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5 Written questions

5 Matching questions

  1. Patient Information Letter
  2. UR
  3. POS
  4. Utilization Review (UR)
  5. ERISA
  1. a - A process based on established criteria, of reviewing and controlling the medical necessity for services and providers use of medical care resources.

    - Known as Utilization or Management Control.
  2. b - Employee Retirement Income Security Act
  3. c - 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).
  4. d Utilization Review
  5. e - Point-of-service Option or Plan

5 Multiple choice questions

  1. 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.
  2. Primary care physician informs the patient and phones the referring physician that the patient is being referred for an appointment.
  3. - Health Maintenance Organization.
  4. - Plans purchase by existing PPOs without notifying providers who have signed contracts.

    - Also known as Silent, Blind, or Phantom PPOs, Discounted Indemnity plans, Nondirected PPOs, or Wraparound PPOs.
  5. 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.

5 True/False questions

  1. Stop-Loss- 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)


  2. MCO- Exclusive Provider Organization.


  3. NCQA- Independent (or Individual) Practice Association.


  4. Ross-Loos Medical GroupThe patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.


  5. Verbal ReferralPhysician informs the patient and telephones the referring physician that the patient is being referred for an appointment.


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