5 Written Questions
5 Matching Questions
- Case Rate Pricing
- a Managed Care Organizations
- b The specialist contracts with the managed care plan for an entire episode of care.
- c - Independent (or Individual) Practice Association.
- d - Exclusive Provider Organization.
- e - Consolidated Omnibus Budget Reconciliation Act
5 Multiple Choice Questions
- - Employee Retirement Income Security Act
- Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
- Traditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.
- Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
- - 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.
5 True/False Questions
Preauthorization → A requirement of some health care plans to obtain permission for a service or procedure before it is done and to see whether the insurance program agrees it is medically necessary.
Tertiary care → - Employee Retirement Income Security Act
MCO → - Managed Care Organizations
Self-referral → The patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.
Physician Provider Group (PPG) → - America's oldest privately owned prepaid medical group.