An organized, interrelated system of people and facilities yhat communicate with one another work together as a unit is commonly referred to as a:
Primary care physicians (PCP)
A specific provider who oversees and HMO member's total healthcare treatment is called a:
A multispecialty group practice where all healthcare services are provided within the building(s) owned by the HMO is called a:
An HMO that contracts with independent, multispecialty physician groups that provide all healthcare services to its members and usually share the same facility, support staff, medical records, and equipment is called a:
A common method of reimbursement used primarily by health maintenance organizations in which the provider or medical facility is paid a fixed, per capita amount for each individual enrolled in the plan, regardless of how many or few services the patient uses.
Open Panel IPA
A managed care system composed of individual healthcare providers who offer healthcare services for HMO and non-HMO patients, but maintain their own offices and indenties, is called a:
A plan that allows patients to use the HMO provider or go outside the plan and pay a higher copayment and deductible is a(n):
System designed to determine the medical necessity and appropriateness of requested medical services, procedure or hospital admission prior, concurrent or retrospective to the evvent is called:
If a particular medical service or procedure is determined not to be "medically necessary", a patient may file a:
procedure required by third pary payers that require permission before a provider can carry out specific procedure and treatments is:
An _________ provides it's members with basic healthcare services for a fixed price for a given period of time
A type of health coverage where the carrier is responsible for both the financing and delivery of health care
When a patient's problem exceeds the expertise of his/her PCP, the PCP can arrange a ________ specialist to take over the patient's care.
The ______ _______ HMO is similar to an IPA except the HMO contracts directly with the individual physicians.
when the PCP sends a patient to another healthcare provider, usually a specialist, for the purpose of the consulting physician rendering his or her expert opinion regarding the patient's condition.
A hybrid type of managed care (also refered to as an open-ended HMO) that allows patients to use the HMO provider or go outside the plan and use any provider they choose.