HCD Healthcare Payment and Delivery Models Exam 2 Practice

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• Which option best describes two-sided risk?
• Which statement best distinguishes episode-based payment from per diem in hospital billing?
• Which are features of ACOs?
• In the Inpatient Prospective Payment System (IPPS), what is an outlier payment?
• Under ACO models, what condition must be met for shared savings to be distributed?
• What are CPT codes used for?
• What are CATEGORY III CPT Codes?
• Medicare's role in payment reform
• Which concept helps ensure equity when comparing provider performance across patient populations?
• What is the goal of risk-based payment models?
• What is the significance of patient attribution in shared-savings models?
• What is global budgeting in health care delivery and its effect on costs?
• How do Medicare Advantage (MA) plans influence care delivery compared to traditional Medicare?
• Who primarily funds nursing home post-acute care?
• In SNF PPS, which classification system determines the case mix?
• What is the '60% rule' in the Inpatient Rehabilitation Facility (IRF) PPS?
• What does the DRG weight primarily reflect?
• What describes the Resource-Based Relative Value Scale (RBRVS)?
• What is the Bundled Payments for Care Improvement (BPCI) initiative intended to do?
• How do APMs and MIPS interact in MACRA?
• What potential effects might payment reform have on hospital behavior?
• Why are performance scorecards used in payment reform programs?
• Why are DRGs used in inpatient payment systems?
• What outcome does the Hospital Readmissions Reduction Program (HRRP) target and how does it affect hospitals?
• Which statement best captures the aim of post-acute care optimization under reform?
• Which statement correctly pairs the codes with their service types?
• Promoting Interoperability in MIPS focuses on which of the following?
• In the Comprehensive Care for Joint Replacement (CJR) model, the payment target includes which elements?
• How does HRRP aim to reduce avoidable readmissions and what system changes support this?
• Which description best defines Improvement Activities in MIPS?
• What is patient attribution in ACOs and why does it matter?
• How do APMs with two-sided risk typically differ from one-sided risk models?
• In value-based care, telemedicine can be included in what aspects?
• What is "claims-based" cost measurement in MIPS and why is it important?
• What are Accountable Care Organizations (ACOs)?
• What are the four performance categories in the MIPS program?
• Which CPT codes correspond to MTMs?
• Which of the following is a key feature of ACOs?
• Identify the four MIPS performance categories used under MACRA.
• Which model is designed to share savings with providers when quality and cost benchmarks are met?
• Which patients are described as dual-eligible in Medicare terms?
• How do payers use risk adjustment to prevent selection bias in MA and MIPS?
• CPT codes for Immunizations?
• How does patient cost-sharing relate to delivery models and value?
• Which statement accurately describes IDN characteristics?
• Which of the following was a consequence of UPCODING?
• IDNs GOALS include focusing on what?
• Which program aims to reduce readmissions by penalizing hospitals with higher 30-day readmissions?
• Under MACRA, which MIPS category is focused specifically on reducing the overall cost of care?
• Which agencies certify PCMHs?
• Under MACRA, Alternative Payment Models (APMs) are primarily designed for clinicians who participate in what type of arrangements?
• Reimbursement models are designed for which stakeholders?
• In what year was the ICD created?
• What is Medicare's daily reimbursement for SNF days 21-100?
• Which statement best describes a characteristic of IDNs?
• What were concerns with UPCODING?
• In MIPS, which category most directly uses electronic clinical quality measures (eCQMs)?
• What are CATEGORY II CPT Codes?
• Under two-sided risk models, providers are exposed to losses in addition to gains.
• Promoting Interoperability in MIPS is primarily about which aspect?
• Which reimbursement model ties payments to outcomes and quality metrics rather than pure volume?
• What is the MA Business Model?
• Why is risk adjustment important in evaluating provider performance?
• How does risk adjustment influence fairness in APM performance evaluation?
• Who is the largest healthcare purchaser and a driver of APM adoption?
• GOALS of Integrated Delivery Networks include which of the following?
• What is the current version of ICD?
• Define an 'episode of care' in episode-based payments.
• Define capitation and how it contrasts with fee-for-service payment.
• What is Current Procedure Terminology (CPT) codes?
• If the DRG base rate increases while the DRG weight stays the same, what happens to the DRG payment?
• Under an ACO, when do participating providers receive a share of savings?
• What distinguishes Home Health Agency (HHA) PPS from IPPS?
• What is the focus of the Comprehensive Care for Joint Replacement (CJR) model and why?
• What is Medicare Advantage (MA)?
• Which statement describes Population based payments plus adjustment for quality metrics?
• Which statement best characterizes upside-only risk compared with two-sided risk?
• What is the per diem payment model used for nursing homes?
• In value-based reform, what is the intended impact of aligning incentives?
• What are CATEGORY I CPT Codes?
• Which statement best describes the relationship between quality and payments in hospital Value-Based Purchasing programs?
