CPHIMS CPHIMS Healthcare Environment Fundamentals 2 — Questions and Answers
Question 1: Which federal act established the conditions for participation that hospitals must meet to receive Medicare and Medicaid reimbursement?
- Health Insurance Portability and Accountability Act
- Social Security Act (Correct answer)
- Affordable Care Act
- HITECH Act
Correct answer: Social Security Act
The Social Security Act established Conditions of Participation (CoPs) that healthcare organizations must meet to receive Medicare and Medicaid payments.
Question 2: In the US healthcare system, what is the primary role of a Federally Qualified Health Center (FQHC)?
- To provide specialty care to insured patients only
- To offer comprehensive primary care to underserved populations regardless of ability to pay (Correct answer)
- To manage electronic health records for rural hospitals
- To coordinate Medicare Advantage plans
Correct answer: To offer comprehensive primary care to underserved populations regardless of ability to pay
FQHCs are community-based healthcare providers that receive federal funding to provide primary care services in underserved areas on a sliding-fee scale.
Question 3: Which of the following best describes 'capitation' as a healthcare payment model?
- Paying providers a set fee for each service rendered
- Paying providers a fixed amount per enrolled patient per month regardless of services used (Correct answer)
- Paying a lump sum for an episode of care
- Reimbursing providers based on reported outcomes
Correct answer: Paying providers a fixed amount per enrolled patient per month regardless of services used
Capitation pays providers a predetermined monthly fee per patient, shifting financial risk to the provider regardless of how many services are actually delivered.
Question 4: The Leapfrog Group is best known for which activity in the US healthcare environment?
- Setting federal EHR certification standards
- Publicly reporting hospital safety and quality scores (Correct answer)
- Accrediting healthcare information professionals
- Administering the CPHIMS examination
Correct answer: Publicly reporting hospital safety and quality scores
The Leapfrog Group is an employer-driven coalition that publicly reports hospital performance data to improve transparency, safety, and quality.
Question 5: Under value-based purchasing (VBP), Medicare withholds a percentage of DRG payments and redistributes them based on what?
- Number of patients served
- Hospital size and teaching status
- Performance scores on quality and patient experience measures (Correct answer)
- Percentage of uncompensated care provided
Correct answer: Performance scores on quality and patient experience measures
CMS withholds a portion of base DRG payments and returns them—potentially with bonuses—based on hospitals' Total Performance Scores across multiple quality domains.
Question 6: Which organization publishes the ICD-10-CM diagnosis coding system used in US clinical documentation?
- American Medical Association
- Centers for Medicare & Medicaid Services and CDC (Correct answer)
- American Health Information Management Association
- The Joint Commission
Correct answer: Centers for Medicare & Medicaid Services and CDC
ICD-10-CM is maintained and published jointly by CMS and the CDC's National Center for Health Statistics for use in US clinical settings.
Question 7: A hospital's 'case mix index' (CMI) is significant in healthcare finance primarily because it:
- Measures patient satisfaction scores across departments
- Reflects the average relative weight of all patient cases and influences Medicare revenue (Correct answer)
- Tracks the percentage of patients with chronic conditions
- Determines staffing ratios required by state regulators
Correct answer: Reflects the average relative weight of all patient cases and influences Medicare revenue
CMI represents the average DRG weight for a hospital's inpatient cases; a higher CMI indicates more complex cases and results in higher Medicare reimbursements.
CPHIMS CPHIMS Healthcare Environment Fundamentals 2
Which federal act established the conditions for participation that hospitals must meet to receive Medicare and Medicaid reimbursement?