Legal And Ethical Issues for Health Professions, 3e 3rd Edition By Elsevier-Test Bank

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Legal And Ethical Issues for Health Professions, 3e 3rd Edition By Elsevier-Test Bank

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WITH ANSWERS
Legal And Ethical Issues for Health Professions, 3e 3rd Edition By Elsevier-Test Bank

Chapter 02: The Basics of Ethics

Test Bank

 

MULTIPLE CHOICE

 

  1. The definition of ethics is:
a. the values that influence human behavior.
b. tying our actions to what is right or wrong.
c. ones moral principles.
d. all of the above.

 

 

ANS:  D

When discussing the definition of ethics, it can mean several things. As a branch of philosophy, ethics studies the values that influence human behavior, tying our actions to a sense of right and wrong. A second aspect is an individuals ethics; this refers to one persons moral principles, the values that govern a single persons decisions with a goal of maintaining ones integrity or conscience.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 18

 

  1. Values are:
a. thoughts a person has.
b. principles one chooses to live by.
c. knowing right from wrong.
d. ones integrity.

 

 

ANS:  B

Values are the principles that an individual chooses to live by. Although these may be personal values, they are also the qualities that drive most ethical behavioral models for groups.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 19

 

  1. The principle of doing no harm is called:
a. integrity.
b. beneficence.
c. nonmaleficence.
d. autonomy.

 

 

ANS:  C

Nonmaleficence is part of a physicians oath to do no harm. In bioethical terms, the principle of nonmaleficence means that healthcare professionals should avoid harming a patient.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 25

 

  1. If there is one heart available for transplant and healthcare professionals must make the decision as to who gets the heart, which bioethical principle is involved?
a. Integrity
b. Beneficence
c. Nonmaleficence
d. Justice

 

 

ANS:  D

The principle of justice means treating everyone fairly, and distributing healthcare justly or fairly is a key issue in many ethical debates.

 

DIF:    Cognitive Level: Application          REF:   pp. 25, 27

 

  1. The reason that most people enter the healthcare field is grounded in the principle of:
a. nonmaleficence.
b. integrity.
c. beneficence.
d. justice.

 

 

ANS:  C

Beneficence is another word for doing good, or being kind, which is a predominant reason that most people enter the healthcare field.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 25

 

  1. Actions that show respect for human dignity, such as being honest and putting the patient first, reflect which of the following principles?
a. Integrity
b. Justice
c. Beneficence
d. Nonmaleficence

 

 

ANS:  A

Integrity is part of the standards of the healthcare profession and the actions that show respect for human dignity.

 

DIF:    Cognitive Level: Comprehension   REF:   pp. 18-19

 

  1. Who is the most important person in the healthcare organizations code of ethics?
a. Healthcare professional
b. Patient
c. Physician
d. Hospital administrator

 

 

ANS:  B

Usually a healthcare organizations code of ethics will include statements regarding the treatment and care of the patient as the most important priority, emphasizing handling all with dignity and respect. These in turn dictate such standards as guarding and respecting patient confidentiality.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 19

 

  1. When healthcare professionals attempt to improve the situations surrounding the patient, they are practicing which of the following principles?
a. Autonomy
b. Beneficence
c. Bioethics
d. Nonmaleficence

 

 

ANS:  B

Beneficence means doing good or being kind, and the actions taken on behalf of the patient should always be aimed at helping the patient.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 25

 

  1. Respect for others whose beliefs, practices, religions, or customs may differ from our own is called:
a. integrity.
b. values.
c. utilitarianism.
d. tolerance.

 

 

ANS:  D

Tolerance is respect for others whose beliefs, practices, religions, or customs may differ from our own. Tolerance must be practiced by all healthcare providers in all fields. We do not have to agree with or condone the behaviors, beliefs, or practices of another individual but can never pass judgment by our actions or words against another.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 20

 

  1. Unwavering adherence to an individuals values and principles with dedication to high standards is:
a. integrity.
b. values.
c. utilitarianism.
d. tolerance.

