5 Written questions
5 Matching questions
- Patient Information Letter
- Utilization Review (UR)
- 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.
- b - Employee Retirement Income Security Act
- 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).
- d Utilization Review
- e - Point-of-service Option or Plan
5 Multiple choice questions
- 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.
- Primary care physician informs the patient and phones the referring physician that the patient is being referred for an appointment.
- - Health Maintenance Organization.
- - 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.
- 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
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)
MCO → - Exclusive Provider Organization.
NCQA → - Independent (or Individual) Practice Association.
Ross-Loos Medical Group → The patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.
Verbal Referral → Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.