Question 1
What is a typical objective of managed care organizations in regulating providers?
Correct Answer:
Increase referrals
Explanation:
The main idea is that managed care organizations regulate providers to control costs and ensure that care is cost-effective and coordinated. They use networks, negotiated rates, credentialing, and utilization management to steer patients to appropriate, efficient services. Tools like gatekeeping, prior authorization, and capitated or performance-based payments align provider incentives with cost containment and quality. Expanding scope of practice isn’t the primary aim of MCOs; it’s determined by licensing and professional regulation outside payer networks. Increasing referrals would typically raise utilization and costs, which runs counter to the goal of containment. Creating new insurance products is about product development, not how providers are regulated within the network.
Question 2
How can health policy influence innovation in digital health and telemedicine?
Correct Answer:
Payment parity for telemedicine supports investment.
Explanation:
Policy shapes the economics and risk that drive innovation in digital health. When telemedicine is paid at parity with in-person visits, providers see a predictable and potentially equal revenue stream, making it financially viable to invest in telehealth platforms, remote monitoring, security, and integration with electronic health records. This financial certainty lowers the barriers to piloting new care models, scaling successful ones, and developing workflows that blend virtual and in-person care, all of which fuels ongoing innovation. Licensure and privacy rules matter too, since they affect cross-state practice and data protection, but they can act as barriers if not harmonized, influencing adoption and invention. Unclear coverage creates revenue risk, which tends to deter investment, whereas clear, parity-based payment policies encourage investment and experimentation.
Question 3
Under the ACA, what does guaranteed issue require?
Correct Answer:
Insurers must cover applicants regardless of health status
Explanation:
Guaranteed issue means insurers must issue a policy to anyone who applies, regardless of health status or preexisting conditions. This ensures that health problems don’t block someone from getting coverage, aligning with the ACA’s aim to expand access to insurance for all. That’s why the correct choice is that insurers must cover applicants regardless of health status. The other options conflict with guaranteed issue: denying coverage for preexisting conditions would violate this principle; requiring only high-deductible plans isn’t a requirement and would limit plan types; and covering only emergency services doesn’t reflect the comprehensive coverage protections guaranteed to applicants.
Question 4
The FDA also regulates which product category?
Correct Answer:
Physician licensing
Explanation:
The FDA’s jurisdiction includes medical devices as a product category, aiming to ensure safety and effectiveness before and after a device reaches the market. Medical devices span items like pacemakers, joint implants, and imaging equipment. The agency uses a risk-based classification and requires premarket review—such as PMA for high-risk devices or 510(k) clearance for lower-risk ones—plus postmarket surveillance and adverse-event reporting. By contrast, hospital budgets are financial plans managed within healthcare facilities, physician licensing is handled by state medical boards, and insurance plans are regulated by state departments of insurance or federal programs, not the FDA. So the product category regulated by the FDA is medical devices.
Question 5
What percent of Medicare reimbursement do PAs receive?
Correct Answer:
85%
Explanation:
Medicare Part B pays for professional services provided by a physician assistant at 85% of the physician fee schedule. In practical terms, if the same service would be paid at $100 for a physician, the PA’s service is reimbursed at $85. This reflects Medicare’s standard approach to non-physician provider reimbursement, which is lower than the physician rate. The other percentages don’t match Medicare’s typical PA reimbursement: 100% would imply equal payment with physicians, which isn’t the norm, while 50% or 70% are not the standard rates for PA-provided care.
Question 1
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Prepare with the Business of Healthcare and Health Policy Practice Test practice quiz. This question bank includes 10 questions covering care, health, policy, medicare, and business. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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Business of Healthcare and Health Policy Practice Test

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