 

 

ANS:  A

Integrity is part of ones individual ethics, which refers to one persons moral principles, the values that govern a single persons decisions with a goal of maintaining ones integrity or conscience.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 18-19

 

  1. Principles that individuals choose to live by are called:
a. integrity.
b. values.
c. utilitarianism.
d. tolerance.

 

 

ANS:  B

Although these may be personal values, they are also the qualities that drive most ethical behavioral models for groups. Individually, a person may value loyalty or privacy as well as freedom. For a group, the code of ethics would mirror these values and require that all employees or individuals involved in that group adhere to the principles prescribed in that organizations code of ethics.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 19

 

  1. Ethical theory based on the greatest good for the greatest number is called:
a. integrity.
b. values.
c. utilitarianism.
d. tolerance.

 

 

ANS:  C

Also called beneficence, utilitarianism is doing the most good and/or benefiting the largest number, which is one of the four foundational principles emphasized by the American Medical Association.

 

DIF:    Cognitive Level: Comprehension   REF:   pp. 25-26

 

  1. This ethical theory is based on the obligation of the individual to perform his or her responsibility no matter the circumstance.
a. Teleology
b. Deontology
c. Rights-based ethics
d. Justice-based ethics

 

 

ANS:  A

The general principle of teleology includes impartial thinking with respect to individuals. All individuals are considered equal and rules are absolute and should be obeyed by everyone. In other words, it is the duty of an individual to adhere to universal rules and regulations, regardless of circumstances.

 

DIF:    Cognitive Level: Comprehension   REF:   pp. 25-26

 

  1. This type of ethics theory emphasizes the specific person and does not consider the general population.
a. Teleology
b. Deontology
c. Rights-based ethics
d. Justice-based ethics

 

 

ANS:  C

This theory is based on the individuals rights. The emphasis is on the specific person and does not always take the consequences of the general population into consideration, asserting instead that those rights should be upheld no matter what the circumstances. If misused, this could lead to individual gain without regard for damage or harm that can be caused to others.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 25, 27

 

  1. Justice is blind ethics theory is considered:
a. teleology.
b. virtue-based ethics.
c. rights-based ethics.
d. justice-based ethics.

 

 

ANS:  D

This theory is that all individuals should be treated with impartiality and there should be no advantages or disadvantages to individuals. Many believe this theory would prevent unfairness and injustice under social contracts, such as the distribution of organ donations.

 

DIF:    Cognitive Level: Comprehension   REF:   pp. 25, 27

 

  1. This ethics theory is based on character traits and qualities of individuals.
a. Teleology
b. Virtue-based ethics
c. Rights-based ethics
d. Justice-based ethics

 

 

ANS:  B

The traits include honesty, integrity, and hard work. Its focus is the individual striving for a better life, and is considered virtue-based ethics.

 

DIF:    Cognitive Level: Comprehension   REF:   pp. 25, 28

 

  1. What is the first question one should ask when making ethical business decisions?
a. Is it true?
b. Is it legal?
c. Is it balanced?
d. How does it make me feel?

 

 

ANS:  B

When facing a difficult choice, keep in mind that no ethical decision should be based on emotions. Ethical dilemmas should be faced and handled with logic and facts, weighing the alternatives and the consequences, and keeping an objective mind.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 29

 

  1. In the seven-step decision-making model, what is the first step that should be taken?
a. Determine the exact ethical issue involved.
b. Determine the rules, laws, principles, or values are involved.
c. Determine all the facts of the situation.
d. List all possible courses of action.

 

 

ANS:  C

The first step to be taken should be to determine the what, when, where, who, and why of the situation. The other options should be done after the facts are determined.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 29

 

  1. In the Dr. Bernard Lo clinical model method of decision making, one should first:
a. clarify the ethical issue.
b. determine the pros and cons of each option.
c. determine the exact ethical issue involved.
d. gather information.

 

 

ANS:  D

One should first gather the patients mental status, comorbidities, views of the other healthcare providers for the patient, and other issues that might complicate the patients case when making an ethical decision.

 

DIF:    Cognitive Level: Comprehension   REF:   pp. 29-30

 

  1. Medical ethics committees formed in very large medical facilities:
a. make decisions with the physicians input only.
b. make decisions based on logic and the codes and standards of the facility.
c. make decisions based on emotions.
d. make decisions with the patients input only.

