Introduction to Healthcare and Public health in the US: Financing Healthcare
(Part 2)
Self-assessment key
1. Samples of an electronic data interchange transaction include (choose all that apply):
a. a fax copy of the claim
b. CMS Form 1500
c. CMS Form 1450
*d. 837 transaction for healthcare claims
Answer: d. Faxes and CMS forms 1450 and 1500 are paper based.
Objective(s): 1
Lecture/Slide(s): a22
2. Which of the following is currently used to code claims for healthcare services
(choose all that apply):
*a. CPT
*b. ICD-9-CM
*c. NDC - National Drug Codes
*d. ICD-10-PCS
Answer: a, b, c, d. All are code sets that can be used for claims processing.
Objective(s): 1
Lecture/Slide(s): a14-17
3. Which of the following is used for diagnosis coding and reporting on claims
regardless of the provider?
*a. ICD-9
b. CPT
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Healthcare and
Public Health in the US
Financing Healthcare (Part 2)
This material (Comp1_Unit5) was developed by Oregon Health and Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
1
c. HCPCS
d. CDT
Answer: a. The ICD-9 is used by all providers to code a diagnosis.
Objective(s): 1
Lecture/Slide(s): a16
4. Fee-for-service payment type include (choose all that apply):
a. episode-of-care
*b. traditional retrospective
c. prospective payment
d. global payment
*e. self-pay
Answer: b, e. Traditional retrospective and self-pay are two types of fee-for-service
payments. Prospective payment and global payment are types of episode-of-care
payments.
Objective(s): 1
Lecture/Slide(s): a25-27
5. The third party payer is
a. the insured
b. the provider
*c. the insurance company
d. all of the above
Answer: c. The insured is the first party, the provider is the second party, and the
insurance company is the third party.
Objective(s): 1
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Healthcare and
Public Health in the US
Financing Healthcare (Part 2)
This material (Comp1_Unit5) was developed by Oregon Health and Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
2
Lecture/Slide(s): a4
6. Episode of care reimbursement types include all of the following except:
*a. self-pay
b. prospective payment
c. capitation
d. global payment
Answer: a. Self-pay is a fee-for-service type payment.
Objective(s): 1
Lecture/Slide(s): a27, 28
7. Managed care reimbursement may be paid using which of the following methods:
a. fee-for-service
b. episode-of-care
*c. either fee-for-service or episode-of-care
d. none of the above
Answer: c. Both fee-for-service or episode-of-care methodologies are used by managed
care organizations to pay providers.
Objective(s): 1
Lecture/Slide(s): a34
8. The sectors of healthcare spending that utilize the most resources include (choose all
that apply):
*a. hospitals
*b. physician services
*c. pharmaceutical costs
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Healthcare and
Public Health in the US
Financing Healthcare (Part 2)
This material (Comp1_Unit5) was developed by Oregon Health and Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
3
d. nursing homes
Answer: a,b,c. Hospital cost, physician services, and pharmaceutical expenses account
for approximately 60% of all healthcare costs.
Objective(s): 2
Lecture/Slide(s): b9, 12, 14
9. Which of the following is not considered a chronic disease?
a. hypertension or high blood pressure
b. diabetes
c. asthma
*d. influenza
Answer: d. Influenza is an acute illness that is expected to resolve. Hypertension,
diabetes, and asthma are chronic diseases that will require ongoing care.
Objective(s): 2
Lecture/Slide(s): b17
10. The age group associated with the highest medical expenses is:
a. children <5
b. adults age 25-44
c. adults age 45-64
*d. adults > 65
Answer: d. Adults age 65 and older average more than $9000 in annual expenses in
2009.
Objective(s): 2
Lecture/Slide(s): b20
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Healthcare and
Public Health in the US
Financing Healthcare (Part 2)
This material (Comp1_Unit5) was developed by Oregon Health and Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
4
11. The EMTALA act requires hospitals receiving federal funds to evaluate individuals
presenting to the emergency department
a. only if they have insurance
*b. regardless if their ability to pay
c. only if they pay in advance
d. only if it is a true emergency
Answer: b. Under the emergency treatment and active labor act, any individual
presenting to the emergency department must be evaluated to see if an emergency
exists regardless of their ability to pay.
