OCC Practice Management & Healthcare Systems Flashcards

Which federal program provides health insurance primarily to individuals aged 65 and older and certain disabled persons in the US?

Answer: Medicare

Medicare is the federal health insurance program for people 65 or older and certain younger people with disabilities.

Under HIPAA, which of the following is NOT considered Protected Health Information (PHI)?

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.

Which value-based payment model rewards healthcare providers for efficiency and quality rather than the volume of services rendered?

Answer: Pay-for-performance (P4P)

Pay-for-performance models tie reimbursement to quality metrics and efficiency outcomes rather than the number of services provided.

The Affordable Care Act (ACA) requires that employer-sponsored health insurance plans cover preventive services with what patient cost-sharing?

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.

An osteopathic physician joins an Accountable Care Organization (ACO). What is the primary goal of an ACO?

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.

Which coding system is primarily used in the US for diagnosis coding in outpatient medical records?

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.