 

 

ANS:  B

Ethics committees generally see or speak with the patients themselves but focus solely on the facts involved in the situation. This helps them make ethical determinations on the issues or cases brought before them based on logic, on the codes and standards, as opposed to emotions.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 30

 

  1. What is accreditation?
a. Officially recognizing a person or organization for meeting standards established by an industry
b. Obtaining enough continuing education credits
c. Recognizing the achievements of healthcare providers publicly
d. Recognizing a healthcare provider for their years of service

 

 

ANS:  A

Accreditation uses standards of care established by an industry to officially recognize an individual or organization. Many facilities and organizations maintain voluntary participation with accreditation organizations, who routinely examine the organization or facility to verify (as an objective party) that the standards of care and procedures of the organizations are in compliance.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 30

 

  1. An important program each healthcare facility should have is:
a. an open policy to speak to any physician.
b. educational assistance for continuing education.
c. employee benefits that include healthcare.
d. quality assurance programs.

 

 

ANS:  D

These programs are formed to evaluate and ideally prevent situations that arise and cause ethical dilemmas. They evaluate patient satisfaction, complaints, and outcomes of treatment. These programs focus on prevention and improvement of policies and recommend and monitor actions that noncompliant healthcare facilities can take for improvement.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 30

 

  1. What is the principle that ethics should be based on what is consistent and fair to everybody?
a. Beneficence
b. Nonmaleficence
c. Autonomy
d. Justice

 

 

ANS:  D

The four main principles of ethics are doing the most good for the most people, doing the least harm to the least amount of people, giving people the right to make their own decisions, and ensuring justice, which requires consistency and fairness to all involved.

 

DIF:    Cognitive Level: Comprehension   REF:   pp. 25, 27

 

  1. What is medical etiquette when dealing with patients?
a. Sharing their file with others
b. Treating them with respect and tolerance
c. Letting their family know what is happening with the patient
d. Treating them like family members

 

 

ANS:  B

The standards of professionalism expected in the medical field need to include showing patients respect and tolerance no matter the circumstances.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 24

 

  1. What is the difference between ethics and laws?
a. Illegal acts are most likely unethical.
b. Unethical acts are illegal.
c. Ethical acts are legal.
d. Legal acts are ethical.

 

 

ANS:  A

As allied health professionals, it is vital that we understand all legal and ethical ramifications of our actions and behaviors. Most would agree that illegal acts are most likely unethical, but there are many unethical behaviors or actions that are not necessarily illegal.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 23

Chapter 08: Statutory Reporting and Public Duties

Test Bank

 

MULTIPLE CHOICE

 

  1. What field is held to the highest standards when it comes to safety?
a. Healthcare
b. Restaurant
c. Hotels and hospitality
d. Schools

 

 

ANS:  A

State and federal guidelines and statutes require all facilities and businesses connected to the general public to maintain standards to ensure that the public is safe. Those in the healthcare field must understand that they are held to the highest professional standards and that the lives and well-being of their patients and the general public must always be of the utmost concern to them.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 118

 

  1. Why are statutory reports required in the healthcare field?
a. So the government can keep track of individuals
b. For statistical data
c. For the welfare of the general public
d. All of the above

 

 

ANS:  C

Statutory report duties, in the healthcare field, refer mainly to the responsibility of healthcare providers to report areas of vital information to the necessary agencies as deemed necessary primarily for the welfare of the general public. These may vary from state to state.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 118

 

  1. At the federal level, who mandates that communicable diseases are reported?
a. OSHA
b. CMS
c. DHHS
d. CDC

 

 

ANS:  D

Coding of accurate diagnoses using this coding system is mandated for all healthcare facilities and providers, and reporting of all areas of concern for the general population, such as communicable diseases, is also mandated by local health departments as well as the federally governed Centers for Disease Control and Prevention (CDC).

 

DIF:    Cognitive Level: Knowledge          REF:   p. 118

 

  1. Who is responsible for verifying that the information reported is accurate and complete?
a. Office manager
b. Physician
c. Nurse
d. Patient

 

 

ANS:  B

Although many allied healthcare workers may assist in the completion and documentation of these events, it is ultimately the legal responsibility of the physician or provider signing the documentation to verify that the information is accurate and complete.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 118-119

 

  1. Where are births legally recorded?
a. The hospital
b. The physicians office of the birth mother
c. The local county clerks office
d. The Department of Health and Human Services

 

 

ANS:  C

After the birth certificate is signed by the physician or provider who assisted in the birth, it is taken by the local county clerk and recorded, and an official birth certificate is issued for the individual. Depending on the local requirements, the form for filing of births may be more extensive to include the health of the mother of the child and/or father if known.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 119

 

