CPHIMS CPHIMS Healthcare Environment Fundamentals 3

Question 1

Which piece of legislation created the Children's Health Insurance Program (CHIP) to provide coverage for uninsured children in families above Medicaid income limits?

Accepted Answer

Balanced Budget Act of 1997

Answer

The Balanced Budget Act of 1997 established CHIP (originally SCHIP), extending health coverage to millions of children in low- to moderate-income families.

Question 2

In a Health Maintenance Organization (HMO), patients typically must:

Accepted Answer

Select a primary care physician and obtain referrals for specialist visits

Answer

HMOs require members to select a primary care physician (PCP) who acts as a gatekeeper and must provide referrals for specialist care within the network.

Question 3

The National Quality Forum (NQF) plays which role in the US healthcare quality landscape?

Accepted Answer

Endorsing standardized performance measures used for public reporting and payment

Answer

NQF is a nonprofit that endorses consensus-based performance measures used by CMS, accreditors, and health plans for quality reporting and value-based payment.

Question 4

What is the primary purpose of the Medicare Severity Diagnosis Related Group (MS-DRG) system?

Accepted Answer

To classify inpatient hospital cases into groups for standardized payment

Answer

MS-DRGs classify inpatient cases into clinically coherent groups with similar resource utilization to establish fixed prospective payment amounts for Medicare.

Question 5

A hospital that participates in a Pioneer Accountable Care Organization (ACO) model primarily aims to:

Accepted Answer

Improve care coordination and share in savings achieved below a spending benchmark

Answer

ACOs coordinate care for an assigned Medicare population and share in any savings when total spending falls below a set benchmark while meeting quality thresholds.

CPHIMS Exam Practice Test

CPHIMS Exam Practice Test

CPHIMS CPHIMS Healthcare Environment Fundamentals 3