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5 Written questions

5 Matching questions

  1. Blue Cross/Blue Shield
  2. MCO
  3. HEDIS
  4. Turfing
  5. Churning
  1. 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.
  2. b Transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer
  3. c - Managed Care Organizations
  4. d Is the largest pioneer in private insurance company in the United States.
  5. e - Health Plan Employer Data Information Set

5 Multiple choice questions

  1. To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.
  2. Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
  3. - Health Maintenance Organization.
  4. The specialist contracts with the managed care plan for an entire episode of care.
  5. Is a physician who controls patient access to specialists and diagnostic testing services.

5 True/False questions

  1. MCO- Exclusive Provider Organization.


  2. Triple OptionPlan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.


  3. Stop-Loss- Point-of-service Option or Plan


  4. QIO- Quality Improvement Organization


  5. Patient Information LetterCard given to each enrollee of a managed care plan include and list patient's the name and member number


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