  1. Why must a death certificate be issued?
a. So the attending physician can bill the patients insurance company
b. So the family can be at rest
c. For banking purposes
d. For statistical reasons for the county

 

 

ANS:  C

The death certificate is needed for proof of death for many reasons. Most often, for banking purposes, insurance companies, and Internal Revenue Service or Social Security notification, just to name a few. The information provided must be accurate and properly documented for the surviving family to manage the estate of the deceased and finalize the settlement of their responsibilities.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 120

 

  1. In what instance is there no requirement for a HIPAA release?
a. When a patient tells the provider they do not care about personal information
b. When a patients family member calls the hospital after hearing the family member was shot on the street
c. When a patient is admitted into the hospital after being in the emergency department
d. When a court issues a subpoena

 

 

ANS:  D

The HIPAA requirement is waived with communicable diseases, criminal acts, subpoena or court orders, and workers compensation injuries.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 121

 

  1. If a patient presents with chest pains and tells you he or she was physically trapped by the spouse, what type of abuse is this considered?
a. Verbal/emotional
b. Psychological
c. Physical
d. Sexual

 

 

ANS:  C

Physical abuse includes pushing, hitting, shoving and punching, biting or choking, and physically trapping or impeding movement.

 

DIF:    Cognitive Level: Application          REF:   p. 123

 

  1. What type of abuse is criticizing considered?
a. Verbal/emotional
b. Psychological
c. Physical
d. Sexual

 

 

ANS:  A

Verbal/emotional abuse includes criticizing, degrading, swearing, blaming, and any attacks that harm self-esteem.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 124

 

  1. If someones space is invaded by another, what type of abuse is this?
a. Verbal/emotional
b. Psychological
c. Physical
d. Sexual

 

 

ANS:  B

Psychological abuse includes throwing things, punching walls, breaking things, stalking, invading privacy or space, sabotaging plans or efforts of othersall to create a sense of fear.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 124

 

  1. If a child shows signs of abuse, why is it important to speak to the child alone?
a. Children will not speak up in front of an abuser.
b. The physician can do a thorough examination without embarrassing the child.
c. The abuser will often speak for the child to keep the child from reporting abuse.
d. All of the above are true.

 

 

ANS:  D

In many cases, if an abuse victim is brought to the physician or hospital for care, the abuser is usually very nearby to ensure the patients silence; the abuser may even speak for the patient and not allow the patient to talk very much. In light of this, current examination standards have been initiated asserting that all patients in suspicious circumstances should be asked (while alone) whether they feel that they are safe, and if there is any possibility that they are not safe and need assistance.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 125

 

  1. What initiated the required reporting of child abuse cases?
a. Child Abuse Act
b. Child Abuse Prevention Act
c. Child Abuse and Prevention Act
d. Child Abuse Prevention and Treatment Act

 

 

ANS:  D

In 1974 the Child Abuse Prevention and Treatment Act initiated standards that now require the reporting of all child abuse cases. All states now have similar abuse prevention mandates. Authorities must be notified of any suspected case of abuse, and a thorough investigation must be done to ensure the safety of the child and further validate, or carefully dismiss, the claim.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 125

 

  1. If you suspect abuse and do not report it, what are the potential consequences?
a. You may endanger the child further.
b. You may be held legally responsible for further abuse.
c. You may lose status with the child as a trustful person.
d. All of the above are true.

 

 

ANS:  D

There have been cases in which physicians were held legally responsible for further abuse and injuries sustained by children when they did not report the cases to the authorities when battered child syndrome was suspected; not reporting abuse that may be happening can endanger the child further. A physician is also a trusted person by a child, and if he or she tells you he or she is being abused and you do not report it, you will lose the childs trust.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 125

 

  1. Munchausens disease by proxy is a disorder in which:
a. the child makes up false abuse allegations.
b. the child pretends to be ill or injured.
c. the parent intentionally makes their child ill for attention.
d. the parent abuses the child and tries to blame the child.

 

 

ANS:  C

In Munchausens disease by proxy, the caregiver gains attention and thrives on the attention that is achieved by making their children sick to gain attention from medical professionals and family and friends, and some cases of Munchausens disease by proxy have resulted in a childs death.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 125

 

  1. A child presents with repeated injuries that are unexplained, or do not make sense. This child could be suffering from:
a. Munchausens disease by proxy.
b. battered child syndrome.
c. child maltreatment syndrome.
d. all of the above.

