Law & Ethics For Health Professions 7Th Edition By Karen Judson

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Sample Test

Chapter 03

Working in Health Care

Multiple Choice Questions

1. A valid out-of-state license is accepted as the basis for issuing a license in a second state without reexamination. This is called:
A. certification
B. accreditation
C. registration
D. reciprocity
E. endorsement

Reciprocity is when a second state accepts the first state’s credentials for licensing a health care provider. Certification, registration, and accreditation are not licensure methods. Endorsement is on a case-by-case basis and infrequently used.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Remember
CAAHEP: IX.C.5. Discuss licensure and certification as it applies to healthcare providers
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 03.01
Topic: Licensure, certification, registration and accreditation

2. Which of the following credentials is a voluntary, national examination that shows the level of competency for an individual?
A. certification
B. accreditation
C. registration
D. reciprocity
E. endorsement

Certification and registration are both voluntary, but certification will require an exam. Reciprocity is when a second state accepts the first state’s credentials for licensing a health care provider. Licensure is a mandatory process. Accreditation is used for organizations, not individuals. Endorsement is on a case-by-case basis and infrequently used.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Understand
CAAHEP: IX.C.5. Discuss licensure and certification as it applies to healthcare providers
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 03.01
Topic: Licensure, certification, registration and accreditation

3. Which of these credentials is mandatory for certain health professionals to practice in their field?
A. certification
B. accreditation
C. registration
D. reciprocity
E. licensure

Licensure is a mandatory process. Reciprocity is when a second state accepts the first state’s credentials for licensing a health care provider. Certification, registration, and accreditation are not licensure methods.

4. A health care provider is explaining to staff members about the accreditation process. Which of the following may be accredited?
A. a pharmacist
B. a hospital
C. a pharmaceutical company
D. a pharmacy
E. a medical supply company

Accreditation is the process by which health care practitioner education programs, health care facilities, and managed care plans are officially authorized. It is the official approval for conforming to specific standards.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Understand
CAAHEP: none
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 03.01
Topic: Licensure, certification, registration and accreditation

5. A new long-term care facility is applying for accreditation of the facility. To which of the following organizations should the facility submit the accreditation application?
A. the American Health Care Association
B. the National Committee for Quality Assurance
C. The Joint Commission
D. the Commission on Accreditation of Allied Health Education Programs
E. the National Association for the Support of Long Term Care

The Joint Commission accredits health care organizations that meet certain standards. The National Committee for Quality Assurance is a recognized accrediting agency for management care plans. An accrediting agency for health care practitioner education programs is the Commission on Accreditation of Allied Health Education Programs. The American Health Care Association and the National Association for the Support of Long Term Care are industry-specific professional organizations.

6. The statutes in all 50 states that govern the practice of medicine are called:
A. medical practice acts
B. medical licensing acts
C. occupational statutes
D. physician licensing acts
E. national board of medical licensing

A medical practice act is established in each state to govern not just licensing, but other practice standards.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Remember
CAAHEP: none
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 03.02
Topic: Physicians’ education and licensing

7. Which of the following is not sufficient grounds for revoking a medical license?
A. conviction of a felony
B. falsifying medical records
C. misdiagnosis
D. personal incapacity
E. unprofessional conduct

In the options provided, a physician may, depending on the state medical practice act, lose his or her license for conviction of a felony, falsifying medical records, incapacity, or unprofessional conduct. A misdiagnosis is not grounds for revoking a license—but that does not mean that the physician won’t be sued for the misdiagnosis.

8. A physician is entering a residency to complete her education. Which of the following accurately describes this process?
A. a period of practical postgraduate training in a nursing home
B. a three-year period of training as an intern
C. a period of practical postgraduate training in a hospital
D. a four-year process that certifies the physician as a NBME Diplomate
E. a one-year period of training as an intern

In order to complete a residency, the physician must complete a period practical postgraduate training, usually in a hospital. The first year of residency is called an internship. After the completion of the internship, and passing the medical boards, the National Board of Medical Examiners certifies the physician as an NBME Diplomate.

ABHES: none
Accessibility: Keyboard Navigation
CAAHEP: none
Difficulty: 3 Hard
Est Time: 0-1 minute
Learning Outcome: 03.02
Topic: Physicians’ education and licensing

9. Most medical training is provided in tertiary care settings. Which of the following is an example of a tertiary care setting?
A. physician’s office
B. trauma center
C. mobile clinic serving migrant workers
D. community health care clinic
E. walk in clinic

Tertiary care settings are those providing highly specialized services, such as would be found in a trauma center. Physician offices, mobile or community health care clinics, and walk-in clinics are primary care settings. Medical residents may spend some time in primary care settings, but the predominant model is trauma and hospitals.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Understand
CAAHEP: none
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 03.02
Topic: Physicians’ education and licensing

10. Both Doctors of Medicine (MDs) and Doctors of Osteopathy (DOs) follow requirements to obtain a degree in their field. Which of the following is the basic difference between these two degrees?
A. MDs require more years of training to complete the program.
B. DOs require more years of training to complete the program.
C. DOs are not allowed to prescribe drugs.
D. MDs are not allowed to practice surgery.
E. MDs are trained in allopathic medicine.

