5 Written questions
5 Matching questions
- Blue Cross/Blue Shield
- a When physician see a high volume of patient more than medical necessary to create revenue. May be seen in fee-service or managed care environment.
- b Transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer
- c - Managed Care Organizations
- d Is the largest pioneer in private insurance company in the United States.
- e - Health Plan Employer Data Information Set
5 Multiple choice questions
- To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.
- Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
- - Health Maintenance Organization.
- The specialist contracts with the managed care plan for an entire episode of care.
- Is a physician who controls patient access to specialists and diagnostic testing services.
5 True/False questions
MCO → - Exclusive Provider Organization.
Triple Option → Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
Stop-Loss → - Point-of-service Option or Plan
QIO → - Quality Improvement Organization
Patient Information Letter → Card given to each enrollee of a managed care plan include and list patient's the name and member number