 

 

ANS:  B

A diagnosis of battered child syndrome refers to a syndrome in which the child has repeated injuries or illnesses that are unexplained. As with other cases of suspected abuse, in the case of a child exhibiting these repeated symptoms, the healthcare provider must initiate a report and investigation immediately.

 

DIF:    Cognitive Level: Application          REF:   p. 125

 

  1. The Older Americans Act of 1987 protects adults older than age 60 from all of the following, except:
a. Abandonment
b. Malnutrition
c. Abuse
d. Exploitation

 

 

ANS:  B

The Older Americans Act of 1987 was designed to protect adults older than age 60 from abuse, neglect, abandonment, and exploitation and made it a reportable offense in most states. Although intentionally withholding food from an older adult is a form of abuse, many older adults may be ill and do not eat well, so malnutrition could be explained by other problems.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 125-126

 

  1. In spousal abuse, what is a sign that abuse may be happening?
a. The spouse is overly concerned about the patient.
b. The spouse shows no sense of concern for the patient.
c. The spouse shows typical concern for the patient.
d. The spouse is not with the patient.

 

 

ANS:  A

Although any of these answers could potentially be abuse, the one to be most concerned with is the overly exaggerated concern from the spouse. Other signs of spousal abuse include the spouse not letting the patient speak for himself or herself and not leaving the patient alone.

 

DIF:    Cognitive Level: Application          REF:   p. 127

 

  1. What is crucial in a rape investigation?
a. The physical examination is crucial.
b. The nurse should stay with the victim at all times.
c. The police should be caring and concerned.
d. The patient should take a shower as soon as possible in case of disease.

 

 

ANS:  A

A physical examination is crucial and includes photos, samples of body fluids, clothing worn, and any foreign objects involved in the crime.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 127

 

  1. While working in the hospital, you suspect a patient of illegal substance abuse. To whom do you report this?
a. Hospital security
b. Hospital administrator
c. Head nurse
d. Law enforcement

 

 

ANS:  D

In the instance of illegal substances, law enforcement agencies should be notified. You should notify the attending physician about your suspicions. Keep in mind, however, that substance abuse can take place using prescription medications.

 

DIF:    Cognitive Level: Application          REF:   p. 128

 

  1. According to the Controlled Substances Act of 1970, a Schedule I drug has a ____ potential for abuse.
a. low
b. low to moderate
c. moderate
d. high

 

 

ANS:  D

A Schedule I drug has a high potential for abuse and severe physical or psychological dependence. There are no accepted uses for a Schedule I drug in the United States. Examples include narcotics, hallucinogens, and cannabis.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 129

 

  1. Amphetamines are considered a Schedule ___ drug.
a. I
b. II
c. III
d. IV

 

 

ANS:  B

Schedule II drugs have a high potential for abuse and include some narcotics, amphetamines, and depressants, such as pentobarbital.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 129

 

  1. Diazepam is a Schedule ___ drug.
a. I
b. II
c. III
d. IV

 

 

ANS:  D

Schedule IV drugs have a lower potential for abuse than Schedule III drugs, and include some depressants, such as diazepam.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 129

 

  1. Preparations containing limited quantities of narcotics (e.g., cough medicine) are considered Schedule __ drugs.
a. II
b. III
c. IV
d. V

 

 

ANS:  D

Preparations containing limited quantities of narcotics are generally cough and antidiarrheal preparations, such as cough syrups with codeine, diphenoxylate hydrochloride with atropine sulfate (Lomotil), and attapulgite (Parepectolin). They have a low potential for abuse.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 130

 

  1. This Act enabled the federal government to add substances to the Schedules of controlled substances under the Convention of Controlled Substances.
a. The Chemical Diversion and Trafficking Act of 1988
b. The Controlled Substances Penalties Amendments Act of 1984
c. The Psychotropic Substances Act of 1978
d. The Domestic Chemical Diversion and Control Act of 1993

 

 

ANS:  C

This Act made it easier for the federal government to add drugs to the various schedules of controlled substances under the Convention of Controlled Substances, which was a UN treaty designed to control the illegal trade of psychoactive substances.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 130

 

  1. This Act was created to combat designer drugs by allowing the DEA to treat any substance that is similar to an illegal drug as if it were a Schedule I drug.
a. The Domestic Chemical Diversion and Control Act of 1993
b. The Federal Analog Act
c. The Chemical Diversion and Trafficking Act of 1988
d. The Controlled Substances Penalties Amendments Act of 1984

