5 Written Questions
5 Matching Questions
- Verbal Referral
- Correct procedure to collect a co-payment on a MCPlan
- a At the time service is rendered.
- b Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
- c - Managed Care Organizations
- d - Health Maintenance Organization.
- e 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.
5 Multiple Choice Questions
- Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
- Is a physician who controls patient access to specialists and diagnostic testing services.
- - Point-of-service Option or Plan
- An authorization request is required by the MCO contract to determine medical necessary, this can be done over the phone, or completed authorization form mailed, transmitted via fax or email.
- Traditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.
5 True/False Questions
PPO → - Exclusive Provider Organization.
Self-referral → An authorization request form is completed and signed by the physician and handed to the patient.
Ross-Loos Medical Group → - America's oldest privately owned prepaid medical group.
EPO → - Exclusive Provider Organization.
QIO → - Quality Improvement Organization