MDs and DOs both spend 12 years or more training to become physicians. Both medical and osteopathic surgeons prescribe drugs and practice surgery. Osteopathic doctors are trained to emphasize the musculoskeletal system and the correction of joint and tissue problems. Medical doctors (MDs) are trained in allopathic medicine, which means “different suffering,” and there is an emphasis on intervention in the form of drugs and/or surgery to alleviate symptoms.

11. Which practice management system allows for a sharing of expenses without sharing profits and liability?
A. associate practice
B. partnership
C. sole proprietorship
D. group practice
E. corporation

An associate practice is one where space and staff may be shared, but not profits or liabilities. In a sole proprietorship, there is only one practitioner. Partnerships, group practices, and corporations share not only profits, but losses and liabilities.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Remember
CAAHEP: none
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 03.03
Topic: Medical practices management systems

12. Medical practices are being consolidated in many forms. Which of the following is not one of those forms?
A. associate practice
B. partnership
C. sole proprietorship
D. group practice
E. corporation

Sole proprietorships are no longer a popular way to practice medicine. In an associate practice, space and staff may be shared, but not profits or liabilities. Partnerships, group practices, and corporations share not only profits, but losses and liabilities. Because of higher technology costs, more managed care, and reduced reimbursements, most physicians practice in some kind of group arrangement.

13. Which of the settings below provides limited liability for the providers?
A. associate practice
B. partnership
C. sole proprietorship
D. group practice
E. professional corporation

While some group practices may be able to establish a limited liability, only corporate practices ensure limited liability.

14. Insured patients must designate a primary care provider (PCP) under which type of plan?
A. indemnity plan
B. point-of-service plan
C. preferred provider plan
D. independent practice plan
E. open access plan

A preferred provider plan usually requires that you select a primary care provider. While the other plans may prefer that you have a PCP, it is not usually required.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Understand
CAAHEP: VII.C.2. Identify models of managed care
Difficulty: 2 Medium
Est Time: 0-1 minute
Learning Outcome: 03.04
Topic: Types of managed care

15. A copayment is
A. a percentage of the fee for services provided that the patient pays.
B. a set amount that each patient pays for each office visit.
C. a portion of the fee that the physician must write off.
D. the actual payment the insurance company makes to the provider.
E. a capitation payment.

A copay and coinsurance are both related to what the patient pays. However, coinsurance is always a percentage, not a set fee.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Remember
CAAHEP: none

Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 03.04
Topic: Types of managed care

16. When physicians, hospitals, and other health care providers contract with one or more HMOs or directly with employers to provide care, it is called a(n)
A. health maintenance plan.
B. physician hospital organization.
C. fee-for-service plan.
D. indemnity plan.
E. open access plan.

In many areas, physicians and hospitals join forces to negotiate with the HMOs or large employers to provide care. A fee-for-service plan and an open access plan focus on patient choice, while an indemnity plan is a more traditional insurance plan, sometimes called fee-for-service.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Remember
CAAHEP: VII.C.2. Identify models of managed care
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 03.04
Topic: Types of managed care

17. Under this concept, a patient is established with a physician in a primary care group practice that provides a long-term partnership between the patient and providers in the group practice and also provides enhanced access for patients.
A. health maintenance plan
B. primary care medical home
C. patient-centered medical home
D. independent practice home
E. open access plan

A patient-centered medical home (PCMH) provides the patient with a team of physicians and other staff whose focus is on coordination of care and shared decision making. This is a relatively new concept in managed care.

18. Coinsurance is
A. a percentage of the fee for services provided that the patient pays.
B. a set amount that each patient pays for each office visit.
C. a portion of the fee that the physician must write off.
D. the actual payment the insurance company makes to the provider.
E. a capitation payment.

A copay and co-insurance are both related to what the patient pays. Coinsurance is always a percentage, not a set fee.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Remember
CAAHEP: none

Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 03.04
Topic: Types of managed care

19. A method used by a health plan to measure the amount and appropriateness of health services used by its members is called a(n)
A. coinsurance review.
B. capitation review.
C. accountable care review.
D. formulary review.
E. utilization review.