 

 

ANS:  B

The DEA battled designer drugs that were found on the street, but could not treat them as an illegal drug because they were not yet known to be on the Schedule of Controlled drugs, so this Act allowed them to treat substantially similar drugs as such.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 130

Chapter 12: Business Aspects of Healthcare

Test Bank

 

MULTIPLE CHOICE

 

  1. This type of provider is not required to complete full medical school requirements.
a. MD
b. DO
c. Surgeon
d. OD

 

 

ANS:  D

Doctors of Optometry (ODs), Chiropractic, Dental Medicine, Dental Surgery, Philosophy, and Pediatric Medicine are all not required to complete full medical school requirements.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 182

 

  1. The providers are not physicians, but may perform similar services.
a. BSNs
b. CMTs
c. PAs
d. EMTs

 

 

ANS:  C

Mid-level providers are not physicians, but they may perform similar services such as writing prescriptions, and they usually bill insurance companies for their services.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 182

 

  1. Allied health professionals include the following, except:
a. OT.
b. BSN.
c. CAN.
d. CPC.

 

 

ANS:  A

An occupational therapist (OT) is a mid-level provider. The others are allied health professionals. These individuals are essential members of the healthcare team but instead of billing separately to the insurance carriers for their services, they operate as paid employees, or sometimes as outside contractors paid by the employer or facility.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 183-184

 

  1. Why must a healthcare professional wear an identifying badge at all times in a hospital?
a. Some people may mistake a mid-level practitioner with a physician.
b. Some people may try to fake being a physician.
c. Some people will try to gain entry by pretending to be a medical staff member.
d. Some people want access to medications for their own use.

 

 

ANS:  A

Patients sometimes confuse medical professionals and may, depending on the setting, assume that everyone is either a nurse or a physician. In facilities like a hospital, all healthcare professionals should have clearly identifying badges or name tags that indicate their specialty and credentials. Students also need to be sure to identify themselves as such.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 184

 

  1. What is an advantage of incorporation?
a. Protection of assets
b. More availability as a physician
c. Access to all patients medical records
d. All of the above

 

 

ANS:  D

Besides protection of assets, incorporation allows a physician to take a day off if needed and have their patients receive care, and when it is a large practice, the physician will have access to all the patients records.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 184

 

  1. Who can bill to insurance companies?
a. RNs
b. BSNs
c. LPNs
d. NPs

 

 

ANS:  D

Mid-level providers such as physician assistants (PAs) or nurse practitioners (NPs) can assist in seeing patients and handling emergencies. Almost all third party payers recognize their services separately and their services are billable under the credentials of the mid-level provider directly. The majority of insurance carriers, however, do reduce the amount of reimbursement for services provided by a mid-level provider instead of a physician.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 185

 

  1. A physician owns a pharmacy down the street from his office, and refers patients there without disclosing that he owns it. The term for this is:
a. scamming.
b. unethical.
c. fee splitting.
d. patient pressure.

 

 

ANS:  C

If a provider has a vested interest in another healthcare-related business, it must be clearly disclosed by signs or notifications so that patients are aware and know that they do not have to use that facility.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 185-186

 

  1. This type of practice has physicians work for him or her, but still owns the practice.
a. Solo
b. Sole proprietorship
c. Associate practice
d. Group practice

 

 

ANS:  B

In a sole proprietorship, the provider has legal agreements to hire other physicians or mid-level providers to work for him or her, but still owns the practice and employees other providers on an hourly or daily basis.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 186-187

 

  1. This type of practice is a corporate structure, and shares in the overhead and personnel expenses.
a. Solo
b. Sole proprietorship
c. Associate practice
d. Group practice

 

 

ANS:  D

A group practice has a corporate structure that assigns designated officers to manage the group, not only enabling the individual physicians to be covered when they are unavailable to see patients, but also enabling them to share overhead and staffing costs and personal protection from liability.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 187-188

 

  1. This type of practice has a two or more providers that share in overhead, but do not share in the profits or losses.
a. Solo
b. Sole proprietorship
c. Associate practice
d. Group practice

 

 

ANS:  C

An associate practice is a common structure that shares overhead only. These corporate structures can be established as individual PCs (professional corporations) or could be established as LLCs (limited liability corporations).

