Healthcare Billing Quiz 2

Questions and Answers

What is one reason large companies can obtain contracts at lower rates?

They are affiliated with government programs.

They have more patients to treat.

They have better healthcare technology.

They benefit from bulk purchasing power. (correct)

What is a characteristic of acute care hospitals regarding their pricing?

They offer discounts for low-income patients.

They publish prices for patient comparisons.

They do not publish their prices for comparison. (correct)

They charge uniform prices across services.

Which statement is true about surprise billing for out-of-network services?

Patients are rarely charged for these services.

Patients are automatically enrolled in a payment plan.

Patients must approve all out-of-network services in advance.

Patients can be charged weeks after receiving care. (correct)

What does the term 'Role Fidelity' imply in healthcare?

Being faithful to the established scope of practice. Signup and view all the answers

What does a Deductible refer to in health insurance?

The portion of the bill that must be paid before insurance kicks in. Signup and view all the answers

How can Global Budgeting benefit healthcare coordination?

By encouraging care coordination with cost reduction. Signup and view all the answers

What is required for a group of physicians to open a new facility?

A Certificate of Need from the State. Signup and view all the answers

Which statement best describes antitrust laws in relation to healthcare companies?

They do not completely prevent market domination. Signup and view all the answers

Which of the following is NOT typically considered a nurse-sensitive indicator?

Physician billing errors. Signup and view all the answers

What is the main purpose of accountable care in healthcare?

To improve health outcomes and service utilization. Signup and view all the answers

Study Notes

Patient Care and Costs

Large companies can secure contracts for healthcare at lower rates, benefiting their employees.
Acute care hospitals do not publish prices, making it difficult for patients to compare services.
Surprise billing occurs when patients unknowingly receive out-of-network services, leading to unexpected charges post-emergency visits.

Regulatory and Safety Standards

Nurse-sensitive indicators, including safety measures, help assess the quality of patient care.
The Joint Commission does not inspect outpatient and inpatient services primarily for cost comparison.
Role fidelity requires healthcare workers to adhere to their defined scopes of practice, relevant in situations like a patient requesting confidentiality.

Healthcare Coordination and Records

Doctors rely on a patient's Electronic Health Record (EHR) to coordinate care effectively.
High-cost insurance does not guarantee the best coverage or service quality.

Market Dynamics and Legal Framework

Antitrust laws may fail to prevent market domination, affecting competition in the healthcare sector.
Certain facilities struggle to remain operational despite state or federal support.

Certificate of Need (CON)

Physicians must obtain a Certificate of Need from the state to establish new healthcare facilities.

Financial Management in Healthcare

Global budgeting promotes care coordination and cost reduction.
Accountability for positive health outcomes is essential for improving public health.

Patient-Centric Care

Managing services and treatments exemplifies prioritizing patient interests.
Patients are responsible for paying deductibles as set by their insurance companies.

Cost-sharing includes deductibles, copayments, and coinsurance, impacting overall health expenses.

Healthcare Payment Systems

Diagnosis Related Groups (DRG) allow for extended hospital stays and additional treatments based on specific conditions.
The Affordable Care Act (ACA) funding is derived from multiple sources to support healthcare accessibility.

Description

Test your knowledge on healthcare billing practices and patient services. This quiz covers various topics including hospital pricing, surprise billing, and safety measures in nursing. Perfect for healthcare professionals and students looking to review essential concepts in medical billing.