What plan allows members of Kaiser permanente Medical Care program to seek medical help from non-Kaiser physicians?
Kaiser Permenente's medical plan is a closed panel program, which means
it limits the patients choice of personal physicians
How are physicians paid who work for a prepaid group practice model?
Salary paid by independent group
What is the name of an organization of physicians sponsored by a state or local medical association that is concerned with the development and delivery of medical services and the cost of health care?
Foundation for medical care
An organization that gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are used is called a
A physician-owned business that has the flexibility to deal with all forms of contract medicine and also offers its own plans is a
Practitioners in an HMO program my come under peer review by a professional group called
quality improvement organization QIO
What is the correct procedure to collect a copayment on a managed care plan?
Collect the copayment when the patient arrives for the office visit.
Benefits under the HMO Act fall under two categories______________ health services and supplemental health services.
UR is the abbreviation for _____ ________ which is necessary to control costs in the health care setting.
When a managed care plan requires the primary care physician to seek approval before referring a patient to a specialist, it is called obtaining
When a certain percentage of the monthly capitation payment is held out of the premium fund to pay for operating an IPA, it is know as a
Ross-Loos Medical Group, America's oldest privately owned prepaid medical group, started in Texas.
The Health Maintenance organization Act of 1973 required most employers to offer HMO coverage to their employees as an alternative to traditional health insurance.
The difference between an IPA and a PPG is that a PPG may not be owned by its member physicians, whereas an IPA is physician owned.
If a primary care physician sends a patient to a specialist for consultation who is not in the managed care plan, the specialist may bill the primary care physician for payment.