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5 Written questions

5 Matching questions

  1. Preferred Provider Organization (PPO):
  2. SOAP stands for:
  3. Who developed ICD:
  4. DRG's:
  5. Capitation:
  1. a S-Subjective
  2. b contracted network of healthcare providers that provide care to subscribers for a discounted fee.
  3. c World Health Organization (WHO) in 1948
  4. d provider accepts preestablished payments for providing healthcare services to enrollness over a period of time (usually one year)
  5. e prospective payment system that reimburses hospitals for impatient stays

5 Multiple choice questions

  1. network of physicians & hospitals that have joined together to contract w/insurance companies, employers.
  2. by American Medical Association in 1966
  3. review for medical necessity of tests/procedures ordered during inpatient hospitalization
  4. a classification system used to collect data for statistical purposes
  5. 1973

5 True/False questions

  1. Primary Care Providers (PCP):PPO


  2. Clinical Laboratory Improvement Act (CLIA):is responsible for supervising & coordinating healthcare services for enrollees & approves referrals to specialists & inpatient hospital admissions (except in emergencies)


  3. Health Maintenance Organization (HMO):1973


  4. Health Insurance Portability & Accountability Act of 1996 (HIPPA):mandates regulations that govern privacy, security, & electronic transactions standards for healthcare information.


  5. Gatekeeper:person in whose name the insurance policy is issued


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