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5 Written questions

5 Matching questions

  1. Tertiary care
  2. Patient Information Letter
  3. Turfing
  4. NCQA
  5. Physician Provider Group (PPG)
  1. a - Inform managed care subscriber in writing what is expected from them and what they can expect in turn.

    - Also known as Waiver of Liability in Medicare program is called Advance Beneficiary Notice (ABN).
  2. b Transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer
  3. c Physician owned business that has the flexibility to deal with all forms of contract medicine and offers its own packages to business groups, unions and the general public.
  4. d - National Committee for Quality Assurance, accredits HMOs.
  5. e Referral of a patient recommended by one specialist to another specialist.

5 Multiple choice questions

  1. Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
  2. - Patient services are more than absorbed amount physician can begin asking to paid.

    - Patient's services are more than certain amount, the physician can begin asking the patient to pay (fee-for-service)
  3. - Point-of-service Option or Plan
  4. Card given to each enrollee of a managed care plan include and list patient's the name and member number
  5. The patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.

5 True/False questions

  1. Indemnity PlanTraditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.

          

  2. MCO- Health Maintenance Organization.

          

  3. QIO- Quality Improvement Organization

          

  4. IPA- Independent (or Individual) Practice Association.

          

  5. EPO- Preferred Provider Organization

          

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