Healthcare Management Flashcards

An employee reports that a supervisor is making unwanted romantic advances. Under Title VII, this is classified as:

Answer: Quid pro quo sexual harassment

Unwanted romantic advances by a supervisor that affect terms of employment constitute quid pro quo sexual harassment under Title VII.

A medical practice's payer mix shifts significantly toward Medicaid patients. The MOST likely financial impact is:

Answer: Reduced net collections due to lower Medicaid reimbursement rates

Medicaid typically reimburses at lower rates than commercial insurance, reducing the practice's net revenue per encounter.

The purpose of credentialing medical staff before they can see patients at a facility is primarily to:

Answer: Verify qualifications and ensure patient safety standards

Credentialing verifies education, licensure, training, and competency to protect patients and ensure only qualified providers deliver care.

When calculating a practice's net collection rate, which formula applies?

Answer: Payments collected ÷ (charges minus contractual adjustments) × 100

Net collection rate measures actual collections against the maximum collectible amount after contractual adjustments, the truest measure of billing effectiveness.

A practice manager wants to reduce no-show rates. Which intervention has the strongest evidence of effectiveness?

Answer: Automated appointment reminders via text/phone

Automated reminders via text message or phone calls are consistently shown to significantly reduce no-show rates in clinical settings.

Under the False Claims Act, a whistleblower (qui tam relator) who reports Medicare fraud may receive:

Answer: A percentage of the government's recovery

Qui tam relators can receive 15–30% of the government's recovery from False Claims Act enforcement actions.

A healthcare manager reviewing OSHA compliance for a medical office must ensure that the Bloodborne Pathogens Standard requires annual:

Answer: Training on exposure control and PPE use

OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) requires annual employee training on exposure control, PPE, and response procedures.