• What defines an Alternative Payment Model (APM)?
• ICD coding, if not properly included, can lead to what outcome?
• Describe the role of telemedicine within value-based care.
• Integrated Delivery Networks are best described as what?
• What are eCQMs (electronic Clinical Quality Measures) and why are they used in MIPS?
• Which components do clinical integration and care networks provide to support value-based payment?
• What role does the Center for Medicare and Medicaid Innovation (CMMI) play in payment and delivery reform?
• What is the main goal of the Hospital Readmissions Reduction Program (HRRP)?
• The IPPS wage index adjustments are designed to reflect what geographic factor?
• What is the main goal of value-based purchasing (VBP) in hospital payments?
• Under Medicare SNF coverage, which period is when the patient pays everything?
• Ambulatory Payment Classifications (APCs) are used in which payment system to categorize outpatient services?
• Why is data interoperability critical for value-based payment reform?
• Which statement best describes Accountable Care Organizations (ACOs)?
• What is the difference between a per diem payment and a per-episode (bundle) payment in post-acute care?
• Which describes a key role of data sharing in value-based payment?
• What is global capitation and what risk does it transfer to providers?
• Which condition must be met to qualify for post-acute reimbursement in SNFs?
• Improving care transitions most directly reduces which of the following outcomes?
• In ACO contracts, which entity typically earns shared savings?
• Which statement best describes a PCMH feature?
• Since 2010, what trend has occurred with reimbursement models?
• In the ICD structure, what can the first character be?
• What sets apart the Outpatient Prospective Payment System (OPPS) from IPPS?
• Which payer funds nursing home post-acute care primarily?
• What is the role of risk corridors in optional experimentation models?
• What are common quality measures used in Medicare Value-Based Purchasing programs?
• In Bundled Payments for Care Improvement, what is included in an episode?
• Who sets the amount paid per RVU?
• Differentiate fee-for-service (FFS) from value-based purchasing (VBP) in hospital payments.
• Which statement defines an Accountable Care Organization (ACO) in the Medicare context?
• What describes shared savings in ACO models?
• Which element is included in DRG consideration?
• In the context of bundled payments, what does an 'episode boundary' specify?
• Which item is identified as a barrier to success in healthcare payment reform?
• Which payment arrangement is typically used by Medicare Advantage plans?
• Define a Medicare Shared Savings Program Accountable Care Organization (ACO).
• What is the current Medicare MIPS category focused on electronic health record use and interoperability called?
• How do quality measures influence payment in value-based programs?
• Which description best describes the Traditional FFS Model?
• MACRA introduced which program for physicians?
• Which combination best indicates readiness for bundled payment implementation?
• In shared-savings models, what does patient attribution determine?
• The Medicare Fee Schedule is a standard fee schedule published for physicians and other providers based on which framework?
• Which factor is NOT considered in DRG determination?
• Which option best describes one-sided risk?
• What is the range of CPT Immunization codes?
• What are the categories of APMs?
• Relative Value Units provide what?
• Which description matches population-based payments?
• Which of the following is true about the PCMH core functions?
• Which statement is true about PCMH accreditation?
• Which of the following is true about SNF reimbursement patterns?
• Which factors are used to adjust DRG payments under IPPS?
• How are quality measures developed and validated in Medicare programs?
• What is the role of the CMS Innovation Center (CMMI) in payment reform?
• What is the basis for payment under the Inpatient Prospective Payment System (IPPS)?
• What is the purpose of the Hospital Value-Based Purchasing (VBP) program?
• What is the purpose of IPPS wage index adjustments?
• Describe Bundled Payments for Care Improvement (BPCI) and what an "episode" includes.
• What is the hallmark of Fee For Service reimbursement?
• Care coordination affects payment outcomes by doing what?
• Which payment system uses per-discharge DRG-based payments?
• How do readmission penalties influence discharge planning and care transitions?
• Quality measures in Medicare are typically updated how often?
• What best describes a bundled payment model compared with fee-for-service?
• What is the 'episode-of-care payment' concept for non-orthopedic conditions?
• Which payment arrangement best describes the facility-paid SNF reimbursement model?
• Which entity is responsible for determining whether a hospital qualifies for IRF PPS payment under the 60% rule?
• What is an 'episode of care' in bundled payment models?
• What is the difference between DRG weight and the DRG base rate?
• What differentiates one-sided risk from two-sided risk in Alternative Payment Models?
• DRGs primarily represented which change in Medicare payment for hospital care?
• How does population health management relate to value-based payment?
• How is 'quality-adjusted cost' used in pay-for-performance?
• Which statement best describes Advancing Care Information within MIPS?
• Which description best captures the ICD code structure?
• What is a Patient-Centered Medical Home (PCMH) in the context of delivery models?
• Which item is included in RVU calculations?
• IDNs are formed by combining which entities?
