OCC Practice Management & Healthcare Systems Flashcards

Which federal law requires hospitals to provide emergency medical screening and stabilization regardless of insurance status or ability to pay?

Answer: EMTALA

EMTALA (Emergency Medical Treatment and Labor Act) requires hospitals with emergency departments to screen and stabilize all patients regardless of payment status.

In a risk-stratified care model, which patient population would be placed in the highest tier requiring most intensive management resources?

Answer: Patients with multiple chronic conditions and frequent hospitalizations

High-risk patients with multiple comorbidities and high utilization are placed in the highest care management tier requiring care coordination and intensive follow-up.

A physician assistant working under a DO's supervision in an outpatient clinic. Which document defines the scope and limits of the PA's practice?

Answer: Supervisory agreement or collaborative practice agreement

Collaborative/supervisory practice agreements legally define the scope, limitations, and oversight requirements for PA practice under a physician.

Which quality improvement methodology uses Define, Measure, Analyze, Improve, and Control (DMAIC) phases?

Answer: Six Sigma

Six Sigma uses the DMAIC framework to systematically reduce defects and variation in processes.

When transitioning a patient from inpatient to outpatient care, which intervention has the strongest evidence for reducing 30-day hospital readmissions?

Answer: Structured transition of care with follow-up phone call within 48 hours

Evidence-based transition care models that include phone follow-up within 48 hours and coordinated handoffs significantly reduce 30-day readmissions.

Which financial metric represents the amount a healthcare organization receives after subtracting contractual adjustments from gross charges?

Answer: Net revenue

Net revenue equals gross charges minus contractual allowances, bad debt, and charity care — it represents actual expected collections.