5 Written questions
5 Matching questions
- Authorization Request Log
- Patient Information Letter
- Silent PPO Plan
- 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).
- b To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.
- c 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.
- d - 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)
- e - 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 Multiple choice questions
- 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.
- The patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.
- - Exclusive Provider Organization.
- Is a physician who controls patient access to specialists and diagnostic testing services.
- At the time service is rendered.
5 True/False questions
HEDIS → - Health Plan Employer Data Information Set
ERISA → - Independent (or Individual) Practice Association.
Identification Card → Card given to each enrollee of a managed care plan include and list patient's the name and member number
Triple Option → Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
Turfing → 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.