 

DIF:    Cognitive Level: Knowledge          REF:   p. 187

 

  1. If an insurance plan is 80/20, what is the term for this plan?
a. Point-of-service
b. HMO
c. PPO
d. Workers compensation

 

 

ANS:  A

If a patient has an 80/20 plan, this means that the insurance carrier is paying 80% of the fees and the patient is responsible for 20%. This is called a point-of-service plan. In this type of plan, the physician or provider cooperates with the insurance company by accepting an adjusted fee scale.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 188

 

  1. In this insurance plan, the patient chooses his or her provider and pays a flat fee to the provider.
a. Point-of-service
b. HMO
c. PPO
d. Workers compensation

 

 

ANS:  C

With a PPO, the patient can choose to see a provider who does not participate with the plan; however, the patient might need to pay before services are rendered and then be reimbursed based on the percentage (out of network) benefit of 80/20 or 70/30, for example, and perhaps a deductible as well.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 190

 

  1. A disadvantage to an HMO is:
a. they are too large.
b. some areas may not have a participating physician.
c. they give too many referrals to specialists.
d. you have to pay first, and then get reimbursed.

 

 

ANS:  B

In some cases some people do not have access to the participating providers that are listed. Also, if the patient wants to see a physician who is not in the network, he or she would have to pay for those services completely on his or her own.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 190

 

  1. Government carriers include all of the following, except:
a. Medicaid.
b. Medicare.
c. Blue Cross/Blue Shield.
d. TRICARE.

 

 

ANS:  C

Although Blue Cross/Blue Shield is widely known, they are a private organization and have no ties to the government.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 191-192

 

  1. A person is under the poverty level. What kind of insurance may he or she have?
a. Medicaid
b. Medicare
c. Blue Cross/Blue Shield
d. TRICARE

 

 

ANS:  A

Medicaid is a federal program that is governed and managed by each individual state to give aid to the indigent or medically needy patient.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 191

 

  1. The insurance used to cover military members and their families is called:
a. Medicaid.
b. Medicare.
c. Blue Cross/Blue Shield.
d. TRICARE.

 

 

ANS:  D

TRICARE (formerly known as the Civilian Health and Medical Program of the Uniformed Services, or CHAMPUS) coverage refers to the plans that cover active military individuals and their dependents, as well as retired military personnel who have served for 20 years or more. The enlisted persons who only serve a few years are not eligible for TRICARE once they leave their branch of service but may be eligible for other veterans benefits.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 191-192

 

  1. Medical coverage for persons 65 and older is called:
a. Medicaid.
b. Medicare.
c. Blue Cross/Blue Shield.
d. TRICARE.

 

 

ANS:  B

Medicare is a federal program for coverage of eligible recipients age 65 or older. Generally these recipients become eligible at age 65 to apply for Social Security benefits at the same time. This coverage is also given to permanently disabled individuals as well.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 191

 

  1. Which part of Medicare covers prescriptions?
a. A
b. B
c. C
d. D

 

 

ANS:  D

Medicare Part D covers the prescription drug plan.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 191

 

  1. Which part of Medicare covers hospital claims?
a. A
b. B
c. C
d. D

 

 

ANS:  A

Medicare Part A covers hospital claims.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 191

 

TRUE/FALSE

 

  1. A person can be covered by both Medicaid and Medicare.

 

ANS:  T

If a person is medically and financially eligible, he or she can be covered by both plans. It is often referred to as Medi-Medi plan.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 191

 

  1. An ERISA plan is a self-insured model.

 

ANS:  T

An employer sets up a savings account and provides funds to that account to cover employees claims.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 190

 

  1. Medicine is a business.

 

ANS:  T

Most people do not view the practice of medicine as a business, but indeed it is a business Many factors take into account the type of structure that is established. Some of these factors include the types of patients that are served and the changes in reimbursement and billing procedures for providers.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 180

 

  1. All specialists must have the same amount of education.

 

ANS:  F

Depending on the type of specialty and board that certifies the provider, different specialties require different amounts of education.

 

DIF:    Cognitive Level: Knowledge          REF:   pp. 181-184

 

  1. All physician assistants bill insurance companies for their services.

 

ANS:  F

Many PAs are independent contractors and will bill the insurance companies for their services, but some are employed by physicians and get a salary.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 185

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