Healthcare Systems and Operations Flashcards
7 cards from real TRIVIUM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Healthcare Systems and Operations flashcards as text
Which federal program primarily provides health insurance coverage for individuals aged 65 and older?
Answer: Medicare
Medicare is the federal health insurance program for people aged 65 and older, as well as certain younger people with disabilities.
What is the primary purpose of a formulary in a health insurance plan?
Answer: To specify covered prescription drugs and their cost tiers
A formulary is a list of prescription drugs covered by an insurance plan, often organized into tiers that determine patient cost-sharing amounts.
In hospital operations, what does the term 'census' refer to?
Answer: The number of patients currently admitted
Hospital census refers to the number of inpatients present in the facility at a given time, used to manage staffing and resources.
Which accreditation body sets standards for hospitals and healthcare organizations in the United States?
Answer: The Joint Commission (TJC)
The Joint Commission is an independent, nonprofit organization that accredits and certifies healthcare organizations based on established performance standards.
What is 'capitation' in the context of managed care payment models?
Answer: A fixed monthly payment per enrolled patient regardless of services used
Capitation is a payment model where a provider receives a fixed amount per enrolled member per month, regardless of how many services that member uses.
Which law requires employers with 20 or more employees to offer continuation of group health coverage after certain qualifying events?
Answer: COBRA
COBRA (Consolidated Omnibus Budget Reconciliation Act) requires employers with 20+ employees to offer continued health coverage after events like job loss or divorce.
What is the role of a utilization review (UR) coordinator in a healthcare setting?
Answer: Evaluating the appropriateness and necessity of medical services
A utilization review coordinator evaluates whether medical services, admissions, and length of stay are medically necessary and appropriate per clinical criteria.