5 Written questions
5 Matching questions
- Member Physician
- Admitting Physician
- Utilization Management
- Managed Care
- a A panel that tracks what their members receive and checks if their medical care meets the standards of the organization.
- b The physician who admits a pt to the hospital (not necessarily the pt's attending physician)
- c A physician who has contacted to participate with an insurance company to be reimbursed for services according to the company's plan.
- 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.
- 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
- A request for payment.
- Insurance purchased by an individual for self and any eligible dependents.
- The authorized signature of the pt for payment to be paid directly to the physician for services.
- The physician who cares for a pt in the hospital (not necessarily the physician who admitted the pt)
- 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
Fee Schedule → A list of approved professional services for which the insurance company will pay with the maximum fee paid for each service.
Capitation → The 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.
Precertification → Prior authorization must be obtained before the pt is admitted to the hospital or some specified outpatient or in-office procedures.
Deductible → A predetermined amt. that the insured must pay each year before the insurance company will pay for an accident of illness.
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.