Trivium Healthcare Systems and Operations 2 — Questions and Answers
Question 1: Which federal program primarily provides health insurance coverage for individuals aged 65 and older?
- Medicaid
- Medicare (Correct answer)
- CHIP
- TRICARE
Correct answer: Medicare
Medicare is the federal health insurance program for people aged 65 and older, as well as certain younger people with disabilities.
Question 2: What is the primary purpose of a formulary in a health insurance plan?
- To list covered medical procedures
- To outline patient rights
- To specify covered prescription drugs and their cost tiers (Correct answer)
- To define network provider directories
Correct 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.
Question 3: In hospital operations, what does the term 'census' refer to?
- Annual staff performance reviews
- The number of patients currently admitted (Correct answer)
- Total hospital revenue for the month
- A count of available equipment
Correct 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.
Question 4: Which accreditation body sets standards for hospitals and healthcare organizations in the United States?
- The Joint Commission (TJC) (Correct answer)
- American Medical Association (AMA)
- Centers for Medicare & Medicaid Services (CMS)
- National Institutes of Health (NIH)
Correct answer: The Joint Commission (TJC)
The Joint Commission is an independent, nonprofit organization that accredits and certifies healthcare organizations based on established performance standards.
Question 5: What is 'capitation' in the context of managed care payment models?
- A fee paid per procedure performed
- A fixed monthly payment per enrolled patient regardless of services used (Correct answer)
- A reimbursement based on diagnosis-related groups
- A bonus paid for achieving quality benchmarks
Correct 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.
Question 6: Which law requires employers with 20 or more employees to offer continuation of group health coverage after certain qualifying events?
- HIPAA
- COBRA (Correct answer)
- ERISA
- ACA
Correct 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.
Question 7: What is the role of a utilization review (UR) coordinator in a healthcare setting?
- Hiring and onboarding clinical staff
- Evaluating the appropriateness and necessity of medical services (Correct answer)
- Managing the facility's supply chain and inventory
- Processing patient billing and claims
Correct 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.
Trivium Healthcare Systems and Operations 2
Which federal program primarily provides health insurance coverage for individuals aged 65 and older?