Chapter 1

Question 1

Accountable Care Organization

Answer 1

A group of health care providers who provide coordinated care to target patient populations, with the intent of tying financial incentives to quality outcomes and lowered costs

Question 2

Electronic health record

Answer 2

Online version of patients charts which can include patient demographics, insurance information, dictations and notes, medication and immunization histories, ancillary test results, etc.

Question 3

Group purchasing organizations

Answer 3

Third-party entities that contract with multiple hospitals to offer cost savings in the purchase of supplies and equipment by negotiating large-volume discounted contracts with vendors

Question 4

HIPAA (1996)

Answer 4

Ensures standardization of billing, privacy, and reporting as institutions convert to electronic systems

Question 5

ICD-10

Answer 5

WHO’s coding system of diseases used in the U.S. for health insurance claim reimbursement

Question 6

ACA

Answer 6

Federal statute requiring individuals to obtain health insurance coverage (“individual mandate”) or pay a penalty. Goal: to provide mechanisms to expand access to care, improve quality and control costs.

Question 7

Value-based purchasing

Answer 7

Payment methodology designed to provide incentives to providers for delivering quality health care at lower costs. Funds are withheld by the payor and redistributed based on providers’ achievement of performance measures

Question 8

Goal of finance in business

Answer 8

To increase revenue, lower expenses, or improve productivity (can affect either 1 or 2 higher revenue or lower expenses)

Question 9

Capitation

Answer 9

A system which pays providers a specific amount in advance to care for the health care needs of a population over a specific time period. Providers are usually paid on per member per month (PMPM) basis. The provider then assumes the risk that the cost of caring for the population will not exceed the aggregate PMPM amount received.