• Which arrangement best aligns with population health management and cost containment?
• Which statements characterize the QUALITY METRICS category of APMs?
• Which statement best describes the relationship between IPPS Value-Based Purchasing and efficiency measures?
• What does it mean if payment is RISK ADJUSTED?
• What best describes value-based payment compared to fee-for-service?
• Which statement accurately describes Accountable Care Organizations (ACOs)?
• Which statement about quality measurement in Medicare Value-Based Purchasing is true?
• Which description best captures Medicare Advantage plans in terms of payment and network structure?
• What did MACRA lead to?
• What is the role of improvement activities in MIPS?
• How do MS-DRGs differ from basic DRGs in Medicare payments?
• What are the two MACRA tracks, and who do they apply to?
• In risk adjustment, which statements are true?
• Which statements describe Patient-Centered Medical Homes (PCMH)?
• How do DRG updates affect hospital reimbursements year over year?
• How is SNF PPS case-mix determined beyond DRGs?
• In Medicare, which plan uses HCC-based risk scores to adjust payments for enrollees?
• Why is post-acute care a focal point in payment reform?
• Which outcome is most directly supported by readmission penalties?
• Which data sources are used to calculate MIPS cost measures?
• How are post-acute care providers integrated into bundled payment structures?
• Which statement best describes Alternative Payment Models (APMs)?
• In DRG payment systems, what is the primary purpose for providers?
• Which statement best describes a purpose of ACOs?
• Which code system is maintained by the American Medical Association (AMA)?
• Which statements characterize the RISK category of APMs?
• The CMS Innovation Center was established under which law, and what is its primary aim?
• How is an Alternative Payment Model (APM) defined under MACRA?
• How does the Comprehensive Care for Joint Replacement (CJR) model structure payments?
• The Medicare Fee Schedule is published for physicians based on which framework?
• Which statement about APMs is true?
• Which statement best describes how risk adjustment affects performance targets in MA and MIPS?
• Which statement best describes ACOs?
• Under ACOs, what triggers the sharing of savings?
• How are Skilled Nursing Facility (SNF) PPS payments determined?
• Which statement describes FFS payment plus bonus payments?
• In value-based contracts, what is the meaning of upside risk and downside risk?
• Explain the difference between one-sided and two-sided risk with respect to financial liability.
• Which CPT codes are used for Smoking Cessation?
• In risk-adjusted payment models, which practices help mitigate selection bias?
• Which of the following is a barrier to success in healthcare payment reform?
• Which are MACRA Quality Payment categories?
• What is a common consequence of the traditional FFS reimbursement model?
• In accountable care and MIPS contexts, what is intended by care management?
• Differentiate between episode-based/bundled payments and global payments.
• What is "claims data" and how is it used in evaluating delivery models like MIPS and APMs?
• In an ACO, what does 'shared savings' mean?
• Which statement describes FFS payment plus population-based payments plus adjustments for quality metrics?
• In risk-adjusted payment models, what is selection bias, and how is it mitigated?
• Which statement best describes the relationship between DRGs and length of stay?
• What does risk adjustment address in performance measurement?
• What is the primary payment mechanism used by the Medicare Inpatient Prospective Payment System (IPPS) for hospitals?
• Which statement best describes the effect of payment reform on discharge planning?
• Which statement describes Medicare Advantage capitation payments?
• What distinguishes IPPS Value-Based Purchasing from bundles or ACOs?
• How do 'duals' (Medicare-Medicaid dual-eligible) influence payment policy and risk?
• What is the purpose of the MACRA Quality Payment categories (Quality, Cost, Improvement Activities, Advancing Care Information) in clinician payment?
• Which practices indicate readiness to participate in bundled payment models?
• Which statement best describes an Advanced Alternative Payment Model (AAPM) under MACRA?
• How does the DSH (Disproportionate Share Hospital) adjustment affect IPPS payments?
• Which outcome is most directly improved by effective care coordination and transitions?
• What is the central goal of hospital Value-Based Purchasing programs?
• What describes the difference in target setting between SNF PPS and IPPS?
• Which statement best captures the core philosophy shift under Alternative Payment Models?
• What is the significance of the 90-day post-acute period in major bundles like CJR?
• What is the difference between voluntary and mandatory alignment in APM participation?
• What are cost measures in MIPS and how are they calculated?
• Identify common challenges in implementing bundled payment models.
• How does CMS define an 'episode of care' for bundles like BPCI?
• Which payment reform model bundles payments for a set of services across an episode?
• What are the two main types of reimbursement models?
• Distinguish between payer-initiated and provider-initiated value-based arrangements.
• What are the five core functions of PCMH?
• IDRs are typically characterized by which governance relationship?
• What does global budgeting imply in hospital payment reform debates?
• Why is health information technology interoperability critical for value-based payment models?
• What distinguishes BPCI Advanced from earlier BPCI models?