MHA Trivia 4 — Questions and Answers
Question 1: What does 'ICD' stand for in medical coding, and who maintains it internationally?
- International Classification of Diseases, maintained by the World Health Organization (WHO) (Correct answer)
- Integrated Clinical Data, maintained by the American Medical Association
- International Coding Directory, maintained by CMS
- Inpatient Clinical Diagnoses, maintained by the Joint Commission
Correct answer: International Classification of Diseases, maintained by the World Health Organization (WHO)
The ICD (International Classification of Diseases) is a WHO classification system used globally to code diagnoses, symptoms, and medical procedures.
Question 2: What is the 'Stark Law' in the context of US healthcare regulation?
- A federal law prohibiting physician self-referral to entities with which they have a financial relationship (Correct answer)
- A state law requiring price transparency in hospital billing
- A regulation governing nursing home staffing ratios
- A law mandating electronic health record adoption
Correct answer: A federal law prohibiting physician self-referral to entities with which they have a financial relationship
The Stark Law (Physician Self-Referral Law) prohibits physicians from referring Medicare/Medicaid patients to entities in which the physician or immediate family has a financial interest.
Question 3: Which payment model bundles payments for all services related to a single episode of care?
- Bundled payments (episode-of-care payments) (Correct answer)
- Fee-for-service payments
- Capitation payments
- Retrospective cost-based reimbursement
Correct answer: Bundled payments (episode-of-care payments)
Bundled payment models provide a single, comprehensive payment for all services delivered during a defined episode of care, incentivizing care coordination and efficiency.
Question 4: What is the purpose of a 'Certificate of Need' (CON) law in healthcare?
- To require state approval before adding new healthcare facilities or expensive services (Correct answer)
- To certify that patients need a specific medical procedure before it is covered
- To license new nurses and physicians entering practice
- To authorize hospitals to bill Medicare for inpatient services
Correct answer: To require state approval before adding new healthcare facilities or expensive services
CON laws require healthcare organizations to obtain state approval before adding new facilities, beds, or expensive equipment to prevent unnecessary duplication of services.
Question 5: In healthcare human resources, what does 'FTE' stand for and why is it significant?
- Full-Time Equivalent — a standardized measure of workforce that enables staffing comparisons (Correct answer)
- Fixed Term Employment — a contract type for temporary clinical staff
- Financial Tracking Estimate — used in budget forecasting
- Facility Training Enrollment — count of staff in mandatory training programs
Correct answer: Full-Time Equivalent — a standardized measure of workforce that enables staffing comparisons
FTE (Full-Time Equivalent) converts all employee hours to a standard unit, allowing administrators to compare staffing levels regardless of whether employees work full-time or part-time.
Question 6: Which of the following best describes 'value-based purchasing' (VBP) in the context of Medicare?
- A program that adjusts hospital payments based on performance on quality and patient experience measures (Correct answer)
- A competitive bidding process for medical equipment suppliers
- A discount program for bulk purchasing of pharmaceuticals
- A system where patients choose hospitals based on published cost data
Correct answer: A program that adjusts hospital payments based on performance on quality and patient experience measures
Medicare's Hospital Value-Based Purchasing program links a portion of hospital payments to performance on quality metrics, outcome measures, and patient experience scores.
Question 7: What is the primary function of a hospital's 'utilization review' department?
- To evaluate the appropriateness and necessity of medical services and length of stay (Correct answer)
- To monitor supply usage and procurement costs
- To conduct employee performance evaluations
- To review marketing materials for regulatory compliance
Correct answer: To evaluate the appropriateness and necessity of medical services and length of stay
Utilization review departments assess whether the type and level of healthcare services provided to patients are medically necessary and appropriate, helping control costs and ensure quality.
MHA Trivia 4
What does 'ICD' stand for in medical coding, and who maintains it internationally?