A utilization review is the method used by health plans to measure appropriate services. A formulary is a list of approved prescriptions for which it will reimburse subscribers. Capitation is a set advance payment made to providers, and coinsurance refers to the amount of money that insurance plan members pay out of pocket.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Remember
CAAHEP: none

Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 03.04
Topic: Types of managed care

20. Under this type of plan, a patient may see providers outside the plan, but the patient pays a higher portion of the fees.
A. health maintenance plan.
B. indemnity plan.
C. fee for service plan.
D. preferred provider plan.
E. open access plan.

In a preferred provider plan, patients have a monetary incentive to stay within the preferred provider plan, but they have a choice of seeking care outside the plan and can seek some reimbursement. An HMO-enrolled patient is prohibited from going outside the plan. Indemnity plans, fee-for-service plans, and open access plans allow patients to see physicians of their choosing.

21. What federal legislation created health insurance exchanges that provide individuals with an ability to purchase insurance?
A. Health Insurance Portability and Accountability Act
B. Health Care and Education Reconciliation Act
C. Healthcare Integrity and Protection Data Bank Act
D. Patient Protection and Affordable Care Act
E. Health Care Quality Improvement Act

The Patient Protection and Affordable Care Act, passed in 2010, better known as the Affordable Care Act, provided for a health insurance exchange process that was put into place in 2014. This process allowed many individuals to purchase low-cost health insurance subsidized by the federal government based on income status. The Health Care and Education Reconciliation Act had a variety of student loan provisions and support for training programs.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Remember
CAAHEP: none
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 03.05
Topic: Legislation affecting health care plans

22. What federal legislation provided employees the ability to keep health insurance coverage when transferring to another job?
A. Health Insurance Portability and Accountability Act
B. Health Care and Education Reconciliation Act
C. Healthcare Integrity and Protection Data Bank Act
D. Patient Protection and Affordable Care Act
E. Health Care Quality Improvement Act

While most people know that the Health Insurance Portability and Accountability Act (HIPAA) is known for its privacy and security provisions, it is also responsible for creating the law that allows individuals to keep health insurance coverage when moving from job to job. The Patient Protection and Affordable Care Act, better known as the Affordable Care Act, provided for a variety of new opportunities to purchase health insurance. The Health Care and Education Reconciliation Act had a variety of student loan provisions and support for training programs. The Health Care Quality Improvement Act created the national Practitioner Data Bank.

ABHES: none
Accessibility: Keyboard Navigation
Bloom’s: Understand
CAAHEP: none
Difficulty: 1 Easy
Est Time: 0-1 minute
Learning Outcome: 03.05
Topic: Legislation affecting health care plans

23. The National Practitioner Data Bank may disclose information to which of the following groups?
A. medical malpractice insurers
B. defense attorneys
C. state licensing boards
D. the general public
E. state legislators

State licensing boards are entitled to the information. Only hospitals conducting professional review and other health care entities with formal peer review programs, a self-query, and some plaintiffs’ attorneys under certain circumstances may access the information.

24. As a provision of the Accountable Care Act, health care insurers were encouraged to unite with health care providers to form what type of an organization?
A. health maintenance organization
B. preferred provider organization
C. open access plan
D. accountable care organization
E. indemnity plan

The Affordable Care Act created opportunities to form Accountable Care Organizations. These ACOs make a commitment to help specific patients with chronic illnesses. The ACOs were in their beginning stages when the book was published. Health maintenance organizations, preferred providers, open access, and indemnity plans are all forms of provider reimbursement plans that were in place before the ACA became law.

25. Under the provisions in the Affordable Care Act, insurance companies must cover dependent children up to age ___.
A. 22
B. 23
C. 24
D. 25
E. 26

The Affordable Care Act requires insurance companies to cover dependent children until age 26, as long as the parents have coverage.

26. A physician is undergoing professional peer review related to an incident of fraud in his practice. Which federal law requires that professional peer review action be taken in this case and also limits the damages for the professional review?
A. Health Care and Education Reconciliation Act
B. Health Insurance Portability and Accountability Act
C. Healthcare Integrity and Protection Data Bank Act
D. Patient Protection and Affordable Care Act
E. Health Care Quality Improvement Act

The Healthcare Quality Improvement Act requires that professional peer review be done in certain cases. It also created the National Practitioner Data Bank. The Patient Protection and Affordable Care Act, better known as the Affordable Care Act, provided for a variety of new opportunities to purchase health insurance. The Health Care and Education Reconciliation Act had a variety of student loan provisions and support for training programs. Health Insurance Portability and Accountability Act (HIPAA) is known for its privacy and security provisions.

27. A remote consultation with physicians or other health care professionals is called
A. social media.
B. patient monitoring.
C. open access.
D. telemedicine.
E. closed-circuit television.

Telemedicine refers to remote consultations with physicians or other health care professionals. Social media began as social networking, but is also now being used with health care. Patient monitoring may be done by closed-circuit television as a form of telemedicine.

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