CSBI (HFMA) EXAM STUDY GUIDE QUESTIONS WITH
ACCURATE ANSWERS
What are the challenging areas of healthcare continuum of care? -- Answer ✔✔ 1-Lack
of Coordination
2-Healthcare Users on their own
3-Service Coordination
What are the types of service on health continuum? -- Answer ✔✔ 1-Well -
preventative care, primary care
2-At Risk - acute care
3-At risk mild - specialty care
4-Early Chronic - chronic care
5-Late Chronic - long-term care
6-Terminal - end of life care
Supply Sensitive Care - a driver of utilization -- Answer ✔✔ Care decisions are strongly
influenced by capacity, rather than medical evidence or severity of illness. Decisions
depend on the number of available hospital beds, clinics, CT scanners, doctors.. Also
based on competition, supplier promotional efforts and influences in supply variations
impacting cost of care delivered.
Preference Sensitive Care - a driver of utilization -- Answer ✔✔ Care selection and
selection frequency driven in large measure by the physician opinion.
What are misalignment with healthcare user and hospitals? -- Answer ✔✔ 1-focus on
cost
2-drivers of service utilization
3-financing mechanism
,What are the Foundational Ideas for Change? -- Answer ✔✔ 1 - Triple Aim
2 - Transparency in cost - gave way to Meaningful Use and now Promoting
Interoperability
3 - Understand Production Cost - gave way to Activity Based Costing (ABC type
analysis)
4- Community Based Services
Disruptive Innovation -- Answer ✔✔ disrupts and replaces existing markets with ways
of working or products previously not thought of as possible, now are possible due to
new technology or other catalysts.
Disruptive Innovation -- Answer ✔✔ Examples are- telehealth, retail health, pharma
firms exploring more direct connections with healthcare users,
PHI -- Answer ✔✔ Protected Health Information
PHI -- Answer ✔✔ a subset of patient level data, composed of 18 unique identifiers -
any of the 18 identifiers by themselves or in combination must be removed to de-
identify the individual/patient.
HIPAA -- Answer ✔✔ Sections include privacy rule and security
HIPAA -- Answer ✔✔ Applies to organizations that are defined as a covered entity and
directly to business associates as well
HIPAA -- Answer ✔✔ Signed into law in 1996, and revised by 2013 Omnibus Rule
HITECH -- Answer ✔✔ Allows for sanctions for non-compliance, including fines of up
to $1.75 million and 10 years prison
HITECH -- Answer ✔✔ Covers application to both CE and individuals
HITECH -- Answer ✔✔ Covers application of the rule to business associate contractors
HIPAA & HITECH -- Answer ✔✔ Covers how PHI is handed and protected.
, Top Challenges confronting Hospital -- Answer ✔✔ 1 - Financial challenges
2- Governmental Mandates & Patient safety and quality
3- Personnel shortage
What are the main functions for organization? -- Answer ✔✔ operations, finance, and
marketing
Operation -- Answer ✔✔ function that meets the demand for product or service by the
market. In healthcare, this includes all production services
Finance -- Answer ✔✔ Must have this function to ensure monetary resources are
available to conduct operation. Accounting is only one component.
Marketing -- Answer ✔✔ function that is focused on understanding what the
marketplace seeks, anticipate shifts, and ensure a strong presence.
Role of Case/Care Managers -- Answer ✔✔ These workers in combination with nurse
educators will play an important role in ensuring expeditious and efficacious movement
of healthcare users in the care system. Will be driven to focus on 30-day readmissions.
Role of Case/Care Managers -- Answer ✔✔ These professionals are at the front lines in
providing situational evaluation and action activities related to potential clinical issues
and social determinants of health likely to affect readmission. Proactive in healthcare
user education and providing guidance on follow-up and continuing care.
Role of Nurse -- Answer ✔✔ Non-physicians performing some management of health
conditions a step further. Moving beyond the traditional role of supportive bedside care
and following physician orders.
Role of Internal Financial Payor Experts -- Answer ✔✔ Will work closely with external
counterparts. Have transparency through the collaborative discovery and sharing of
information. These professionals must increase understanding of and capabilities at
pricing contract risk.
