

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?

Accepted Answer

Launch a hierarchical condition category (HCC) coding education program

Answer

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?

Accepted Answer

A physician referring Medicare patients to a lab in which she holds an ownership interest

Answer

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?

Accepted Answer

INTERACT (Interventions to Reduce Acute Care Transfers)

Answer

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?

Accepted Answer

Compensation set in advance and not based on the value of referrals

Answer

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?

Accepted Answer

Door-to-provider time

Answer

Door-to-provider time directly measures how quickly patients receive initial clinical evaluation, reflecting ED throughput efficiency.

(CMD) Certified Medical Director Practice Test

(CMD) Certified Medical Director Practice Test

CMD Healthcare Administration & Management 2