QUESTIONS 2025 2026 UPDATE TEST BANK
2026 UPDATED QUESTIONS WITH
ANSWERS GRADED A+
⩥ Accountable Care Organization (ACO). Answer: Goal: Improve
patient outcomes, reduce healthcare costs, coordinate care across
providers. Focus is value-based care, not profit maximization.
⩥ Fee-for-Service (FFS). Answer: Providers paid for each service
performed. Problems: Encourages more services, higher costs.
⩥ Point-of-Service (POS). Answer: Hybrid of HMO + PPO. Patients can
go outside network but pay higher costs.
⩥ Health Insurance Portability and Accountability Act (HIPAA).
Answer: Purpose: Protect patient privacy, ensure confidentiality of
health information. Key rule: Only individuals with a need to know may
access patient information.
⩥ False Claims Act. Answer: Targets: Fraudulent billing, billing
government programs for services not provided. Example: Billing
Medicare for procedures never performed.
, ⩥ Affordable Care Act (ACA). Answer: Major goals: Expand insurance
coverage, improve quality of care, reduce healthcare costs. Important
feature: Health Insurance Marketplace allows individuals to compare
and purchase plans.
⩥ Joint Commission. Answer: Role: Sets quality and safety standards,
accredits healthcare organizations, improves patient care quality.
⩥ Electronic Health Record (EHR). Answer: Main purpose: Share
patient information across providers and facilities. Benefits: Improved
coordination of care, faster access to records, better patient safety.
⩥ Clinical Decision Support Systems. Answer: Purpose: Help clinicians
make better clinical decisions. Example: Alerts for drug interactions,
diagnostic suggestions, evidence-based recommendations.
⩥ Healthcare Analytics / Business Intelligence. Answer: Used for: Data
analysis, decision-making, performance monitoring. Example data
analyzed: Costs, outcomes, utilization, quality metrics.
⩥ Matrix Structure. Answer: Employees report to multiple leaders.
Example: Nurses may report to nursing director and medical director.
Purpose: Improve collaboration across departments.