ACCURATE ANSWERS
What are the challenging areas of healthcare continuum of care? -- Answer ✔✔ 1-Lack
of Coordination
2-Healthcare Users on their own
3-Service Coordination
What are the types of service on health continuum? -- Answer ✔✔ 1-Well -
preventative care, primary care
2-At Risk - acute care
3-At risk mild - specialty care
4-Early Chronic - chronic care
5-Late Chronic - long-term care
6-Terminal - end of life care
Supply Sensitive Care - a driver of utilization -- Answer ✔✔ Care decisions are strongly
influenced by capacity, rather than medical evidence or severity of illness. Decisions
depend on the number of available hospital beds, clinics, CT scanners, doctors.. Also
based on competition, supplier promotional efforts and influences in supply variations
impacting cost of care delivered.
Preference Sensitive Care - a driver of utilization -- Answer ✔✔ Care selection and
selection frequency driven in large measure by the physician opinion.
What are misalignment with healthcare user and hospitals? -- Answer ✔✔ 1-focus on
cost
2-drivers of service utilization
3-financing mechanism
,What are the Foundational Ideas for Change? -- Answer ✔✔ 1 - Triple Aim
2 - Transparency in cost - gave way to Meaningful Use and now Promoting
Interoperability
3 - Understand Production Cost - gave way to Activity Based Costing (ABC type
analysis)
4- Community Based Services
Disruptive Innovation -- Answer ✔✔ disrupts and replaces existing markets with ways
of working or products previously not thought of as possible, now are possible due to
new technology or other catalysts.
Disruptive Innovation -- Answer ✔✔ Examples are- telehealth, retail health, pharma
firms exploring more direct connections with healthcare users,
PHI -- Answer ✔✔ Protected Health Information
PHI -- Answer ✔✔ a subset of patient level data, composed of 18 unique identifiers -
any of the 18 identifiers by themselves or in combination must be removed to de-
identify the individual/patient.
HIPAA -- Answer ✔✔ Sections include privacy rule and security
HIPAA -- Answer ✔✔ Applies to organizations that are defined as a covered entity and
directly to business associates as well
HIPAA -- Answer ✔✔ Signed into law in 1996, and revised by 2013 Omnibus Rule
HITECH -- Answer ✔✔ Allows for sanctions for non-compliance, including fines of up
to $1.75 million and 10 years prison
HITECH -- Answer ✔✔ Covers application to both CE and individuals
HITECH -- Answer ✔✔ Covers application of the rule to business associate contractors
HIPAA & HITECH -- Answer ✔✔ Covers how PHI is handed and protected.
, Top Challenges confronting Hospital -- Answer ✔✔ 1 - Financial challenges
2- Governmental Mandates & Patient safety and quality
3- Personnel shortage
What are the main functions for organization? -- Answer ✔✔ operations, finance, and
marketing
Operation -- Answer ✔✔ function that meets the demand for product or service by the
market. In healthcare, this includes all production services
Finance -- Answer ✔✔ Must have this function to ensure monetary resources are
available to conduct operation. Accounting is only one component.
Marketing -- Answer ✔✔ function that is focused on understanding what the
marketplace seeks, anticipate shifts, and ensure a strong presence.
Role of Case/Care Managers -- Answer ✔✔ These workers in combination with nurse
educators will play an important role in ensuring expeditious and efficacious movement
of healthcare users in the care system. Will be driven to focus on 30-day readmissions.
Role of Case/Care Managers -- Answer ✔✔ These professionals are at the front lines in
providing situational evaluation and action activities related to potential clinical issues
and social determinants of health likely to affect readmission. Proactive in healthcare
user education and providing guidance on follow-up and continuing care.
Role of Nurse -- Answer ✔✔ Non-physicians performing some management of health
conditions a step further. Moving beyond the traditional role of supportive bedside care
and following physician orders.
Role of Internal Financial Payor Experts -- Answer ✔✔ Will work closely with external
counterparts. Have transparency through the collaborative discovery and sharing of
information. These professionals must increase understanding of and capabilities at
pricing contract risk.
