OCC OCC Practice Management & Healthcare Systems 1 — Questions and Answers
Question 1: Which federal program provides health insurance primarily to individuals aged 65 and older and certain disabled persons in the US?
- Medicare (Correct answer)
- Medicaid
- CHIP
- TRICARE
Correct answer: Medicare
Medicare is the federal health insurance program for people 65 or older and certain younger people with disabilities.
Question 2: Under HIPAA, which of the following is NOT considered Protected Health Information (PHI)?
- Fully de-identified health data (Correct answer)
- Patient name combined with diagnosis
- Date of birth with medical record number
- ZIP code with treatment information
Correct answer: Fully de-identified health data
HIPAA only protects individually identifiable health information; fully de-identified data that cannot be linked to a specific individual is not PHI.
Question 3: Which value-based payment model rewards healthcare providers for efficiency and quality rather than the volume of services rendered?
- Pay-for-performance (P4P) (Correct answer)
- Fee-for-service (FFS)
- Capitation only
- Cost-plus reimbursement
Correct answer: Pay-for-performance (P4P)
Pay-for-performance models tie reimbursement to quality metrics and efficiency outcomes rather than the number of services provided.
Question 4: The Affordable Care Act (ACA) requires that employer-sponsored health insurance plans cover preventive services with what patient cost-sharing?
- No cost-sharing (zero copay or deductible) (Correct answer)
- 10% copay only
- Standard deductible applies
- State-determined cost-sharing
Correct answer: No cost-sharing (zero copay or deductible)
The ACA mandates that recommended preventive services (A/B grade USPSTF recommendations) be covered without any cost-sharing in most plans.
Question 5: An osteopathic physician joins an Accountable Care Organization (ACO). What is the primary goal of an ACO?
- Coordinate care to improve quality and reduce costs (Correct answer)
- Increase specialist referrals for complex cases
- Maximize procedure volume for revenue
- Focus exclusively on inpatient hospital care
Correct answer: Coordinate care to improve quality and reduce costs
ACOs are groups of providers who voluntarily coordinate care for Medicare patients to deliver high-quality, cost-effective care.
Question 6: Which coding system is primarily used in the US for diagnosis coding in outpatient medical records?
- ICD-10-CM (Correct answer)
- CPT-4
- HCPCS Level II
- DRG system
Correct answer: ICD-10-CM
ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is the standard for diagnosis coding in US outpatient settings.
OCC OCC Practice Management & Healthcare Systems 1
Which federal program provides health insurance primarily to individuals aged 65 and older and certain disabled persons in the US?