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5 Written questions

5 Matching questions

  1. Member Physician
  2. Medicaid
  3. Admitting Physician
  4. Utilization Management
  5. Managed Care
  1. a A panel that tracks what their members receive and checks if their medical care meets the standards of the organization.
  2. b The physician who admits a pt to the hospital (not necessarily the pt's attending physician)
  3. c A physician who has contacted to participate with an insurance company to be reimbursed for services according to the company's plan.
  4. d A system of medical team members organized into groups to provide quality and cost-effective care that encompasses both the delivery of health care and payment of the services.
  5. e A joint funding program by federal and state governments (excluding Arizona) for low-income pt's on public assistance for their medical care.

5 Multiple choice questions

  1. A request for payment.
  2. Insurance purchased by an individual for self and any eligible dependents.
  3. The authorized signature of the pt for payment to be paid directly to the physician for services.
  4. The physician who cares for a pt in the hospital (not necessarily the physician who admitted the pt)
  5. This plan offers different insurance coverage depending on whether the pt receives services from a contracting network or non-network physician. The benefits are higher if the physician provider is a member of the PPO (or is a network physician).

5 True/False questions

  1. Fee ScheduleA list of approved professional services for which the insurance company will pay with the maximum fee paid for each service.


  2. CapitationThe health care provider is automatically paid a fixed amt. per month regardless of provided services for each pt who is a member of a particular insurance organization.


  3. PrecertificationPrior authorization must be obtained before the pt is admitted to the hospital or some specified outpatient or in-office procedures.


  4. DeductibleA predetermined amt. that the insured must pay each year before the insurance company will pay for an accident of illness.


  5. TRICARE-Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)Established to aid dependents of active service personnel, retired servces personnel and their dependents, dependents of services personnel who died on active duty, with a supplement for medical care in military or public health service facilities.


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