ACC 111 EXAM 2

Which of the following characteristics is common to each of these three payment models: Medicare Advantage plan, Commercial Risk Adjustment, and the Medicaid Chronic Illness and Disability Payment System?

• All use MS-DRGs to classify patient severity.

• Each is a risk adjustment model.

• All are concurrent payment models.

• Each is a risk stabilization program.

Answer explanation

Each of these payment models—Medicare Advantage, Commercial Risk Adjustment, and Medicaid Chronic Illness—utilizes risk adjustment to account for patient health status, making 'Each is a risk adjustment model' the correct choice.

How does Pay-for-Performance (P4P) reward the provision of quality care?

• The system awards grants to develop new programs based on best practices.

• The provider is required to privately report performance measures.

• The provider’s payment system is based on performance and incentives.

• The system is based on performance metrics aligned with the volume of services.

Answer explanation

Pay-for-Performance (P4P) directly ties the provider's payment to their performance and quality of care, incentivizing them to improve care standards and outcomes.

How does Pay-for-Performance disrupt the traditional fee-for-service model?

• Organizations have to focus on building additional volume for their current services.

• Providers spend less time capturing data to support their billing claims.

• Hospitals are required to focus on factors unrelated to a fee-for-service system.

• Physicians invest more time in completing paperwork than with their patients.

Answer explanation

Pay-for-Performance shifts focus from volume-based care to quality and outcomes, requiring hospitals to prioritize factors like patient satisfaction and health outcomes, which are not emphasized in the traditional fee-for-service model.

What is a significant disadvantage reported by Pay-for-Performance providers?

• Transparency decreases as a result of the focus on improving innovative outcomes.

• It can reduce access to health care for socioeconomically disadvantaged populations.

• Metrics associated with the care of disadvantaged populations are privately held.

• It stresses the number of services provided to socioeconomically disadvantaged populations.

Answer explanation

The correct choice highlights that Pay-for-Performance can limit healthcare access for socioeconomically disadvantaged populations, as providers may prioritize metrics over equitable care.

How do purchasers like Medicare hold providers of health care accountable for both the costs of healthcare and its quality?

• by providing training resources to improve care after claims are made

• by providing equal payment to all providers regardless of specialty area

• by requiring clinicians and physicians to participate in three tracks of care

• by financially incentivizing providers for health outcomes and efficiency

Answer explanation

Purchasers like Medicare hold providers accountable by financially incentivizing them for achieving better health outcomes and efficiency, ensuring that both cost and quality of care are prioritized.

What quality factor does the Health Information and Management Systems Society define as the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged?

• interoperability

• protocol

• information complexity

• integration

Answer explanation

The correct answer is 'interoperability', which refers to the ability of different IT systems to communicate and exchange data effectively, ensuring that the information can be utilized across various applications.

What determines if measures reported to CMS on behalf of the Hospital Value-Based Purchasing Program are considered valid?

• They are based on clinical best practices.

• They are clinically relevant and scientifically sound.

• They promote interoperability of information.

• They are consistent over time, site, and data collectors.

Answer explanation

Measures reported to CMS must be clinically relevant and scientifically sound to ensure they accurately reflect quality of care and support effective decision-making in the Hospital Value-Based Purchasing Program.

Which program awards incentive payments to nursing facilities based on the quality of care they provide to Medicare beneficiaries as measured by hospital readmissions?

• Skilled Nursing Facility Relief Fund

• Hospital Inpatient Quality Reporting

• Skilled Nursing Facility Value-Based Purchasing Program

• Hospital Value-Based Purchasing Program

Answer explanation

The Skilled Nursing Facility Value-Based Purchasing Program incentivizes nursing facilities based on the quality of care, specifically targeting hospital readmissions for Medicare beneficiaries.

What is one way that health care organizations respond to value-based purchasing and prepare themselves to increase satisfaction for both patients and health care providers?

• use of key performance indicators

• use of efficiency ratios

• use of profitability ratios

• use of operating margins

Answer explanation

Health care organizations use key performance indicators (KPIs) to measure and improve service quality, ensuring higher satisfaction for both patients and providers. KPIs provide actionable insights that drive performance improvements.

Which of the following is not a revenue cycle key performance indicator?

• health information

• types of denials

• total patient experience

• preregistration

Answer explanation

The total patient experience is not a revenue cycle key performance indicator. It focuses on patient satisfaction rather than financial metrics, unlike health information, types of denials, and preregistration, which are directly related to revenue.