5 Written questions
5 Matching questions
- Blue Cross/Blue Shield
- a - A portion of the monthly capitation payment to physicians retained by the HMO until the end of the year to create an incentive for efficient care.
- If the physician exceeds utilization norms, he or she will not receive it.
- b - Consolidated Omnibus Budget Reconciliation Act
- c Is the largest pioneer in private insurance company in the United States.
- d - National Committee for Quality Assurance, accredits HMOs.
- e - Employee Retirement Income Security Act
5 Multiple choice questions
- The specialist contracts with the managed care plan for an entire episode of care.
- - Health Plan Employer Data Information Set
- Managed Care Organizations
- Utilization Review
- - 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.
5 True/False questions
EPO → - Preferred Provider Organization
Correct procedure to collect a co-payment on a MCPlan → At the time service is rendered.
QIO → - Quality Improvement Organization
Authorization Request Log → To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.
IPA → - Exclusive Provider Organization.