CPHIMS CPHIMS Healthcare Environment Fundamentals 2

Question 1

Which federal act established the conditions for participation that hospitals must meet to receive Medicare and Medicaid reimbursement?

Accepted Answer

Social Security Act

Answer

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)?

Accepted Answer

To offer comprehensive primary care to underserved populations regardless of ability to pay

Answer

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?

Accepted Answer

Paying providers a fixed amount per enrolled patient per month regardless of services used

Answer

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?

Accepted Answer

Publicly reporting hospital safety and quality scores

Answer

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?

Accepted Answer

Performance scores on quality and patient experience measures

Answer

CMS withholds a portion of base DRG payments and returns them—potentially with bonuses—based on hospitals' Total Performance Scores across multiple quality domains.

CPHIMS Exam Practice Test

CPHIMS Exam Practice Test

CPHIMS CPHIMS Healthcare Environment Fundamentals 2