Test Bank For Medical Law, Ethics, and Bioethics for the Health Professions, 7th Edition

Chapter 2: Medical Practice Management True/False Indicate whether the statement is true or false. ____ 1. “Bond” is a document banked for an employee to provide a bonus for work well done. ____ 2. “Conglomerate” is a corporation of different companies operating in many different fields. ____ 3. “Co-payment” is the expense providers pay for insurance participation. ____ 4. “Opt-out option” allows members to seek treatment outside their health-care plan. ____ 5. Providers are responsible for both general liability and professional liability. ____ 6. Corporations are easy and inexpensive to establish. ____ 7. Physician-hospital organizations combine hospitals and insurance companies to offer a “one-stop shopping approach.” ____ 8. General liability helps a provider to cover any malpractice suits. ____ 9. A MSO allows providers to focus on client care. ____ 10. An employee who works only in the clinical area may be asked to become bonded. Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 11. A provider who receives all the profits and takes all the risks is practicing in a: a. partnership. c. sole proprietorship. b. professional service corporation. d. joint venture. ____ 12. Advantages of a partnership include: a. increased financial strength. b. incompatibility of partners. c. increased managerial skill and shared workload. d. A and C. ____ 13. The HMO: a. was introduced to emphasize preventive health care. b. is a form of health-care delivery decreasing in popularity. c. places emphasis on curative medicine. d. places control of health care in the hands of providers. ____ 14. Preferred Provider Organizations: a. are physician-hospital organizations providing “one-stop shopping” for client health care. b. do not employ sole proprietors. c. contract with providers for medical care to an established number of clients. d. are federal forms of medical insurance. ____ 15. Employees might choose to work in a group practice because: a. they like to work independently. b. there are opportunities for advancement. c. their only supervisor would be their provider-employer. d. the workload will be less complex. ____ 16. All but one of the following is an example of payment for medical services: a. pay for performance c. deductible b. co-payment d. bonding ____ 17. Providers who practice in any integrated organization must remember: a. antitrust laws will not apply to their decision. b. Medicare/Medicaid may not recognize some business arrangements. c. Medicare/Medicaid referrals cannot be made to any entity in which they have financial interest. d. B and C. ____ 18. A type of managed care that reimburses providers for their progress toward a fixed goal. a. HMO c. P4P b. PPO d. CFO ____ 19. This health plan is one of the largest, not-for-profit HMOs in the country: a. Kaiser Foundation Health Plan c. Tufts Health Plan b. Blue Cross/Blue Shield Health Plan d. Medicare Health Plan ____ 20. A HMO makes use of the concept of a primary care provider (PCP) as a method of controlling costs. This PCP is known as a: a. crossing guard. b. gatekeeper. c. fence closer. d. herder. Completion Complete each statement. 21. Some communities may require providers to obtain a/an ____________________ before allowing a facility to open for the practice of medicine. 22. The ____________________ owns and operates health-care centers staffed by providers contractually employed directly by the plan. 23. ____________________ pays health-care providers a fixed monthly fee for a range of services for each HMO member in their care. 24. ____________________ is a common management choice for the increasing number of providers in complementary medicine. 25. The ____________________ is the most intricate of all forms of medical practice and can be formed by one or more individuals. 26. The federal government has set forth incentives for medical school graduates to pay their college loans if they commit to practice in ____________________ for a set amount of time. 27. ____________________ first provided insurance for hospital costs in the early 1930s. 28. The increased power of ____________________ continues to take decision making away from providers and clients. 29. A ____________________ allows a provider to make all the decisions and to incur minimal organizational costs. 30. ____________________ at both the state and national levels is also affecting health-care delivery systems. Short Answer 31. List and describe the four main types of group practice. 32. Identify your personal choice of business management or organization for employment and justify your response with the advantages and disadvantages discussed. 33. List and describe the general liability protection a provider-employer should carry. 34. List two advantages of the PSC for health-care employees. 35. Define general liability for providers. Matching Match the terms with their definitions. a. Insurance contract that protects against f. financial loss to the employer caused by the act of an employee b. Medical expense that is a member’s g. responsibility usually paid at the time of service c. Pays providers for each service h. performed d. Sharing arrangement in which a i. member pays a set amount toward Type of managed care that encourages providers to improve the quality of their clients’ care Type of business management where hospitals, providers, and clinics form to offer client care Legal entity that is granted many of the same rights enjoyed by individuals Arrangement for health care in which a health insurance company acts as an covered services before the insurance carrier begins to make any payments e. Practice of medicine that looks at the whole person including body, mind, spirit, and lifestyle ____ 36. pay for performance ____ 37. deductible ____ 38. multiple service organization ____ 39. joint venture ____ 40. managed care ____ 41. co-payment ____ 42. corporation ____ 43. fee for service ____ 44. bond ____ 45. integrative medicine j. intermediary between the client and the provider Organization developed to perform office management services Chapter 2: Medical Practice Management Answer Section TRUE/FALSE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. ANS: F ANS: T ANS: F ANS: T ANS: T ANS: F ANS: F ANS: F ANS: T ANS: F PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: 1 1 1 1 1 1 1 1 1 1 PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: 1 1 1 1 1 1 1 1 1 1 MULTIPLE CHOICE 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. ANS: C ANS: D ANS: A ANS: C ANS: B ANS: D ANS: D ANS: C ANS: A ANS: B COMPLETION 21. ANS: business license PTS: 1 22. ANS: staff-model HMO PTS: 1 23. ANS: Capitation PTS: 1 24. ANS: Sole proprietorship PTS: 1 25. ANS: professional service corporation PTS: 1 26. ANS: a rural area PTS: 1 27. ANS: Blue Cross PTS: 1 28. ANS: insurance carriers PTS: 1 29. ANS: sole proprietorship PTS: 1 30. ANS: Political influence PTS: 1 SHORT ANSWER 31. ANS: Single-specialty provides services in only one field of practice or major specialty, for example, a group of pediatricians joining together in practice. Multispecialty provides services in two or more fields of practice or major specialties, for example, a group of obstetrician-gynecologists and pediatricians joining together in practice. Primary care group providers join together in practice, for example, a pediatrician, an obstetrician, a gynecologist, a family practice, and an internist. Hospital-managed medical groups offer all the same services as a regular group practice but are owned by a hospital. PTS: 1 32. ANS: Answers will vary depending on each student’s preferences, but students should mention the advantages and disadvantages of their choice listed in the text. PTS: 1 33. ANS: Building and grounds—protects provider from anyone injured on premises. Automobile—protects provider for injuries incurred while doing business in the automobile. Theft, fire, and burglary—protects provider and business from damages due to all three. PTS: 1 34. ANS: Answers will vary but should include profit-sharing plans/pensions and corporate medical reimbursement plans that may be available to employees. PTS: 1 35. ANS: Answers will vary but should include the following: General liability regards business matters and protects a provider against loss. A provider needs to be covered against theft, burglary, fire, and employees’ safety. Nonowner automobile insurance may also be necessary. PTS: 1 KEY: CAAHEP: IX.C.6 MATCHING 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. ANS: F ANS: D ANS: J ANS: G ANS: I ANS: B ANS: H ANS: C ANS: A ANS: E PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: PTS: 1 1 1 1 1 1 1 1 0 0