Objective(s): 2
Lecture/Slide(s): b27
12. Healthcare spending can be slowed by
a. reducing unnecessary services
b. reducing care of marginal value
c. rationing resources
*d. all of the above
Answer: d. All the choices have the potential to slow healthcare spending, but some are
more acceptable than others.
Objective(s): 3
Lecture/Slide(s): c9-11
13. Evidence-based medicine is
a. provided by physician experts during malpractice suits
b. leads to higher medical costs
*c. examines the evidence gathered from scientific research and applies it to clinical
decision making
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Healthcare and
Public Health in the US
Financing Healthcare (Part 2)
This material (Comp1_Unit5) was developed by Oregon Health and Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
5
d. cannot be used to predict a treatment outcome
Answer: c. EBM uses review of the published scientific literature to determine the best
course of treatment.
Objective(s): 3
Lecture/Slide(s): c11-13
14. Defensive medicine
a. results in increased healthcare expenditures
b. a practice to safeguard the provider against potential malpractice lawsuits
c. involves additional testing or valuations that is of marginal value in the treatment and
care of an individual
*d. all of the above
Answer: d. Defensive medicine involves the use of additional healthcare services at
increased cost that provide little value to the treatment of individuals in the belief that a
malpractice suit can be avoided.
Objective(s): 3
Lecture/Slide(s): c8
15. Concierge medicine or retainer practices
a. is a business model that involves the payment of a monthly or annual retainer or
membership fee
b. limits the total number of patients in the practice
c. does not eliminate the need for health insurance
*d. all of the above
Answer: d. Concierge medicine is a variation of the medical home that involves a
retainer payment for improved access to the provider.
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Healthcare and
Public Health in the US
Financing Healthcare (Part 2)
This material (Comp1_Unit5) was developed by Oregon Health and Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
6
Objective(s): 3
Lecture/Slide(s): c14-18
16. Alternative methods for delivering primary care at a low cost include (choose all that
apply):
*a. urgent care
*b. retail clinics
c. emergency departments
d. requiring specialists to also provide primary care
Answer: a,b. Urgent care centers and retail clinics provide access to primary care
providers at a cost lower than available through the emergency department.
Objective(s): 3
Lecture/Slide(s): c19
17. (Choose all that apply) Factors that contribute to escalating healthcare expenditures
in the US include:
*a. Technology.
*b. Chronic disease.
*c. Increased demand and utilization.
*d. An excess of primary care doctors.
*e. New pharmaceutical treatments.
*f. Administrative costs.
*g. The uninsured.
Answer: a, b, c, e, f, g. All of the above contribute to rising healthcare expenditures in
the US except for answer d - an excess of primary care doctors. The shortage of
primary care doctors in the US (the so called “primary care crisis”) may contribute to
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Healthcare and
Public Health in the US
Financing Healthcare (Part 2)
This material (Comp1_Unit5) was developed by Oregon Health and Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
7
overutilization of more expensive services, such as the hospital emergency department
or specialists for healthcare services that could be provided in the primary care setting.
Objective(s): 4
Lecture/Slide(s): b8-29
18. Methods to control healthcare costs that raise ethical questions for providers, policy
makers, and patients include which of the following?
a. Rationing.
b. Changing utilization patterns through wellness and prevention.
c. Use of evidence based medicine and clinical practice guidelines.
d. Changing utilization patterns through increased patient out-of-pocket expenses.
*e. a and d
f. b and c
g. All of the above.
Answer: e. Rationing of healthcare services and requiring patients to pay for an
increased proportion of healthcare services raises ethical issues in caring for the
disadvantaged and creating a two-tier system of healthcare.
Objective: 5
Lecture/Slide(s): c9, 10-21
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Healthcare and
Public Health in the US
Financing Healthcare (Part 2)
This material (Comp1_Unit5) was developed by Oregon Health and Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
8