Healthcare Payment Systems ACTUAL
QUESTIONS AND CORRECT ANSWERS
PCMH: What does it stand for? - Correct answers✔✔Patient-Centered Medical Home
PCMH: What 5 things do they strive for? - Correct answers✔✔(CCCACQS)
Healthcare that is patient centered, comprehensive, coordinated, accessible, committed to quality
and safety.
ACO: What does it stand for? - Correct answers✔✔Accountable Care Organization
ACO: Define it - Correct answers✔✔An organization of health care providers who agree to be
responsible for quality, cost, and overall care of Medicare beneficiaries who are enrolled in
traditional fee-for-service programs who are assigned to their ACO.
What is the most important new healthcare law since the ACA? - Correct answers✔✔MACRA
(Medicare Access and CHIP Reauthorizations Act) (CHIP=child health insurance plan)
What changes does MACRA enact? - Correct answers✔✔Starting in 2019, the three current
Medicare quality reporting/incentive systems (PQRS, Meaningful Use and Value Based
Modifier) will be combined into MIPS (Merit-Based Incentive Payment System). MIPS allows
physicians to more clearly determine their eligibility for incentive payments.
How does MIPS work?
What 4 categories is score based on? - Correct answers✔✔Each professional will be given a
composite score of 0-100 based on performance in 4 categories:
1: Clinical Quality (Specialty defined) 60%
2: Advancing Care Information 25%
, 3: Resource Use (Cost) 0%- will be phased in eventually.
4: Practice Improvement 15%. If provider chooses quality improvement activities or not. If
enrolled in PCMH, automatically get highest P.I. score.
Composite score results in a negative or positive Medicare reimbursement.
*Physicians participating in ACO or PCMH can choose to take a different path and receive a 5%
bonus every year from 2019-2024.
What is the triple aim of healthcare? - Correct answers✔✔Improve:
Quality of Healthcare (patient experience of healthcare)
Cost of Healthcare (per capita cost)
Population-Based Health
The current US Healthcare System is... - Correct answers✔✔Burdensome, Suboptimal and
complex.
What percentage of non-elderly adults were uninsured in 2016? - Correct answers✔✔10%
This is down from 16.2% in 2013
Who pays for half of all insurance in the U.S.? - Correct answers✔✔The Government
1/3 of the U.S. Healthcare system is spent on what? - Correct answers✔✔Administration
If the U.S. cuts its administration spending to equal the international median, how much money
would be saved annually? - Correct answers✔✔$920 million
QUESTIONS AND CORRECT ANSWERS
PCMH: What does it stand for? - Correct answers✔✔Patient-Centered Medical Home
PCMH: What 5 things do they strive for? - Correct answers✔✔(CCCACQS)
Healthcare that is patient centered, comprehensive, coordinated, accessible, committed to quality
and safety.
ACO: What does it stand for? - Correct answers✔✔Accountable Care Organization
ACO: Define it - Correct answers✔✔An organization of health care providers who agree to be
responsible for quality, cost, and overall care of Medicare beneficiaries who are enrolled in
traditional fee-for-service programs who are assigned to their ACO.
What is the most important new healthcare law since the ACA? - Correct answers✔✔MACRA
(Medicare Access and CHIP Reauthorizations Act) (CHIP=child health insurance plan)
What changes does MACRA enact? - Correct answers✔✔Starting in 2019, the three current
Medicare quality reporting/incentive systems (PQRS, Meaningful Use and Value Based
Modifier) will be combined into MIPS (Merit-Based Incentive Payment System). MIPS allows
physicians to more clearly determine their eligibility for incentive payments.
How does MIPS work?
What 4 categories is score based on? - Correct answers✔✔Each professional will be given a
composite score of 0-100 based on performance in 4 categories:
1: Clinical Quality (Specialty defined) 60%
2: Advancing Care Information 25%
, 3: Resource Use (Cost) 0%- will be phased in eventually.
4: Practice Improvement 15%. If provider chooses quality improvement activities or not. If
enrolled in PCMH, automatically get highest P.I. score.
Composite score results in a negative or positive Medicare reimbursement.
*Physicians participating in ACO or PCMH can choose to take a different path and receive a 5%
bonus every year from 2019-2024.
What is the triple aim of healthcare? - Correct answers✔✔Improve:
Quality of Healthcare (patient experience of healthcare)
Cost of Healthcare (per capita cost)
Population-Based Health
The current US Healthcare System is... - Correct answers✔✔Burdensome, Suboptimal and
complex.
What percentage of non-elderly adults were uninsured in 2016? - Correct answers✔✔10%
This is down from 16.2% in 2013
Who pays for half of all insurance in the U.S.? - Correct answers✔✔The Government
1/3 of the U.S. Healthcare system is spent on what? - Correct answers✔✔Administration
If the U.S. cuts its administration spending to equal the international median, how much money
would be saved annually? - Correct answers✔✔$920 million
